Common Overuse Injuries in Musicians-Vocal Nodules

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Being a professional musician is like being a professional athlete. Maintaining physical and mental well-being directly influences musical performance. This month’s newsletter is the first in a series that will focus on common overuse injuries in musicians starting with vocal nodules.   

What are vocal nodules?

Vocal nodules are small noncancerous rough spots on the vocal cords (or vocal folds) that are like callouses. These callouses can interfere with effective closure and vibration of the vocal cords when making sound.

How do I know if I have them?

If you experience hoarseness or vocal changes for more than two weeks, see your doctor. You may be referred to an ENT, or ear, nose, and throat specialist. The ENT will want to know if you have the following symptoms: 

  • Hoarseness
  • Scratchy sounding voice
  • A limit to your pitch range
  • Pain
  • A feeling of a lump in your throat

How is it diagnosed?

Laryngoscopy. First, the ENT will note your health history. Then the doctor will take a peek in your throat with either a mirror or a flexible lighted tube with a camera on the end that goes through the nose or mouth.

What causes vocal nodules?

They are generally caused by trauma to the vocal cords. For some people, there may be more than one factor involved:

  • Screaming or straining to vocalize
  • Smoking
  • Excessive use of caffeine or alcohol
  • Vocal cords that are regularly dry
  • Allergies or respiratory infection
  • Tense muscles
  • Acid reflux

How are vocal nodules treated?

Conservative treatment may include vocal rest, vocal therapy, anti-inflammatory medications, and a change in vocal habits. Conservative treatments may only manage the issue, but it doesn’t have to mean the end of a musical career. In fact, many professional musicians have vocal nodules that never become symptomatic in the first place.

Tell me more about vocal rest?

Someone may be asked to not talk or talk very little for a short period of time to allow the inflammation in the vocal cords to go down, but this is only the first of many steps needed to address the problem.  If vocal rest is the only thing done, the problem may immediately come back again.

And vocal therapy?

Vocal therapy is administered by a speech-language pathologist. It takes 6-12 weeks and includes exercises along with education on vocal hygiene.

Vocal hygiene?

Vocal hygiene teaches behavior modification to improve the condition. These are habits to support a healthy strong voice such as: 

  • Reduced screaming or overtaxing of the voice
  • Avoiding smoking or regularly breathing in second-hand smoke
  • Decreased caffeine and alcohol intake
  • Staying well hydrated
  • Hand washing and avoidance of respiratory viruses
  • Monitoring or careful use of any medications that may be drying to the vocal cords
  • Sufficient rest
  • Careful throat clearing
  • Minimizing tension in neck muscles
  • Good posture
  • Minimizing spicy foods if you are susceptible to acid reflux

How do I prevent nodules in the first place?

Good vocal hygiene can be used for both management of an existing problem and prevention of a new one.  

Where can I learn more?

“Vocal Cord Disorders” from John Hopkins
“Nodules” from the Weill Cornell Medicine Sean Parker Institute for the Voice
“Taking Care of Your Voice” from the National Institutes of Health

Professional musicians challenge their bodies to create their music. That’s why learning about overuse injuries and how to manage or prevent them is important for the success and longevity of participation in music performance. Watch for next month’s newsletter when a new music-related overuse injury is discussed.

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