vocal folds

What are Nodes?

Vocal fold nodules, commonly called nodes or singer’s nodes, are basically small blisters or calluses on the vocal cords.  They can be caused by vocal abuse, such as excessive screaming, or by singing or speaking with poor technique.

To better understand vocal fold nodules, it’s important to have basic knowledge of how the voice works.  The vocal folds (commonly called vocal cords) are a small pair of muscles inside the larynx, which are covered by a delicate membrane.  As air passes through the larynx, the vocal folds vibrate together, which produces sound.  To make a higher pitch, the vocal folds stretch to become thinner and longer.  For more information on this process, see my previous post, “How the Voice Works: An Overview.”

Nodules are generally caused by prolonged unhealthy use or overuse of the voice.  Vocal abuse can cause hemorrhaging (bleeding) in the vocal folds.  Over time, the vocal folds can develop callus-like lesions, which we call nodules.  Nodules come in many shapes and sizes, and their effect on the voice varies accordingly.

The singing voice of someone with nodules often sounds breathy or raspy.  It may be hard to hit higher pitches or feel like extra effort is needed to make sound.  In severe cases, the voice can be extremely raspy and rough sounding.  Nodules are usually not painful, since there are no nerve endings on the vocal folds.

Nodules are usually treated with speech therapy, which corrects the behavior that caused the nodes and develops healthy vocal habits.  In some cases, surgery may be necessary.  Rehabilitating the voice must be done carefully and under the guidance of a speech therapist and laryngologist.  Singers suffering from nodules should be sure to carefully follow their doctors’ instructions to ensure a full recovery.

The best way to prevent nodules is to sing and speak in a healthy way.  Many people don’t realize that speaking is just as tiring for the vocal cords as singing.  Vocal fry (speaking at the lowest part of your range, with a creaking or rattling quality) is a particularly unhealthy speaking trend, which leads to tension and fatigue in the vocal folds.  Hoarseness or a scratchy-feeling throat can indicate that your vocal folds are fatigued and maybe even slightly swollen.  When this happens it’s important to let your voice rest.

Another important (and easy!) way to keep your vocal folds healthy is to drink plenty of water.  Staying hydrated protects your vocal folds by keeping the mucous membranes moist.  Dry vocal folds are more prone to damage and fatigue.

How the Voice Works: An Overview

As a voice teacher, I often find myself explaining to students how the voice works and why it’s important to take good care of it.  While it’s not necessary for all singers to know all the tedious details (muscle names, etc), a basic knowledge of how the voice works is important because it helps singers understand their instrument.  

Sound is produced by the vocal folds (commonly called vocal cords), which are tiny muscles inside the larynx (aka “Adam’s apple”).  They are about the size of a dime in women and the size of a nickel in men.  They form a “V” shape, which can open or close, and when they are fully closed they block the airway to the lungs.  (To experience this, try to lift something very heavy while inhaling or exhaling.  It should be difficult if not impossible.)  To produce sound (for speaking or singing), the vocal folds gently come together and vibrate as air is passing through.  This process is called phonation.  

The vocal folds stretch to become longer and thinner for high pitches, and thicken and shorten for low pitches.  When the muscles of the larynx are trained to work together efficiently, the singer will be able to smoothly and evenly move throughout his or her range.  Voice breaks and cracks are signs that these muscles are not working together effectively.  

The vocal folds are covered  by a delicate mucous membrane, which is an important part of the vibration that creates sound.  This membrane moves in a wave-like rippling motion.  It is very important for singers to drink plenty of water so that this membrane stays moist and does not dry out.  A dry mucous membrane is much more susceptible to damage, including hemorrhages and nodules.  

The sound produced by the vocal folds is different from the sound we hear outside of the singer’s body.  At the source, it is a soft buzzing sound.  As this sound passes through the throat and mouth, or resonators, it is filtered and amplified into the sound that we recognize as singing.  This process is why things like jaw and tongue position and mouth shape are so important for singers: these things shape our sound, and a small adjustment can make a big difference.  

There are some really cool videos on YouTube that show the vocal folds in action.  Just search for “vocal fold stroboscopy” (this process uses a tiny camera and a strobe light to show the vibrations in slow motion).   

If you are interested in a more detailed and scientific description of the vocal folds, watch this video from Anatomy Zone.