This past Christmas break I was working on music for a faculty voice recital, scheduled for January 20, 2011. As I practiced, I noticed that something was just NOT right with my voice. Singing classically, I was fine, if sounding slightly tired. The problem came when I was trying to sing a slightly higher Broadway belt sound (D4-E4). My voice was making extra noise and just wouldn’t phonate properly. I knew that I felt I was working too hard, and my self-diagnosis was muscle tension dysphonia (in other words, using too much muscle and “overblowing” the cords).
So, on January 13, 2011, I went to an ENT to have my cords looked at. I was shocked when the doctor told me that I had small bilateral pre-nodules on the leading edge of the vocal folds. I have always had “cords of steel” and been able to pretty much sing through anything. This diagnosis of pre-nodules really made me re-think how I was approaching my voice.
What are pre-nodules? Here’s the layman’s version: the vocal folds are covered with the same skin as the outer layer of the skin on the outside of your body (squamous epithelium). Nodules are similar to calluses that form from repetitive motion. If, when you notice that a callus is forming, you change your behavior, the callus can go away pretty quickly. This is similar to the situation of pre-nodules on the vocal folds: it’s what is the beginning of the formation of a callus, but the skin has not yet hardened. Because I knew my voice and knew that what was going on was NOT just because I was exhausted, I got myself to the doctor quickly. 
What causes nodules? Nodules are most often a vocal disorder of vocal misuse. But, in any voice disorder, there are generally a confluence of factors that contribute to the diagnosed disorder. In my case, I had many factors that contributed: 1) On top of my private studio teaching and my regular performance schedule, I began teaching in a university setting in September 2010 (including 13 private students and class voice) which drastically increased my voice use, 2) in December my daughters became ill, & I ended up with very little sleep for 2+ weeks while continuing the crazy schedule that is a singer’s life in the Christmas season, 3) because I am able to be loud, I was speaking too loudly at home to my daughters, 4) I was singing in the Turandot chorus, which for mezzo-soprano is on the upper end of the tessitura (it hangs D5-F5), 5) I was working learning how to belt while my voice was tired, not the style in which I’m most highly trained, 6) I had an undiagnosed case of Laryngo-Pharyngeal Reflux Disease (LPRD). All of these factors combined to create what I had felt was just a “tired voice,” but ultimately resulted in something that COULD have been very drastic.
How are pre-nodules diagnosed? Read more…
