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Phase 1: The "Anti-Slam" Technique (Easy Onset)
Phase 1: The "Anti-Slam" Technique (Easy Onset)
The most damaging thing for a granuloma is a "Hard Glottal Attack." This happens when you start a word by banging the cords together (e.g., a sharp "Apple" or "Okay"). We need to soften this.
The Exercise: The /h/ Initiation
Place your hand on your belly to ensure you are breathing from your diaphragm, not your shoulders.
Before you say a vowel, release a tiny puff of air (an /h/ sound).
Visualize the air starting before the sound.
Instead of "Apple," think "h-Apple."
Instead of "Okay," think "h-Okay."
Practice words: Hello, Happy, Home, Who, How.
Advance to phrases: How are you? / Who is he?
Goal: To create a "cushion" of air between the vocal cords so they don't slam together when you start speaking.
Phase 2: Confidential Voice Therapy
Phase 2: Confidential Voice Therapy
This is often the first line of defense for granulomas. It is NOT whispering (whispering actually tightens the throat). It is a soft, breathy voice, like you are speaking confidentially to someone in a library or a temple.
The Exercise:
Imagine you are telling a secret to someone standing close to you.
Use a low volume, but keep the voice "on" (don't whisper).
You should feel a lot of air escaping with your words.
Rule: Your vocal cords cannot slam together if you are letting this much air through.
Note: This is usually a temporary voice used for 2–3 weeks to allow the ulcer to heal.
Phase 3: Pitch Adjustment (Stop the "Fry")
Phase 3: Pitch Adjustment (Stop the "Fry")
Many patients with granulomas speak in a very low, gravelly pitch (Glottal Fry). This grinds the arytenoids together.
The Exercise: The "Mmh-hmm" Placement
Make a sound of agreement: "Mmh-hmm" (as if saying 'yes').
Notice that the "hmm" part usually sits slightly higher than your habitual speaking voice and you feel a buzz in your nose/lips.
Sustain that "hmm" pitch: "Hmmmmmmm."
Gently open into a word: "Hmmmm-one," "Hmmmm-man."
Goal: To move the resonance from the back of the throat (where the pain is) to the "Mask" (lips and nose).
Phase 4: The Mumbai Lifestyle Protocol (Crucial)
Phase 4: The Mumbai Lifestyle Protocol (Crucial)
The "3 Hour" Rule: You must not lie down within 3 hours of eating. We often eat dinner late (9:30 or 10:00 PM). If you have a granuloma, you must shift dinner to 7:30 or 8:00 PM.
Dietary Triggers: Strictly reduce caffeine (chai/coffee), spicy foods (decrease the masala), and oily foods (vada pav, fried snacks) for at least 6 weeks.
Stop Throat Clearing: This is violent for the vocal cords. If you feel an itch, do a "Silent Swallow" (swallow hard with your chin tucked down) or take a sip of water.
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