Question about vocal cord nodules?

I have a friend that is a soprano she has a really powerful voice well about 4-5 years ago she found out that she has vocal cord nodules but she has refused to remove them.She says that if she did that she would loose about an octave off her range the funny thing is the only thing the nodules affect is her speaking voice I mean after she sings her voice is really horse for about a day.But her singing voice is just amazing last time she checked with her doctor she still had her nodules she still takes vocal lessons.And she uses some kind of throat spray and a humidifier my question is.How can singers with vocal nodules still sound so amazing?