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Economical approach for vocal nodes treatment

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Here's what I figured out from readings. Let me know your input.

If something happens to your voice, and you suspect you have vocal nodes, here's an approach to tackle this economically.

Practice total silence for about a week (or at least vastly minimize your talking, singing, grunting, growling, etc.). Use notepads, nod at people, whispering is nearly as bad as talking.

During this week, restructure your voice (this I will explain in ZenSinging.org). Try for example, Al Greene's book, which is a method of restructuring for singing improvement, without vocalizing. Also, read up on using resonance while singing.

At the end of the week, see how's your voice. If still bad, consider an ENT doctor, or continue another week.

Here's why, for the above. The first treatment for vocal nodes is silence anyhow, so, instead of spending the money and time to visit an ENT, just go ahead and start the treatment. My understanding is that vocal nodes can disappear with rest.

The amount of use, technique, and some health issues (e.g. sore throat and allergies) can affect creation of nodes. The amount of use and health issues are topics outside of the discussion scope of this forum. Technique can be improved though. Nodes are sometimes caused by excessive force; hence, learning to use resonance best can reduce this force.

However, if it's other bad technique issues, you might as well learn preventative methods anyhow. You can spend the money and time and go see a speech therapist, or use Al Greene's book that describes how to restructure to prevent without fees and while you're practicing the silence treatment. Notice, by technique, I mean speaking techniques as well.

So, by utilizing the above, you'll save a doctor's visit and perhaps a number of trips to the speech pathologist.

Of course, the symptoms may be due to other factors than vocal nodes, so there is a small risk involved.

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Chen I disagree there, If you suspect nodes you need to shut up and see an ent or voice therapist. They will only disappear if they are cought before they are developed other wise you will require therapy , steroid help or removal. You also then need to shut up until you get a new technique or new training, because if they were developing to begin with your doing something wrong, resting in and of itself will not retrain your habits and it will just repeat itself worse.

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You're partially right. I think we're not defining nodes the same.

The first line of treatment for nodes is silence for a week or two--this is on nearly every medical website I've read. If this doesn't work, then the others are needed.

Also, it's not clear that the nodes are caused principally by singing technique. It can be, and apparently usually is (at least in non-singers) caused by speaking technique. I'm suggesting then that vocal tension, in addition to speaking and singing techniques, are to blame; the vocal tension causing or reinforcing the mal-technique. That's why I'm saying use Al Greene's silent training of the voice (which relieves vocal tension) to train while in silence.

What do you mean by caught before they are developed? Do you mean using stroboscopy to examine the vocal cords to see the capillary striations? If using mirror, instead it seems these are more likely to catch nodes already developed. Or maybe you mean irreversible nodes stage.

If one has the time and money to go see physicians for all suspicious symptoms. your method is certainly the best. This is simply an economical approach. In general, do no further harm first, and I don't see anything wrong with first deploying the silence treatment and waiting a week. If one goes to the physician, he'll probably, after examination, ask the person to go silent for a week, return, and reexamine.

Lastly, I think you're referring more to the cases of a professional singer and I'm referring more to cases of amateur or semi-pros.

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Here's another example. At the same time I was concerned about vocal cords, I developed canker sores (which is rare for me). So, I had two reasons to visit ENT. I usually read background information before visiting physicians, so read into canker sores. Found out this is frequently treated by taking vitamins. So popped a multi-vitamin, and problem solved.

What I'm trying to say is before visiting physicians, research and try somethings first. When you get there, the limited-time physician will be better able to help you, the diagnosis and proposed treatments are much faster. This doesn't always work, if the illness gets progressively worse without treatment. Vocal nodes in themselves shouldn't get worse, if the silence treatment is deployed. The real cost here is research time, which is usually good learning. Or, it can be a more serious, progressive illness, and there is a risk cost here.

Also, causal factors are very complicated. The time-limited physician may see vocal nodes, and immediately recommend some kind of treatment. A large number of errors in communications, diagnosis, treatment modalities, patients' motivation, services renders, true effectiveness of treatment can occur here.

Additionally, what's causing the vocal nodes can be very complicated and the physician may not have the time to determine this. You will have to determine this yourself. This will affect, in particular, your preventative treatments. I have access to some of the world's best physicians, because I provide marketing services to physicians in the Texas Medical Center. I've frequently had to create my own treatment programs, in addition to their proposed treatments.

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Yes I mean before permanant, if cought before fully developed rest and or combination of steroids and rest or rest and therapy can stop reverse the effect, once they thicken, harden it usually take surgery. You would however need someone qualified and the right equipment to see whats going on in there and at what stage. Inflamation isn't nodes but usually preceeds the nodes, best to catch that early.

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Rest... and actually trying not to speak if possible. How do you do that? You try to only ask people close ended questions "yes or no"... I know that seems extreme, but if you want to give your vocal folds a rest, you can drastically reduce your speaking.

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Rest... and actually trying not to speak if possible. How do you do that? You try to only ask people close ended questions "yes or no"... I know that seems extreme, but if you want to give your vocal folds a rest, you can drastically reduce your speaking.

Use a notepad, nod; pretend you're mute or have severe laryngitis (sp), and you'll be surprised at type of things you'll be able to listen and communicate (other than by phone).

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  • 6 months later...

You can usually tell when your voice is not alright. When you do that I strongly recommend to get checked.

I would like to share what happend to me with you:

I have been treated from nodes and they where detected because I did a preventive check.

Background... my band participated in an important contest... we passed to the finals...I got sick 2 days after preliminary round... went to the MD and got medicated so I could perform in a gig and in the final... we played at the finals... we won... I got medicated again so we could perform at the party where the prices were given, radio and internet interviews, we even performed at a TV show... and that went on for a little more than a month at that rhythm, of course besides our regular giging.

When things slowed down and I healed properly I wasn't feeling anything weird in my voice (the video I have in my profile is from a couple of days before detecting the nodes) ... but I knew I did too much, I overworked. I got checked "just because", I could sing normaly... but the nodes where already there. Thank god they where really tiny.

Don't wait until you lose your voice to get checked and don't underestimate vocal issues. Nodes are not the only vocal problem that exist.

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Agree with Ursula! well said.

WebandNet wrote

//Additionally, what's causing the vocal nodes can be very complicated and the physician may not have the time to determine this. You will have to determine this yourself. //

Actually, this is where a speech therapist can be extremely helpful [one who specializes in voice; not all do]. At least a third of my time with voice patients (e.g. singers with nodules) is spent in detailed interview & problem-solving. Sometimes it takes a few sessions for the real causes to emerge -- oh yeah, that month of cold& cough& too many gigs DID come right after a family crisis// or// wow, I guess I was starting to have trouble a year ago but my life was crazy I couldnt pay attention back then//

This kind of compassionate-listening-counseling can lead to layers of personal growth & healing/self-care that go far beyond the nodules. At the very least the singer gets a clearer idea of what components in daily usage need to change, & speech therapist can also suggest solutions.

Not to disagree with the need to research & experiment for one's own treatment approach -- but even that searching doesnt always need to be a solo adventure.

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  • 2 weeks later...

The problem with going to the experts on health matters is that it is expensive in time and money. A doctor's visit, including driving and parking, is usually well in excess of $150. Also, my experience is that their accuracy of the causal factors and delivering effective treatment of the causal factors is less than 25% accurate. I find it takes a lot of personal research and experimentation to accurately determine causal factors.

I even find health experts delivering long-term symptom treatment relief to be less than 50% effective. The body is very complicated, and it takes a lot of personal research to find accurate answers. If you want to get well, learn to know your health first.

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Hi. I made one seminal visit to a doc years ago and he told me how to manage my voice. Never sing over a cold, and always stop immediately if you feel pain. Try never to cough. Take an over the counter cough medicine. If your nose is stuffed take a decongestant.

Another doc diagnosed my sore throat - so intense I was avoid, a wedge to sleep on, and in days I was better. The list is on my fridge.

Self care and a good vocal technique save your from trouble. But the minute you feel you have made a wrong move, you stop singing and observe silence for a while Try a sip or two of water and 5 minutes off. If you are not better right away you have to take the day off.

I got a fresh start on technique by doing Tomatis listening, and laying off singing for a a few weeks while I did it.

then I went on to train my voice with a good teacher, following all the above rules. NO, I have never had a node. My voice is sensitive and I always stop the minute it feels funny.

Best

Roberta

If you get lots of sore throats and especially if you get nodes, the problem lies with the way you use your voice. That is in the realm of technique. Never sing over nodes.

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>>>"Try never to cough."

This is what I mean about not diagnosing the proper cause. Coughing is the body's natural defense mechanism for something. If one tries not to cough, one is suppressing muscles in some unusual way. So, one vocal cords may be spared, but one's overall throat muscles are suppressed. May wind up singing worse.

>>>a wedge to sleep on

This now shows the first doc's diagnosis may be incorrect. Wedge reduces acid reflux damages. Acid reflux helps people to catch colds and flus. Colds and flus make sore throat. The major cause of the problems was likely acid reflux, not colds, stuffy nose, etc.

The question remains--what causes acid reflux? VocalPosture.com postulates that acid reflux can be prevented by posture changes. VocalPosture.com also further postulates and has shown that acid reflux can be reduced by posture changes.

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Coughing is a really important cause of hoarseness and is a particular problem for patients with chronic airway diseases such as asthma. It's really important to try and suppress that cough because of the vicious cycle of having a irritation which causes a cough, which leads to further inflammation making you want to cough more. There are techniques one can use instead of properly coughing and a good speech therapist can take you through some of them.

RE the reflux, I've just completed some research on laryngo-pharyngeal reflux working with the voice specialist for the Cardiff Singer of the World competition (it's basically like a world 'xfactor' or 'american idol' for young classical singers. Huge event in the classical calender) and it appears that LPR is caused by only a minimal amount of acid refluxate, in a predisposed patient, reaching the laryngopharynx via capillary action. Therefore crucially, unlike GORD, different postures are unlikely to have an effect on patients with chronic laryngo-pharyngeal reflux.

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How does capillary action get reflux from the stomach to the nasal-pharynx? Or are you saying that once the reflux has occurred upto to near the nasal-pharynx, then the capillary action takes place?

Additionally, weakening of the lower esophageal valve is known to be the primary cause of acid reflux. What's not known is what causes the weakening of the lower esophageal valve. There are gastroenterologists who believe this is caused by bad posture. Makes good sense-- if one continually stretches the lower esophageal valve with repeated bad posture, then, naturally, it would weaken, causing excessive reflux and GERD and then LPR.

Thus, GERD can be prevented and reflux reduced by posture alignments. As I understand it, the amount of reflux produced affects LPR. Thus, even if it's capillary action, the amount of acid reflux bypassing the lower esophageal valve will affect the degree of LPR.

...

When doctors and speech therapists can heal, I'll believe them more. Doctors and speech therapists help in healing. The body is the healer, and coughing is a mechanism that the body is trying to say something or act against some illness.

If asthma cannot be treated, and one coughs, I guess the tradeoff in suppression of muscles versus hoarseness is leaning in favor of alternative cough method. But, it's unclear whether coughs due to other causes should be suppressed.

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In addition to what I'm postulating--that posture can help prevent GERD, here's how it reduces the effect of GERD and LPR. Stomach cells are not sensitive to low pH. Esophagus cells are injured over time by low pH. Nasal pharynx are easily injured by low pH.

In order for the acid to reach the nasal pharynx, it has to travel a distance. A person can lengthen this distance-- simply by straightening his posture. A lengthening of the distance from stomach to vocal cords and surrounding vocal tract muscles, as short as 1/2 inch, may be all that is needed to reduce acid reflux effects significantly. This is how I believe posture can reduce existing effects of acid reflux.

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GORD is indeed increased by reduced tone of the cardiac sphincter. However, this is not necessarily true in the case in LPR. There is a level of reflux that occurs constantly. However, the resilience of the oesophageal mucosa to acid damage combined with the relatively few afferent nerve fibres in the this area means that this is asymptomatic in the vast majority of individuals. It's also completely normal. However, in some predisposed patients, it is suspected that this minimal amount of acid can reach the laryngopharynx via capillary action. Therefore, LPR cannot really be associated so absolutely identically to GORD.

One might reasonably presume that it is a higher amount of acid than required for GORD that would lead to LPR. However, if that were the case, it would be reasonable to also expect a strong correlation between laryngeal symptoms and heartburn. This has been proven to not be the case.

There are a number of reasons why this pathology is suspected. Firstly, the evidence that we have suggests that standard acid supression therapy such as lanzoprazole 30mg OD (I've found to be the most common therapy prescribed for GORD AND GERD) doesn't work any better than placebo. However, there is evidence to suggest that this is not due to the fact that this treatment doesn't work but is due to actual undertreatment of the condition. There is further evidence showing that high dose, aggressive therapy in LPR, that may include a antacid and prokinetic) does perform statistically significantly better than a placebo treatment. This suggests that a higher amount of acid supression is necessary, further supporting evidence that it's only a minimal amount of acid traveling to the laryngopharynx that leads to the problem. It also is evidence of how the amount of acid bypassing the cardiac sphincter doesn't really have an effect how symptomatic a patient may present.

RE the cough. It's not a sign of healing, it's a sign of irritation of the laryngeal tissue. In the study I have just completed, 40% of patients presenting with symptoms consistent with LPR had a chronic cough. For patients already experiencing voice deterioration with acidic damage, coughing only further escalates the problem. Another very common problem associated with LPR is globus pharyngeus, the sensation of a lump in the throat. This leads to further throat clearing, again enhancing the problem. We're are talking about more chronic causes of cough here. It is essential, for example, that a patient post-op coughs in order to remove any secretions from the airways to prevent pneumonia. It's just common sense really.

Perhaps you may be correct in delaying the effect of refluxate reaching the laryngopharynx via alterations in posture but the vast majority of LPR problems occurs when sleeping, where you have no control over your posture. You can raise the bed etc but looking at the pathology it is unlikely that this will actually stop LPR. If it's already traveled 30 cm up the oesophagus with no problem it's unlikely 1/2 an inch will reduce this problem, especially when such aggressive acid suppression therapy is often required in many patients.

It's worth noting I'm not talking about the very occasional indigestion that everybody experiences. This is clinically chronic LPR that is referred to secondary care.

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I agree that doctors and speech pathologists (like me) don't do the healing, the voice "owner" does. My job is to be a health coach, advocate, and teacher.

Re. GERD/LPR and cough:

chronic irritable cough is VERY common when the vocal cords are irritated (such as by acid/pepsin from the stomach). The cords just get oversensitive or "jumpy" and they overreact to tiny changes in air temperature, odor, dryness, etc. This is a cough that clearly feels triggered in the throat, as opposed to the cough triggered in chest which relates to problems deeper in the airway.

Best recommendations (this comes from many experts in my field) are

(a) DON't use any cough-suppressing lozenges or cough drops if they contain menthol, mint, benzocaine. These chemicals irritate the throat further & will make things worse rather than better.

(B) replace the cough with a vigorous swallow, either saliva or water. Ice cold water can be especially helpful in "distracting" the throat sensations.

© learn to recognize the tickly feeling that comes right before the cough, and consciously don't respond with a cough, swallow instead. Keep telling yourself that the urge to cough is a false alarm.

(d) if you're in a dry region, use a humidifier at night and/or take longer showers or find some other way to get moisture into the air. This is generally soothing & will help the vocal cords calm down.

Most people whom I work with are able to eliminate the cough in about a week by following these guidelines.

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