What are Vocal Fold Nodules?

What are vocal fold nodules?

Vocal fold nodules develop due to trauma of the vocal folds. When you use your voice incorrectly over time, the vocal folds might become swollen. These swollen areas then become nodules that are sometimes called ‘soft nodules’ but as they progress they can be called ‘hard nodules’ and be harder to treat. They usually form a pair – opposite each other on each vocal cord. Occasionally a diagnosis of a nodule on one vocal cord is made, with only some slight swelling on the opposite vocal cord.

What causes vocal fold nodules?

Vocal fold nodules are typically caused by voice misuse. This may include shouting, screaming, singing or excessive use of voice over long periods of time.

When we use our voice ineffectively and develop habits that use too much force with our voices, this puts strain on the vocal folds. Nodules are common whose work involves using their voice for long periods of time. Typical jobs might be singers, teachers or actors.  Due to the importance of communication in these jobs, a nodule affecting the voice can have a big impact on sustaining voice throughout the day. This can be very stressful when our voices are essential to our work and income.

What are the symptoms of vocal fold nodules?

You will notice voice changes such as a gradual onset of hoarseness, breathiness and an effortful voice with breaks.

When producing normal voice, the vocal folds meet fully together. When there is a nodule, this causes a gap between the vocal folds, resulting in air escape through this gap, and a subsequently breathy voice.

You may also have a lower pitch, experience throat discomfort and throat clearing. You may additionally feel some soreness in your larynx after using your voice for long periods.

How are vocal fold nodules diagnosed?

Typically an Ear, Nose and Throat Consultant puts a camera up your nose, called an endoscopy, to gain a view of your vocal folds. They will inform you of your diagnosis in this examination.

Can vocal fold nodules go away on their own?

In the acute stages, vocal nodules may resolve with voice rest alone. However, if it is due to repetitive vocal misuse, then Voice Therapy treatment will be required. Voice Therapy is first choice rather than surgery. If surgery is required, Voice Therapy following surgery to prevent reoccurrance is recommended. Online Voice Therapy for Voice is effective for treating nodules.

Can I have Voice Therapy with the NHS?

The ENT consultant will often refer you to a NHS Voice Therapist. We see people who have seen an ENT consultant privately due to a long NHS wait, or those that are waiting for an NHS appointment but are keen to get started due to the impact on their income.

Our UK based Private Voice Therapists are Clinical Specialists in Voice with a minimum of 15 years experience Specialising in Voice Therapy. Book a free 15 minute consultation or email us at thespeechnetwork@hotmail.com to enquire about our reasonable fees for Voice Therapy.

Why has my Voice changed?

Why has my voice changed?

If your voice has suddenly changed, the most common reason for this is Laryngitis, which is a loss of voice, often alongside a cough and/or sore throat. It typically lasts 1-2 weeks. Drinking fluids and voice rest is recommended.

When should I worry about Voice changes?

If you have a hoarse voice that has lasted longer than 6 weeks, its advisable to request your doctor refer you to an Ear, Nose and Throat Consultant (ENT) for an examination of your Larynx (Voice box). A camera is put up your nose to examine your voice box. This procedure is not painful and is safe. ENT will confirm the reason for your voice changes.

What causes Voice changes?

There are many reasons that cause changes in voice. One of the reasons most people are worried about is laryngeal cancer. The earlier it is diagnosed, the easier it is to treat it, and for treatment to be successful.

There are many other reasons that you may experience voice changes. There are many other reasons that you may experience voice changes. These might be due to Muscle Tension Dysphonia (MTD) , Vocal cord Nodules or a Vocal fold palsy.

• Muscle Tension Dysphonia (MTD) : A voice disorder characterised by a hoarse voice due to excessive muscle tension in the Larynx. It produces voice symptoms without any physical damage.

• Vocal cord Nodules: Swollen areas on the vocal folds caused by using your voice incorrectly over a long period of time. Nodules are typically seen in children or women. People with jobs who use their voice excessively are often affected such as singers, actors and teachers.

• Vocal cord Paralysis: Typically, one vocal cord not moving as a result of an infection or damage to the nerve due to surgery results in a breathy, hoarse and weak voice.

• Spasmodic Dysphonia: A Neurological Disorder than affects the voice.

Following assessment by ENT, Voice Therapy is recommended for the treatment of Muscle Tension Dysphonia (MTD), Vocal cord Nodules, Vocal cord Paralysis and Spasmodic Dysphonia.

Why do I keep losing my voice?

Voice loss is ‘multi-factorial’. This means there is often not one reason. It is important that ENT diagnose the reason you are losing your voice. Voice Therapy will explore the reasons in greater depth that you lose your voice frequently. This may be due to the ways in which you use your voice ineffectively, tension within the larynx, reflux or not taking care of your voice in the best way. Voice Therapy the recommended treatment for voice disorders.

Why do I have a muscle tightness in my throat?

Voice disorders such as Muscle Tension Dysphonia (MTD) or Vocal Nodules can cause excessive tension in the larynx (the throat area) which results in a sensation of muscle tightness. Sometimes people complain about tension in their laryngeal area with no vocal symptoms or changes in voice.

People may describe an ache, constriction, or a lump in their throat. A sensation of a lump in the throat, where no lump exists, is known as ‘Globus’. You may experience a sensation that you want to clear your throat regularly. These unpleasant changes in sensation can make talking feel very effortful and tiring.

Voice Therapy can help reduce this discomfort minimising the effort you feel when speaking.

Why do I feel like I am straining my voice when I speak?

Voice Disorders can result in excessive tension in the laryngeal area. Often the voice is being used ineffectively, which causes additional strain on the larynx (voice box). You may not be projecting effectively resulting in poor amplification of sound. This is known as resonance. Resonance is how your voice is shaped by your voice box, nose and mouth. You may need to learn how to use your breath more effectively to reduce strain.

You may also need to improve your breath support for Speech so that you can use your voice effectively. Often people with Voice disorders use only the upper part of their chest to breathe. Breathing from the diaphragm provides effective breath for speech and reduces tension in the laryngeal area.

Voice Therapy can help reduce strain and discomfort when speaking, to free your voice and improve your confidence.

Can I have NHS voice Therapy?

Yes - we often see people when they are waiting for NHS voice therapy or there is no service in their area.

Our UK based Private Voice Therapists are Clinical Specialists in Voice with a minimum of 15 years experience Specialising in Voice Therapy. Book a free 15 minute consultation or email us at thespeechnetwork@hotmail.com to enquire about our reasonable fees for Voice Therapy.

How can reflux affect the Voice?

How does reflux affect the voice ?

Laryngo-pharyngeal reflux (LPR) is also known as ‘silent reflux’ because many people do not show any symptoms such as heartburn commonly associated with reflux.

What is laryngo-pharyngeal reflux (LPR)?

Stomach juices are made up of digestive acids. Some of these juices can travel up the oesophagus, spill into the throat, affecting the voice. This is called laryngo-pharyngeal reflux (LPR). This causes hoarseness. Additional symptoms are throat clearing, a sore dry throat, an unpleasant taste in the mouth, a feeling of phlegm in the throat, chronic cough or excessive burping. A lump in the throat sensation called ‘Globus’ is a common symptom.

How is laryngo-pharyngeal reflux (LPR) diagnosed?

An Ear, Nose and Throat doctor uses a small thin camera that is passed through your nose, to view your larynx or voice box. This is called an endoscopy. Our Voice therapist will ask you about your symptoms and often use a short questionnaire to identify your symptoms.

How is Laryngo-pharyngeal reflux (LPR) treated?

It can be treated by medications to treat stomach acid, through dietary changes working with our team of Voice Therapists, and occasionally surgery.

How can a Speech Therapist help with reflux?

Muscle Tension dysphonia (MTD) and laryngo-pharyngeal reflux (LPR) often co-occur. We see clients that may have not responded to medications, and alleviate symptoms often attributed to LPR. Voice therapy can boost the recovery period and is essential to reduce discomfort and overcome damaging behaviours

Our Private Voice Therapists are Clinical Specialists in Voice. Book a free 15 minute consultation or email us at thespeechnetwork@hotmail.com to enquire about our reasonable fees for Voice Therapy.

What is a vocal fold paralysis?

What is a vocal cord paralysis?

A vocal fold palsy or vocal fold paralysis is when one or both of the vocal folds do not open or close properly. In most cases, only one vocal fold is affected. Paralysis of both vocal folds is a rare and serious condition.

The vocal folds are two elastic bands of muscle tissue located in the voice box directly above the windpipe. When you use your voice, air from the lungs causes your vocal folds to vibrate between open and closed positions. If you have a vocal fold paralysis, the paralysed fold may remain open. The voice then becomes weak and breathy.

What causes a vocal fold paralysis?  

The most common cause is a viral infection. It can be as a result of nerve damage due to surgery, injury or certain cancers. Neurological conditions such as Parkinson’s disease of multiple sclerosis can also lead to a vocal fold paralysis.

What are the symptoms of vocal fold paralysis?

Symptoms of a vocal fold paralysis are changes to a person’s voice. A breathy, hoarse or weak voice is common. Some people report difficulties swallowing and a swallowing assessment may be required by a Specialist Speech and Language Therapist in Dysphagia. Sometimes people become more breathless with exercise or find it hard to life heavy items.

Can vocal fold paralysis be cured?

Typically, damage is temporary and will improve over several weeks. However, the majority of people will require Voice Therapy by an experienced Speech and Language Therapist to improve their voice. Treatment is available via the NHS for free. We often treat people when there is no voice therapist available or they are waiting for NHS therapy. Online Speech Therapy for Voice is effective.

Our Private Voice Therapists are Clinical Specialists in Voice. Book a free 15 minute consultation or email us at thespeechnetwork@hotmail.com to enquire about our reasonable fees for Voice Therapy.

How do you feminise your Voice ? It's not all about pitch.

Its not all about pitch

Sometimes the assumption of sounding more feminine is to focus on a higher pitched voice. However, a women’s voice is not only a higher-pitched version of a man’s voice. If we only focus on pitch, it is unlikely that you will be satisfied with the results of your therapy. In order to raise your pitch, we also need to change other aspects of your voice and speech. For natural-sounding speech we need to focus upon your intonation, resonance and other aspects to achieve a natural higher pitch. It’s important that you are able to use a flexible feminine voice that matches your personality and lifestyle, in a variety of situations.

What will happen in Voice Feminisation sessions?

Aside from pitch, we will be focusing upon:

Stress and intonation: Stress is often conveyed by using a higher pitch or louder intensity. Intonation patterns are pitch changes at the sentence level. Subtle differences in intonation patterns might hint at the speakers gender so its important to work on these aspects.

Resonance: Resonance amplifies sound and is often referred as projection in voice. We want to diminish the ‘chest’ sound that is often identified with the male voice.

Articulation: we focus on patterns for vowels and consonants that females produce that can be imitated in MTF voice training.

Volume: We might focus on reducing the loudness of your voice

Therapy is like building blocks – we build your voice together gradually. It takes practice and you will be given bespoke exercises after your sessions. The more you practice, the more natural it will feel.

How much does Voice Feminisation Therapy cost?

If you send us an email we can send your further information about number of sessions required and costs.

We are Clinical Specialists in Voice, Voice Feminisation and Voice Coaching. Feel free to book a free consultation or email us for more information.

Can Voice Feminisation harm my voice?

Many clients that come to us having already attempted some voice therapy independently using YouTube videos or voice Apps.  They are often concerned that they may have harmed their voice. 

Inappropriate voice use may strain or cause tension leading to voice damage known as Muscle Tension Dysphonia.  In some research studies, up to 30% of Male to female Transgender Voice clients had a voice disorder in their initial assessment caused by trauma to the voice box (larynx). Muscle Tension Dysphonia can be caused by excessive effort.

You can read more about Muscle Tension Dysphonia here. It can be caused by excessive elevation of the larynx, poor vocal hygiene, excessive tension and using an inappropriate pitch level. Excessive breathiness also leads to excessive tension in the larynx. 

Looking after your voice is important - read more here. 

For more information about Voice Feminisation Therapy - click here

Our aim is to prevent trauma by teaching you the best ways to achieve a feminine voice.  We are Clinical Specialists in Voice, Voice Feminisation and Voice Coaching.

How can I train my voice to sound feminine?

Trans* Voice - Tips for learning and exploring your voice

In therapy you will be exploring your voice. Repetition outside the clinic room is important to change. It is comparable to going to the gym for your voice. You are developing flexibility and freedom for your voice. When learning and exploring try to:

Be Playful – try out new things

Be Mindful – notice without judging

Be Curious – use all of your sense to explore your voice

Be Imaginative – find your own images, hand gestures to support exercises

Be Positive

Be Regular – Be creative about when and where you practice – little and often.

Be Patient – Let things develop and transfer to situations that are easiest first

Be Reflective – record your voice, keep a diary

Be Sociable – try to step out of solo practice into getting support from others

Adapted from The Voice Book for Trans and Non-Binary People – Matthew Mills and Gillie Stoneham

For more information about Voice Feminisation Therapy click here

We are Clinical Specialists in Voice, Voice feminisation and Voice Coaching. Send us an email or book a free consultation for more information.

What can I do to look after my Voice?

• Stop smoking. If you can’t give up, cut down. Smoking irritates and damages the vocal folds. Talk to your GP about advice to support stopping smoking.

• Avoid eating spicy foods. Spicy foods can cause stomach acid to move into the throat or oesophagus, causing heartburn or reflux. If you do experience reflux, talk to your GP about possible medications.

• Avoid too much coffee, fizzy drinks and alcohol. These can dry out the vocal cords. Try drinking decaffeinated tea or coffee or follow an alcoholic drink with a soft drink.

• Avoid shouting and whispering

• If your voice feels tired or strained then rest it. This is your bodys way of telling you to rest your voice

• Try not to clear your throat unnecessarily. It can create excessive mucous and lead to a further need to clear your throat. Try drinking water instead or swallowing.

• Avoid dry and dusty atmospheres as they may dry out the vocal cords. Wear a mask in a dusty environment.

• Try to drink 2 litres (3 ½ pints) of liquid a day (not including coffee, alcohol or fizzy drinks). This will prevent dehydration of the vocal cords.

• Try steaming to keep the vocal folds hydrated

Our Private Voice Therapists are Clinical Specialists in Voice. Book a free 15 minute consultation or email us at thespeechnetwork@hotmail.com to enquire about our reasonable fees for Voice Therapy.