A Bit About Vocal Health and Voice Disorders – Part 2

This is a follow-up post to my article last week on vocal health. You can read that here first if you’d like. Again, I would like to state my disclaimer that I am not a medical or vocal health professional, simply a singer and pedagogue. Please consult a medical professional if you have concerns about your own vocal health.

There are more voice disorders than those listed here, but I have attempted to condense this list to various health concerns that can directly affect singers. None of these pathologies are major risks to your overall health. Most voice disorders or vocal health problems are treatable and rarely create permanent damage. For more information on these or any other problems, please refer to www.voicemedicine.com



This is probably the most common disorder amongst singers yet the one that causes the most concern. It should first be known that nodules are not mainly caused by poor technique (though this can be a factor), but instead by overuse, misuse, or abuse of the speaking voice. Nodules are like callouses on the vocal folds that create slight bilateral lumps (bumps on both sides), usually in the center of the folds. They can cause raspiness and/or ariness in both the singing and speaking voice and generally are not felt. Treatment involves vocal therapy administered by a speech pathologist and ideally a singing voice specialist as well. Complete vocal rest is not required or even recommended. Know though that nodules are really only a problem when they are symptomatic. Many singers may have nodules without knowing it. As long as it does not inhibit their singing, they really are not a problem.



Polyps are like vocal blisters and are caused by some sort of vocal trauma. Generally a polyp will occur on only one vocal fold and look like a mass in the middle of the fold. Again, they are painless but can cause raspiness or airiness in the voice. Sometimes they can be felt as an obstruction to the vocal folds and create the sensation of needing to clear your throat. Polyps can also be a precursor to a vocal hemorrhage (see #4). Treatment does require surgery to remove them as therapy will not reduce them, but therapy is necessary during the recovery period to prevent a reoccurrence.



Cysts are fluid-filled sacs that appear on the vocal fold for unknown reasons. They generally appear in the middle of the fold, suggesting that vocal trauma may be a cause of their formation, but doctors are unsure about that. They cause painless hoarseness and can cause irregular vocal fold closure. Cysts are extremely similar to polyps and can easily be mistaken for such. Cysts also generally require surgery, though depending on its placement and your symptoms, surgery may not be necessary.



Generally caused by vocal trauma, a hemorrhage is a bleed in the vocal fold. Most people who have experienced a hemorrhage say they feel it immediately as a sort of pop, and they experience raspiness in their voice almost immediately afterwards. This is the only voice concern that requires complete vocal rest for a period of time. Be sure to see a doctor if you suspect a hemorrhage, but know that the immediate fix is complete vocal rest. Depending on how frequently it occurs or what caused it, voice therapy may be required.



It is widely, yet falsely, believed that laryngitis is whenever you lose your voice. While this is a common symptom of laryngitis, it is actually defined as the inflammation of the vocal folds for any reason, such as a virus. It is sort of a nonspecific term, but is usually treated just like any other virus. Voice rest is recommended along with plenty of fluids. If the hoarseness continues for more than 2-3 weeks, this is the time to seek out a medical professional.


Acid Reflux

This is not a voice disorder so much as a condition that can affect the vocal folds. It also is relatively common in singers due to our greater diaphragmatic use and how that tends to push more stomach acids through our trachea. More often than not, reflux is silent, but sometimes people can experience heartburn, halitosis, or difficulty using their voice effectively in the morning. There is no cure for reflux but it can be managed through a less acidic diet and not eating or drinking at least 3 hours before you go to bed. You can also lift the head of your bed (your whole bed, not just your pillows) to keep acid from rising in your sleep.


Vocal Fold Paralysis

This is where one (or both) of the vocal folds become immobile due to damage in its main nerve. Paralysis is twice as likely in the left fold than in the right, and their causes are slightly different. Both are most often caused due to complications from surgery near the nerve, which runs down the neck and through the chest. Symptoms include hoarseness, breathiness, difficulty breathing, and feeling the need to swallow. Occasionally voice paralysis will resolve on its own, but most often treatment involves therapy to learn how to utilize your voice to the best of its ability.


If you have any more questions or concerns or anything to add, feel free to say so! If you have concerns about your own vocal health, research your local ENTs and make an appointment. Even if you feel fine, a visit to the doctor can be good to establish a relationship and to have a baseline for what your vocal folds should look like and act.

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