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Episode 24 – Do you have NODULES?! Vocal health with Laryngologist Reena Gupta MD

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Today, we are excited to be talking to Doctor Reena Gupta.

Do you have VOCAL NODULES?

Reena Gupta Osborne OHNI

Reena is a laryngologist, which in simple terms, is an ear, nose and throat (ENT) surgeon that has specialised in the larynx. After her medical training, she spent a year developing skills to be an expert in how to care for laryngeal problems, and is a voice specialist within laryngology. Throughout her life, she has always been a keen singer, and found this path was the ideal alignment of passion and profession. Her work spans across many professional voice users. Essentially anyone who uses their voice for a living, and not just actors and singers. Sales people, and even ENT surgeons also rely on their voice to make a living.

She is now based at the Osborne Head and Neck Institute (OHNI) in Los Angeles, and we were lucky enough to speak with her on the topic of NODULES… a subject at which the thought of makes even the most seasoned singer panic. Yet, on hearing you have them, is it always awful news?

‘We all know what a star Reena Gupta is but I don’t think we can truly fathom her generosity and dedication. Reena is BEYOND. She’s such a great communicator, I love how she shares her great knowledge with humour, finesse and her beautiful smile. I’m filled with gratitude for her.’

Lisa Haupert, Vocal Coach – Nashville

Reena certainly has a very personable approach and we find that she has the ability to explain things in a way that makes it so easy to understand.

First things first…

What are vocal nodules?

They are a frictional problem with the cords, mainly through poor technique, or even through having a ‘nodular personality’ (the ‘entertainer’ personality, constantly laughing or talking loudly).
NB:Nodules are always paired, you will never have just one.

If you are using your voice incorrectly for a long period of time, the friction will make the lining thicker until it’s like a callous on each vocal cord edge. For example, the inside lining of your mouth is soft and smooth, as it has no contact or direct friction. However your fingertips are constantly exposed to friction, and are harder to protect the flesh underneath. It’s basically a defence mechanism!

When you go out for an evening, to a noisy restaurant or club perhaps, the next day you’re bound to be a little bit hoarse. But because the voice has the ability to restore itself to what we consider or perceive as normal, we are much more casual about abusing it.

It’s about finding a balance. Don’t drink or smoke, and reign in the vocally destructive habits, for example prolonged speaking or excessive speech volume. Sometimes it’s good to listen; your friends will like you more (wink face).

So what are the warning signs?

Ask yourself some key questions:

  • Is your voice consistently raspy?
  • Is your vocal break wider?
  • Have you lost some notes off the top of your range?

These are signs for you as a singer that there MIGHT be nodules present.

Then ask your vocal coach for a second opinion:

  • Can they help you negotiate that wider vocal break?
  • Have you just slipped into some bad habits?

These 2 steps alone should eliminate a lot of panic and will answer the question for you positively.

Spot it in your speech

It’s worth noting that a nodular voice can be spotted from regular speech. You cannot have nodules if your voice is clear in all pitches. You don’t speak on one pitch. However you do ‘dance around’ pitches in speech, which would likely show nodule-like tone production. If your speaking tone is clear but your range is affected, it could be acute swelling on the folds.

But let’s say, theoretically, you have confirmation from your coach that something’s afoot. You need to know what’s going on! Questions to ask would be:

  • Can your vocal coach recommend a trusted laryngologist?

If yes then great! An ENT would certainly be able to assist, but a specialist in voice is always preferable!

  • What kind of scope will be used?

Ideally, you want a rigid stroboscope that goes into the mouth. They are larger, high def, and have better lights for showing up the area needed to be seen. There is greater magnification and overall you’ll receive a much better impression of your vocal folds. Why’s this important? Misdiagnosis of course! Phlegm even looks likes nodules, so misdiagnosis is common with through-the-nose endoscopes.

But… you’ve been diagnosed with nodules. Now what?

Firstly, its not the end of your career!

They are callouses so don’t fret: IT’S A REVERSIBLE CONDITION!!! They are genuinely much easier to fix than other diagnoses such a polyps or cysts.


We hear you cry…

Throughout her career, Reena has operated on just 3 cases on nodules. If surgery is desperately needed, she will rid the vocal folds of approximately 80% of the nodules and let the body heal itself of the rest. Why take this approach? In surgery it’s possible to take away too much of the vibrating layer on the folds, and this is irreversible. A sad example of this situation would be someone like Julie Andrews, who never recovered from nodule surgery. During the surgery the delicate layer of the vocal cord was breached by the surgeon and forever damaged.

Whilst being very diplomatic, Reena suggests that over-aggressive surgery, like Julies,  results in potentially losing too much of the vibrating layer. Just a matter of a millimetre can result in a career ending result for the singer. This is why Reena would prefer to let the body either heal itself, or remove part of the nodule to let the body do the rest. There is no quick fix so really, for the sake of a few weeks extra recovery and having a voice forever, it’s worth avoiding the surgery and putting in the hard graft for the road to recovery.

How long can it take to recover from nodules?

It will take a longer time to reverse the problem if you’ve been sitting on the issue for a long time. If its been 2 years with no rehab, rest, or treatment then there’s no quick fix.
Can you get fixed without surgery? – yes
Are your odds for recovering lower if you have surgery? – unfortunately  yes
Which is the perfect case for getting things diagnosed early and not sitting on it too long after seeing the signs!

With surgery done well and conservatively, a singer can be back and working around 4 to 6 weeks.


Who would PREFER nodules???

Reena prefers nodules to other diagnoses, because they are not necessarily surgical. The fear of them combined, resulting in not doing anything about it is what causes nodules to get out of control. You are bound to be hoarse after working your voice hard, but it will always come back. A singer knows on the same day if something ‘serious’ has happened, so make an appointment!

Ladies beware…

Others things to be wary of are womens ‘time of the month’. Premenstrually, blood vessels that dilate down south also dilate up north. This leaves them more prone to haemorrhage. So the week before you’re due, reign in your voice use as much as is possible if you tend to suffer at this time.

Another mention is regarding supplements and how they always been a popular choice for singers. However be cautious ! They can thin the blood too much which can exacerbate the chance of haemorrhage! Be careful with herbal remedies like ginko, ginger and garlic (the 3 G’s).

Wow! That was jam packed with info!! You can reach out to Reena, at her personal website She checks the emails personally don’t you know! Dr. Gupta also wrote another article for us which you might be interest in.

You can also find out more about the Osborne Head and Neck Institute here!

Have you had any issues regarding vocal health? Are you experiencing anything now?

Drop her a message or get in touch with us here at The Naked Vocalist. Don’t suffer in silence.

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