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Dear Ken,
Your question is a good one and one that your doctor should be able to answer.
Myself, I see nodules come in all different sizes. Since a nodule is basically a callus, really just like the ones you get on your hands from overuse - that is, a nodule is a thickening of the skin from rubbing and overuse - the size of nodules depends on how much the vocal cords have been overused.
In order to test the size of the swelling, basically the higher and softer one can sing, the smaller the swellings are on the vocal cords. Conversely, the larger the swellings are on the vocal cords, the more that the high and soft singing voice will be impaired. See vocal capabilities testing at http://www.voicedoctor.net/Optimal-exam/vocal-capabilities.
For your voice problems, you might seek out a laryngologist, someone who specializes in voice. I list quite a few of them here on this website. A pitch issue is directly related to the vocal cords, so seeing the vocal cords vibrate and testing your pitch range, a laryngologist should be able to answer your questions..
I have read scientific literature that suggests it is possible to develop antibodies to botulinum toxin. However, I have also met patients who were told they had antibodies and yet I was still able to treat them with botulinum toxin. In my experience, I have found that technique of injection more often affects outcome then development of antibodies. See comments on "The art of the injection". Consequently, while I don't know of other medications, there are times when seeing a different physician who utilizes a different approach or technique or injects a different muscle can lead to a different outcome.
The answer to your question lies in getting a good examination. You might consider visiting a laryngologist, someone who specializes in vocal cord issues.
Dear Jimmy,
I list the doctors that I know on this website - http://www.voicedoctor.net/Physicians-0/index-000
if you aren't getting better on treatment, that can be because the diagnosis is incorrect. The only way to know what is the cause of losing your voice is to have a good examination. I also talk about how to evaluate the quality of your examination on this website - http://www.voicedoctor.net/Physicians-0/Choosing-your-doctor
Best wishes,
James P Thomas
