Artwork provided by George Butler.
This episode was written and produced by Anna Bennett.
A diagnosis of vocal nodes is every singer's worst nightmare. Musicians like Justin Timberlake, Adele, Björk and Rod Stewart have all had surgery to treat them. Nodes are so widely discussed, they've almost become a boogeyman in the singing community. But is this condition really as common as people fear? And when nodes do develop, is all hope truly lost? Featuring vocal coach Katie Talbot and Professor and Chairman of the Ear, Nose, and Throat Department at Drexel University of Medicine Dr. Robert Sataloff.
MUSIC FEATURED IN THIS EPISODE
Coming For Ya by Yes Yes No Maybe
Idle Ways by Simple Light
Requiem by Davis Harwell
The Falls by Sound of Picture
Charmed by Sound of Picture
Spring Solstice by Sound of Picture
Running on Empty by Sound of Picture
Warm Fingers by Piano Mover
Wax Paper Jewel by Origami
The Consulate by Holyoke
Paper Trails by The Field Tapes
Silent Flock by Migration
Twenty Thousand Hertz is produced out of the studios of Defacto Sound and hosted by Dallas Taylor.
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View Transcript ▶︎
Imagine your favorite voices. Your spouse. [SFX: “love you babe”] Your kids. [SFX: child laughing] The barista at your local coffeeshop. [SFX: “The usual?”] Your jam on the radio. [Music in: Coming For Ya by YES YES NO] Your best friend’s terrible rendition of that jam. [SFX: “Coming For Ya” done poorly] The voices in our lives weave a comforting sonic tapestry around us.
But what if... one of those voices went silent?
[music/riser out]
You’re listening to Twenty Thousand Hertz, I’m Dallas Taylor.
[music in]
We’re all aware of the ways professional athletes can be sidelined by an injury. And even those of us who aren’t athletes are familiar with the effects of repetitive stress on the body: things like tennis elbow, carpal tunnel syndrome, and tendonitis.
But there’s another part of the body that’s also vulnerable to injury but rarely talked about: your vocal folds, more commonly known as the vocal cords.
All of our voices are part of our identity but if you’re a singer, a teacher, an actor, or a vocal performer of any kind, your voice is also your livelihood. Here’s Katie Talbot, a vocal coach in Nashville.
[music out]
Katie: My mirror in my room knew me as Brittany Spears, Christina Aguilera, Celine Dion, you name it.
In her early 20s, Katie signed with an agent and moved out to LA.
[Music clip: Katie singing]
Katie: And then I was singing in Hollywood, probably about three times a week.
Meanwhile, she was working to pay the bills.
Katie: I was working at Starbucks as my day job.
[SFX: Espresso making & sipping]
Katie: So I was doing early, early morning openings drinking tons of coffee to keep up with the lifestyle out there.
[SFX: Coffee bar chatter]
Katie: And then of course, 20 and 21 I'm going out a lot too. So, not only am I singing [Music clip: Katie singing] in the clubs around midnight, 1:00 AM depending on when we go on, but I was also talking super loud.
[SFX: Increased club chatter, which suddenly cuts music off harshly to an annoying alarm clock buzzing]
Katie: And then I'd have to wake up, [SFX: Hits alarm snooze button] have very little sleep, and then go to work.
During this time, Katie estimates that she was using her voice professionally 30-50 hours per week.
Katie: And just did not realize it because I just thought, "It's my voice. That's it."
So, Katie kept up the hustle and grind: [SFX: Drum loop in, speeds up over this section] late nights [SFX: crickets], loud clubs [SFX: club walla, background music adds electronic/club beat], high notes [SFX: belting voice], no sleep [SFX: alarm clock], lots of coffee [SFX: Coffee pouring], late nights [SFX: owl], recording sessions [SFX: belting voice, background music adds ride], shouting out orders [SFX: ridiculous Starbucks order (half soy, non-fat, vanilla etc…], late nights [SFX: wolf howl], noisy bars [SFX: club walla, background music adds electronic/club beat], little sleep [SFX: alarm clock]…
Katie: My personal bad habit as a singer, I love to be loud. I grew up thinking, "If I'm loud, I'm good."
Katie’s agents and managers had her singing in a pop rock style in the studio, but she also sang for a heavy metal band.
Katie: And I would sing whistle tone like, way above their metal melodies.
[SFX: Whistle tone]
Katie: Whistle is actually something that is a very light coordination in the voice, it's very small. Katie: And when you're trained for it, it's actually pretty easy to get. But I was finding that I could not get it, and even my talking voice was getting raspy.
At first, Katie blamed the dry Southern California air... she thought doing better warmups would help, and she sang even more than before.
[music in]
Katie: So I would do the warmups for a little bit, I was also very impatient. So I would just sing through it and start just putting more power into it to try to overcompensate for what I felt I had lost.
Katie: But I thought, you know, "I can just push through it. Push through it. Push through it, my voice will come back."
After a few months, it became clear to Katie that whatever was happening to her voice wasn’t something she could just push through.
Katie: I basically lost my whole top register and only had a little bit of my chest voice when it came to singing.
It was at this point that Katie realized she needed help.
Katie: So, I'm little 21 year old Katie from Franklin, Tennessee, going into Beverly Hills and paying so much money for this doctor to see me, and I see everyone he's worked with is on the wall from Kurt Cobain to Whitney Houston, LeAnn Rimes, Mariah Carey; so I knew I was in good hands. And I went in, he saw me for about five minutes, he goes, "Okay, you have nodules."
Katie: And my heart just sank, because here I am thinking there goes anything I want to do, anything I want to do.
For a singer, a diagnosis of vocal nodules is devastating, and could be career-ending.
[music out]
Even if you don’t know what they are, you might have heard what they sound like. [SFX: horrible vocal node]
That’s the sound of a vocal nodule, also known as a node; both of those words can be used interchangeably. Vocal cord injuries like nodules, tears and hemorrhages have sidelined more superstars than you may realize. Stars like Justin Timberlake, Adele and Mariah Carey have all dealt with this.
Dr. Sataloff: The edges of the vocal folds are extremely delicate and extremely complex.
That’s Dr. Robert Sataloff.
[music in]
Dr. Sataloff: I am the Professor and Chairman of the Ear, Nose, and Throat Department and Senior Associate Dean at Drexel University College of Medicine and Director of Otolaryngology and Communication Sciences Research at the Lankenau Institute for Medical Research.
That’s a very long title that essentially means… that Dr. Sataloff really knows his stuff. He’s also a lifelong musician.
Dr. Sataloff: I discovered my love for music as a child. There was always music in the house. My father was also an ear, nose and throat doctor, so there were no professional musicians. But I love music, and we sang around the house from the time I was a youngster.
Dr. Sataloff: My voice changed early when I was 10, and was lower than it is. And we thought I was going to be a Russian bass, and so I started studying singing when I was 13 and singing professionally when I was 15.
[music out]
Today, Dr. Sataloff is a world-renowned physician of voice medicine, which is still a relatively new field. He’s quite literally written the book on it. Well, actually, more than 60 books.
Dr. Sataloff: When I was in training at the University of Michigan in the 70’s we didn't know anything about the layered structure of the vocal folds. Singers came in to most excellent otolaryngologists and complained about threadiness in their upper mid-range. The doctors had no idea what they were talking about.
But Dr. Sataloff had been singing professionally since his teen years. He recognized that there was a “language gap” between performers and physicians — luckily he could speak both languages fluently. The singer you’re hearing right now is Dr. Sataloff.
[music clip: Dr. Sataloff singing]
Today, thanks to Dr. Sataloff’s work, our understanding of the vocal folds is much more nuanced than it was 50 years ago. Interestingly, even though the vocal folds are the source of the human voice, it’s not what actually sets our voices apart.
Dr. Sataloff: If you cut off somebody's head just above the vocal folds [SFX: Guillotine]…
Ew, well that’s vivid.
Dr. Sataloff: You'll get a very unattractive buzz [SFX: Buzzing brass mouthpiece] whether you're Pavarotti [SFX: Pavarotti long note] or a normal person [SFX: poor imitation of Pavarotti]. It sounds really just like lips buzzing against a trumpet mouthpiece. If you take a trumpet mouthpiece [SFX: Mouthpiece buzz into trumpet tone] and put it on a trumpet and then a French horn [SFX: Mouthpiece buzz into French horn tone], you will hear trumpet and French horn. It's not the mouthpiece, it's the resonator system that gives us our distinct personal sound. [SFX: Buzzing mouthpiece turns into Pavarotti]
So it’s the resonator system above the vocal folds that makes it clear whether Dr. Sataloff is talking...
Dr. Sataloff: Or whether you're talking.
[music in]
And just like professional athletes are prone to stress injuries of joints and muscles, professional singers can be prone to injuries of their vocal folds. Remember back when Katie said this about overusing her voice?
[music out]
[SFX: Film rewind, Katie continues under film scrolling]
Katie: So, not only am I singing in the clubs around midnight, 1:00 AM depending on when we go on, but I was also talking super loud.]
[music in]
Dr. Sataloff: So if you speak too loudly chronically, you may injure the vocal fold acutely and get a tear or a cyst, which is a fluid-filled bubble on the vocal fold. The cyst will then strike the other vocal fold and create a reactive mass from repeated trauma.
It’s when these cysts continue to strike one another and harden that they become the dreaded nodes. That’s why they almost always occur in pairs — one on each cord, striking each other over and over again, like chafing or biting the same spot on your cheek again and again.
[music out]
Over time, this alters the sound of your voice.
Dr. Sataloff: If you have masses on the vocal folds they interfere with closure of the vocal folds.
Try this: Make a peace sign with your pointer and middle finger, then wrap one of your fingers from your other hand around your pointer finger. Now try to bring your two peace sign fingers together.
Dr. Sataloff: You can't. They stay separated. That's what happens with masses. So there is air escape from the incomplete closure, and there is turbulence just as you would get if you took a piece of paper and touched a vibrating guitar string [SFX: Guitar string buzz], the voice buzzes [SFX: Vocal node buzz].
But Dr. Sataloff says this much-feared condition isn’t nearly as common as people think it is. According to him, singers with more common conditions often get misdiagnosed as having nodes.
Dr. Sataloff: Of every 50 patients referred to me with a diagnosis of vocal nodules, between one and two have them.
He also emphasises that even if you have vocal nodules, surgery is an absolute last resort, and not a quick fix. Whether it’s a cyst, a lesion, a tear or a nodule, the best medicine is often vocal therapy.
More than 90% will go away or become asymptomatic with voice training, physical therapy for the voice.
[music in]
A serious vocal fold injury can interrupt or end a singing career. But well-intended surgeries to repair these injuries do occasionally go wrong, and one surgery in particular cost an icon her voice.
We’ll get to that, after the break.
[music out]
[MIDROLL]
[music in]
The delicate tissues of the vocal folds are the unsung heroes of the human voice. If something happens to them, well, that’s it. There’s no Sam Smith, no Justin Timberlake, no Ariana Grande, and no Julie Andrews.
Now, all four of these singers have very publicly dealt with vocal fold injuries. And three of them made incredible comebacks thanks to advanced surgical techniques. But one of them went under the knife and didn’t come back the same.
[music out]
[Music clip: “The Sound of Music”]
You may know Julie Andrews as Maria from The Sound of Music, or as Mary Poppins [SFX Clip: Mary Poppins “Supercalifragilisticexpialidocious”], or as the royal grandmother in The Princess Diaries [SFX Clip: Princess Diaries].
[music in]
In the late 90s, Julie underwent what was supposed to be a routine surgery to remove her vocal nodes. But something went wrong, and after the surgery she wasn’t able to sing. It was absolutely devastating. In this interview with Barbara Walters, Julie explains the emotional toll losing her voice has had on her.
*[SFX Clip: Barbara Walters Interview
...Julie: “to not sing with an orchestra, to not be able to communicate through my voice, which I’ve done all my life, and not be able to phrase lyrics, and give people that kind of joy, I think I would be totally devastated. So I am in some kind of denial.
I simply can’t do a song for you.”]*
[music out]
Dr. Sataloff is among several prominent doctors who have worked with Julie since the initial surgery that went wrong. After many years of continued therapy and medical care, Julie was able to sing in a low register. Her first singing performance after the surgery was a song in The Princess Diaries 2.
[SFX Clip: Princess Diaries 2]
Dr. Sataloff: I can't talk about Julie much, although she has talked in public about the fact that I have taken care of her after her surgery. Because she's acknowledged that, I can mention that I know that voice well, and I consider it a national treasure lost.
[Music clip: Julie soprano voice: “Smile, my honey dear while I kiss away each tear”]
**For every Julie Andrews, though, there are many surgeries that go right: Adele, Cher, Bjork, John Mayer and so many other stars have come away from vocal procedures sounding better than ever.
Dr. Sataloff: With our new techniques which were designed when we acquired knowledge of the layered structure of the vocal fold, the results usually are excellent, but not always.
[music in]
Back in the 80s, Elton John was in the middle of a massive world tour. He’d performed close to 200 concerts in 15 months, and all of that singing was taking a toll on his voice. Eventually, he had to cancel his remaining tour dates, and went in for throat surgery. Now, at the time, Elton John’s publicist said he was being treated for a quote “non-malignant lesion”—a pretty vague phrase that could easily describe a vocal node.
Thankfully, everything went according to plan, and Elton was back in the studio the following year. But fans have pointed out that ever since the surgery, Elton’s voice has been noticeably deeper and fuller than it was before.
[music out]
Case in point: Here’s Elton performing “Tiny Dancer”before the surgery.
[Music clip: Tiny Dancer 1984]
Now here he is on the tour where he injured his voice:
[Music clip: Tiny Dancer 1986]
And now here he is ten years after the surgery. Notice how he’s still hitting the same notes, but his vocal tone is much fuller:
[Music clip: Tiny Dancer 1997]
Fortunately for singers like Katie Talbot, vocal nodes usually don’t require surgery. But the road to recovery is still hard.
In this recording of Katie talking with her sister, you can hear the strain and dryness in her laughter.
[SFX Clip: Katie and her sister talking]
Katie: My talking voice would literally sound like this, completely broken. But I'd have to be really loud with it if I wanted to get anything out. It was rough. I sounded like I smoked 20 packs a day.
[music in]
So, on doctor’s orders, Katie made the lifestyle changes needed to restore — and keep — her voice.
Katie: And so I had him tell me all the changes that I needed to make and I just started rigorously so really cutting out coffee, and then training myself to breathe through my nose actually, when I sleep.
It turns out that breathing through your mouth seriously dries out your vocal folds, which need to be nice and mucus-y to strike together without inflicting damage.
So, one of the things that I even did was talking a little bit higher. So I wasn't talking so loud and down in my voice, but just a little bit lifted. I pretended I was a British person talking up here, you know? And taking pressure off of my cords, and that seemed to help.
[music out]
Katie’s recovery was extensive, but after a few months she was able to sing again. Eventually, her vocal folds fully healed. Through this experience, Katie was able to gain some perspective…
[music in]
Katie: It actually helped me start a transition in my life where I went towards artist development. So, as traumatic as the nodules were for me, it was actually a shifting point in my career, which I'm very thankful for, and I don't know if I would have seen it had nodules not happened to me.
Today, as a vocal coach and artist development specialist, Katie provides the sort of insight, training and support that might have stopped her from developing nodes in the first place.
Katie: I tell the artists that I work with now, it's so important to take care of your voice because. It's your sound, it's why people connect with you. It's why you have fans, and it is your paycheck. You have got to take care of it. You just have to.
[music out]
Fortunately for Katie and artists everywhere, the field of arts medicine is growing. Athletes rely on sports medicine to stay in the game. For artists and performers, arts medicine can help them perform their best for as long as possible.
Dr. Sataloff: Performers have special needs. They also have forced physicians to be better. That is due in part to a different definition of normal. If I, as a microsurgeon, break my finger shooting hoops on the weekend and my hand surgeon gets me back to 95% function, I'm happy.
Dr. Sataloff: If I am a world class pianist or violinist, the difference between that last 5% or 2% or 1% is the difference between renown and obscurity. [music in]
Katie: My voice is how I impact anyone and everyone around me. I'm not only a career woman, but I'm also a wife and a mom. So having my voice to use, whether it's in singing or speaking, I sing to my son every night before he goes to bed and I know how much that impacts him, because he immediately calms down whenever we sing our song.
Dr. Sataloff: My voice has always been an integral part of my identity as it is for most singers.
Dr. Sataloff: I got a Doctorate of Musical Arts and Voice Performance primarily operatic singing and sang professionally including as a cantor for 50 years until about six years ago when I developed thyroid cancer and ended up with vocal fold paralysis and eight voice operations so that I could be able to speak well enough to do interviews with you, but I can't sing anymore. Dr. Sataloff: It still causes considerable sadness not to be able to sing. I used to call all my friends on their birthdays and sing happy birthday. I was a cantor for 50 years, and it's really hard to go to high holy day services and listen to somebody else sing. And I miss it.
Dr. Sataloff: However, I'm also this year celebrating my 50th anniversary as conductor of the Thomas Jefferson University choir, so I am still making music and singing with lots of other people's voices.
[music out]
[music in]
Twenty Thousand Hertz is produced out of the sound design studios of Defacto Sound. Find out more at defacto sound dot com.
This episode was written and produced by Anna Bennett. And me, Dallas Taylor. With help from Sam Schneble. It was story edited by Casey Emmerling. It was sound designed and mixed by Soren Begin and Jai Berger.
Thanks to Dr. Robert T. Sataloff for his expert medical insight. Thanks also Katie Talbot for sharing her story and experience.
You can check out Katie’s vocal warm-up subscription at Vocal Lab Collective dot com.
If you’d like to learn even more about protecting your voice, we left a handy link on our website, so be sure to check it out at twenty kay dot org.
Thanks for listening.
[music out]
