Voice Clinic:

Voice Clinic is specialized comprehensive clinic with ultra-modern technology and trained specialists for diagnosis and management of voice, airway, swallowing disorders and laryngeal cancer. Voice clinic brings technology par excellence and clinical experience together to harness them towards compassionate patient care.

How To Reach To The Clinic:

1 St Floor, Superspeciality Building (New Building)
Deenanath Mangeshkar Hospital and Reserch Center

Contact Us:020 – 49153114


Who Can Visit This Clinic:

Patient who has one or more than following complaints:

  • Hoarseness
  • Breathiness
  • A "rough" voice, "scratchy" voice
  • Harshness in voice
  • Shooting pain from ear to ear
  • A "lump in the throat" sensation
  • Neck pain
  • Decreased pitch range
  • Voice and body fatigue
  • Laryngitis
  • Vocal cord cysts or polyps
  • Cancer
  • Neurological conditions
  • Trauma
  • Inhalation of a foreign body or caustic substance.
  • Exposure to other irritating substances.
  • Long-term use of inhaled corticosteroids
  • Allergies
  • Acid reflux/Heartburn
  • Thyroid conditions

If you are a vocational voice user (i.e., someone who uses their voice for their living, such as a singer, actor, voiceover artist, etc), you will possibly notice:

  • Chronic hoarseness
  • Pitch change in your voice
  • Significantly decreased range (no longer hitting higher notes easily)
  • Inability to sing quietly
  • Inability to hold a pitch steady
  • Throat pain
  • Voice fatigue

Self Care / Self Help

  • Speak minimally, only as per requirement.
  • Always speak softly with a gentle and easy onset.
  • Do not speak excessively, avoid whispering.
  • To attract attention or discipline children, do not shout, scream, call out or answer back.
  • Use non vocal means such as gesture, clapping, etc..
  • Schedule period of voice rest during the day 4 periods of 15 min. each.
  • Do not speak continuously for more than 5 minutes at a time.
  • Do not cough loudly; drink water after a cough.
  • Do not talk over long distance and in outdoor situations.
  • Move closer so you can be heard without shouting.
  • Do not address large audiences without proper amplification. Learn good microphone technique.
  • Do not hold breath while speaking or speak too quickly on insufficient breath
  • Decrease tea and coffee consumption.
  • Avoid smoking
  • Avoid dry, smoky and dusty environment.
  • Avoid oily spicy, citrus food.
  • Do not sleep immediately after eating.
  • Drink plenty of water 15 glasses per day.
  • Avoid eating late.

Antireflux Instructions

In some people, irritating acid stomach juices may leak out of the stomach into the esophagus and throat. This causes irritation and muscle spasm in the throat. Some of the symptoms that people have from this include: cough, burning sensations or soreness, throat clearing, excess mucus, bad taste an sensation of a lump in the throat.

The following instructions are designed to help neutralize the stomach acid, reduce the production of acid and prevent acid from coming up to the esophagus. You should use as many of these measures as needed to get relief. If these measures do not help, or if your symptoms get worse, you should let your doctor know about it.

  • Take an antacid in liquid form (Gelusil, or others of your choice) 30-40 minutes after meals and at bedtime. If the symptoms are severe, take Antacids every one and half or two hours between meals. If you are overweight, you should try and reduce your weight.
  • Diet restrictions help to control symptoms. A bland diet divided into multiple, small feedings is recommended. You should avoid highly seasoned food, fats, citrus, tomato, onion, pepper, potato chips and fried foods. Other things that promote reflux include chocolate, nuts, pastries, olives and vegetable oil. Each meal should include proteins for stability (e.g. meat, fish eggs, chicken, sereals cottage chese). Care should be taken to chew food properly. Alcohol, tobacco and coffee are irritants to the esophagus and should be avoided. Alcohol and coffee also stimulate acid stomach secretions. Avoid all strongly flavoured candies, lozenges, chewing gum, fresheners etc. Do not eat for 1 ½ - 2 hours before retiring.
  • For night time relief, sleep with the head of your bed elevated since symptoms are more likely to occur if you lie flat. This can be achieved by elevating the head end of the bed. The desired elevation ranges from 4 to 8 inches (10-20 cm), with 6 inches (15 cm), a customary average. If this is not practical, sleep on two or three pillows or a foam wedge. Sometimes sleeping on the right side prevents distressing attacks.
  • Clothing that fits tightly across the mid-section of the body should be avoided. Women should not wear a girdle. Men should not wear a belt, but should use Suspenders (braces) instead. Use of 'abdominal supporting belts' should be prohibited.
  • You should practice abdominal or diaphragmatic breathing when you are having symptoms. This means that you have to concentrate on pushing out the stomach with each breath, instead of expanding the chest.
  • Do not bend or stoop any more than is absolutely necessary. This includes activities such as gardening and exercises requiring lifting or bending.
  • Maintaining a relaxed attitude in your activities helps to reduce symptoms.

Vocal Hygiene: How to Get the Best Mileage From Your Voice.

  • Don't Abuse Your Voice.
  • Don't clear your throat or cough habitually
    Instead : Yawn to relax your throat
    Swallow slowly, drink some water
    Hum : concentrate on vocal resonance sensations.
  • Don't yell, cheer or scream habitually
    Instead : Use nonvocal sounds to attract attention; clap, whistle, ring a bell, blow a horn.
  • Find nonvocal ways to train / discipline children and pets.
  • Avoid prolonged talking over long distances and outside.
    Instead : move closer, so that you can be heard without yelling;
    Learn good vocal projection techniques.
  • Avoid talking in noisy situations: over loud music, office equipment, noisy classrooms, or public places; in cars, buses, aeroplanes. Position yourself close to your listeners. Wait until students / audience are quiet and attentive; Find non vocal ways to elicit attention.
  • Don't try to address large audiences without proper amplification. You should be able to lecture at a comfortable loudness to be heard in any situation.
    Instead : Use a microphone for public speaking
    Learn microphone technique
  • Don't sing beyond your comfortable range.
    Instead : know your physical limits for pitch and loudness; Seek professional vocal training;
    Always use an adequate monitoring system to guide your voice use during performance; Never sing a high note that you can't sing quietly.
  • Avoid vocally abusive nervous habits of public speaking; throat clearing Breath = holding, speaking quickly, speaking on insufficient breath, speaking on low, monotone pitch, aggressive or low-pitched fillers; um… ah…
    Instead : monitor and reduce vocal habits that detract from your presentation; learn strategies for effective public speaking.
  • Don't speak extensively during strenuous physical exercise.
    Instead : avoid loud and aggressive vocal 'grunts'. After aerobic exercise, wait until your breathing system can accommodate optimal voice production.
  • Don't talk with a low-pitched monotone voice. Don't allow your vocal energy to drop so low that the sound becomes rough and gravelly ('glottic fry') Instead : keep your voice powered by breath flow, so the tone carries, varies, and rings; allow your vocal pitch to vary as you speak.
  • Don't hold your breath as you're planning what to say. Avoid tense voice onsets ('glottic attacks') Instead : Keep your throat relaxed as you begin speaking. Use the breathing muscles and airflow to start speech phrases; the coordinated voice onset.
  • Don't speak beyond a natural breath cycle : avoid squeezing out the last few words of a thought with insufficient breth power.
    Instead : speak slowly, pausing often at natural phrase boundaries, so your body can breathe naturally.
  • Don't tighten your upper chest, shoulders, neck, and throat to breathe in, or to push Sound out. Instead : allow your body to stay aligned and relaxed to breathe is natural; Allow your abdomen and rib cage to move freely.
  • Don't clench your teeth, tense your jaw or tongue.
  • Instead : Keep your upper and lower teeth separated Let your jaw move freely during speech. Learn specific relaxation exercises.
  • Avoid prolonged use of unconventional vocal sounds; whispering, growls, squeaks, Imitating, animal, or machine noises …
    Instead : If you must talk when your voice is strained, use a soft, vocal tone instead of a loud, harsh whisper, If you must produce special vocal effects for performance make sure you are using a technique that minimizes muscle tension and vocal abuse.
  • When you sing, don't force your voice to stay in a register beyond its comfortable Pitch range. Especially, don't force your 'chest voice' too high; and don't force your 'head voice' high into falsetto range.
    Instead :allow vocal registers to change with pitch; Consult your singing teacher to learn techniques for smooth register transactions.
  • Don't demand more of your voice than would the rest of your body. Instead allow for several periods of voice rest throughout the day.
  • Don't use your voice extensively or strenuously when you are sick or when you feel tired.
    Instead : rest your voice with your body; it's sick too !
  • Don't use your voice when it feels strained.
    Instead :learn to be sensitive to the first signs of vocal fatigue; hoarseness, throat tension, dryness.
  • Don't ignore prolonged symptoms of vocal strain, hoarseness, throat pain, fullness, Heartburn, or allergies. Instead : consult your doctor if you experience throat symptoms or voice change for more than ten days.
  • Don't expose your voice to excessive pollution and dehydrating agents; cigarette smoke, chemical fumes, alcohol, caffeine, dry air.
    Instead : Keep the air and your body clean and humid drink 8-10 cups. of non caffeinated beverages daily, more if you exercise, don't drink alcohol or caffeine; maintain 30% humidity in the air. Quit smoking !
  • Don't slouch or adopt unbalanced postures.
    Instead : Learn and use good posture and alignment habits.

Instruction for Patient During Visit to the Clinic


  • Kindly carry your previous reports and file.
  • Are you using any kind of denture.

Pre Operative:

  • Medical fitness
  • Nil by mouth from midnight
  • Avoid smoking for 24 hours before surgery
  • Follow voice rest.

Post Operative:

  • Please do not smoke/consume tobacco for at least 2-4 weeks as your tissue heals.
  • Avoid alcohol
  • Drink plenty of water to keep your voice box hydrated
  • A regular diet may be resumed the next day without chilly or oily food.
  • Please observe relative voice rest for at least three days. This gives the raw tissue in the larynx a chance to begin to heal.
  • If you are a professional voice user, for example a teacher, actor or singer we suggest you try to stay quiet for five days after the operation.
  • Avoid excessive coughing, throat clearing, shout or sing which may damage vocal cord during the healing process.
  • Do not push or strain to talk. In most instances, your voice may be hoarse for a period after your surgery and this is to be expected whilst swelling.
  • After your three/five days of relative voice rest, start talking that is always comfortable and feels effortless present.

What Is Hoarseness?

Hoarseness is also referred to by the medical term "dysphonia." It is an abnormal sound produced when you try to speak. This may be raspy, breathy, soft, tremulous or as changes in the volume of your voice. There may also be some pain or a strained feeling when trying to speak normally. A hoarse voice can be caused by anything that interferes with the normal vibration of the vocal cords, such as swelling and inflammation, polyps that get in the way of the vocal cords closing properly or conditions that result in one or both of the vocal cords becoming paralyzed.

Possible Causes are-

  • Laryngitis
  • Vocal cord cysts or polyps
  • Cancer
  • Neurological conditions
  • Trauma
  • Spasmodic dysphonia
  • Laryngeal nerve paralysis
  • Inhalation of a foreign body or caustic substance.
  • Exposure to other irritating substances
  • Long-term use of inhaled corticosteroids
  • Allergies
  • Acid reflux/Heartburn
  • Thyroid conditions
  • Smoking

Here are some of the images showing common lesions of vocal cords-


Vocal Cord Nodules and Polyps

Vocal cord nodules are benign (noncancerous) growths on both vocal cords that are caused by vocal abuse. Over time, repeated abuse of the vocal cords results in soft, swollen spots on each vocal cord. These spots develop into harder, callous-like growths called nodules. The nodules will become larger and stiffer the longer the vocal abuse continues.

Polyps can take a number of forms. They are sometimes caused by vocal abuse. Polyps appear on either one or both of the vocal cords. They appear as a swelling or bump (like a nodule), a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke's edema. The best way to think about the difference between nodules and polyps is to think of a nodule as a callous and a polyp as a blister.

Nodules and polyps cause similar symptoms:

  • hoarseness
  • breathiness
  • a "rough" voice
  • a "scratchy" voice
  • harshness
  • shooting pain from ear to ear
  • a "lump in the throat" sensation
  • neck pain
  • decreased pitch range
  • voice and body fatigue

If you have experienced a hoarse voice for more than 2 to 3 weeks, you should see a physician. A thorough voice evaluation should include:

  • A physician's examination, preferably by an otolaryngologist (ear, nose, and throat doctor) who specializes in voice.
  • A voice evaluation by a speech-language pathologist (SLP), and
  • Possibly a neurological examination.

The team will evaluate vocal quality, pitch, loudness, ability to sustain voicing, and other voice characteristics. An instrumental examination may take place that involves inserting an endoscope into the mouth or nose to look at the vocal cords and larynx in general. A stroboscope (flashing light) may be used to watch the vocal cords as they move.

Nodules and polyps may be treated medically, surgically, and/or behaviorally. Surgical intervention involves removing the nodule or polyp from the vocal cord. This approach only occurs when the nodules or polyps are very large or have existed for a long time. Surgery is rare for children. Medical problems may be treated to reduce their impact on the vocal cords. This includes treatment for gastroesophageal reflux disease (GERD), allergies, and thyroid problems. Medical intervention to stop smoking or to control stress is sometimes needed.

Many people receive behavioral intervention, or voice therapy, from an SLP. Voice therapy involves teaching good vocal hygiene, reducing/stopping vocal abusive behaviors, and direct voice treatment to alter pitch, loudness, or breathe support for good voicing. Stress reduction techniques and relaxation exercises are often taught as well.

Nodules are most frequently caused by vocal abuse or misuse. Polyps may be caused by long-term vocal abuse but may also occur after a single, traumatic event to the vocal cords, such as yelling at a concert. Long-term cigarette smoking, hypothyroidism, and GERD may also cause polyp formation. Vocal abuse takes many forms and includes:

  • allergies
  • smoking
  • tense muscles
  • singing
  • coaching
  • cheerleading
  • talking loudly
  • drinking caffeine and alcohol (dries out the throat and vocal cords)

It has been noted that, for unknown reasons, vocal nodules occur more frequently in women between the ages of 20 and 50.


The most common ways for the lining to be injured and result in exposed cartilage are:

  • Intubation for surgery (breathing tube placed during all general anesthesia)
  • Intubation for illness (breathing tube placed during hospitalizations, for example, head injuries, lung infections, etc.) Forceful voice use, including:
  • Singing aggressive styles (i.e., gospel, rock, etc.)
  • Singing incorrectly (i.e., poor technique, when unwell)
  • Singing in poor environments (i.e., poor amplification, poor monitors, loud environment, etc)
  • Throat clearing
  • Coughing
  • Shouting

Once the lining is injured, it is difficult for it to heal. You are probably still doing things that prevent the lining from healing (talking, singing, shouting, etc.). When the lining cannot heal, the body tries to cover the cartilage by creating a granuloma.

Imagine what happens when you fall and skin your knee. If you do not touch the area of injury, it will begin to heal and scab over. However, if you keep on picking the scab, the injured area will not heal. Picking the scab is the same thing as continuing to talk after you have injured the vocal lining. The lining cannot heal under these conditions.

The symptoms of a vocal granuloma vary according to your vocal demands.

If you are a vocational voice user (i.e., someone who uses their voice for their living, such as a singer, actor, voiceover artist, etc), you will possibly notice:

  • Chronic hoarseness
  • Pitch change in your voice
  • Significantly decreased range (no longer hitting higher notes easily)
  • Inability to sing quietly
  • Inability to hold a pitch steady
  • Throat pain
  • Voice fatigue

It is rare, if not impossible, to access your full vocal range with a granuloma.

It is not always easy to know if you have a granuloma. Two possible self-checks are

  • See if you feel discomfort when you rub your neck around your larynx (voice box). Often pain develops from granulomas due to incorrect voice use.
  • After a good warm-up, attempt to glissando to the highest notes you can normally reach. If you are unable to reach them comfortably, without increased effort, you may have a granuloma.
  • If you are an avocational voice user, you will possibly notice:
  • Throat discomfort, pain, or tightness
  • Hoarseness in your speaking voice

A granuloma will look like a growth that occurs on one side of the larynx. It occurs in the back of the larynx, at the site of the cartilage.

It may be whitish, yellowish, or occasionally blood-stained. Rarely there are granulomas on both side of the larynx. On stroboscopy, the cord may not vibrate at all due to the weight of the granuloma on the vocal cord. The granuloma may sit on top of the cord and dampen the vibration. In cases of smaller granulomas, the vibration may be less affected.

The only way to know if your symptoms are due to a granuloma is to have your vocal cords examined. This requires the use of videostroboscopy by a laryngologist.

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