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

Contact Us:020 – 49153114

Email:voicelaser@dmhospital.org

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

Facilities

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

General

• 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.