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After the nodes... The nodes are gone, what now?

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Ursula
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Hi everybody,

I have been doing some research and some important questions came to my head.

What are the consecuences of having voice problems? Do the vocal folds recover a 100%?

A node is a callus, after it heals does the vocal fold hardens? If so... how does that affects your singing?

I hope to find some answers.

Ursula

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The vocal folds do have the opportunity to fully recover depending on the stage of disease at which it was caught.

There are generally considered to be 3 stages of nodule development and these are, very basically speaking, 1)fluid buildup 2)further inflammatory response 3) Fibrosis.

Early on the nodes are very soft and respond very well to relative vocal rest, better vocal hygiene and improvement in vocal technique. The further down the line you are, the less likely they are to fully heal with conservative (non surgical) management.

Fibrotic tissue is very hard and fixed to the underlying cord, reducing the chance of full recovery. I'm not entirely sure how patients generally respond to speech therapy for advanced disease. For that, I would defer to a speech therapist as they manage this condition until they feel assessment for surgery may be required.

Obviously, surgery is a very last resort (or a first line treatment for some pros who are in the middle of a tour and can't rest) because any disruption in the mucosal wave that produces sound will result in alteration of voice quality. We are better at this surgery now but I must admit I wouldn't personally jump at the chance of going under the knife (not that cold techniques such as the use of scalpels are used anymore). That being said, I've seen patients with extensive laryngeal disease that have had coblation procedures (basically an electric current) on the vocal folds and have not only had instant improvement from dysphonia but actually gone on to have a very good speech voice quality indistinguishable from someone who hasn't undergone sugery. How this would affect a singer, I'm not sure as I haven't seen any that have undergone the procedure.

That the sort of thing you were after?

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Open Mic thank you very much for your response. It's exactly the kind of contribution I was looking for.

The different stages of nodule development also consider time (how old the nodule is)?

The thing with vocal problems is that they are tabu among singes... most have had some issues at some point of their career, but they are ashamed to tell (I have asked directly some friends that are singers and most of them "confesed" having some sort of problems at some point and also most of them identified the cause as overwork). I might be wrong with my assumptions, but I want to put my grain of sand.

I find a lack of information and fear to ask.

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Time is also a factor, along with the degree of vocal abuse and other associated pathologies such as laryngo-pharyngeal reflux which can contribute. You can occasionally tell on examination how long a node has been there for. For example, I recently saw a young girl who is an aspiring musical theatre singer. She was obviously hoarse the moment she entered the clinic with a breathy quality and had been complaining of frequent voice deterioration, particularly in a period of heavy singing. On videostroboscopy examination it was clear she had nodules and had the characteristic white masses associated with fibrotic lesions. On top of this, there was absolutely no sign of active inflammation and we can therefore only conclude that they have been there for some time. Although referred for speech therapy and advised to find a good vocal coach, it is highly likely that due to the advanced stage of disease she will need surgery.

Singers don't like admitting that they have had problems like this and it's not surprising. You are essentially admitting that your technique is flawed and us singers can be an egotistical bunch. Being based near a music college and the national opera company I've seen alot of singers come through the ENT department and I must admit, they are so convinced that their technique is 'perfect' it can be quite difficult, so I have heard from the speech therapists, to get them to go back to the basics of their technique.

That being said, the best singers never have any problems. They have good technique and sound knowledge of vocal hygiene. They respect their voice and look after it according. We need never see them in clinic.

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