Phase 1: Vocal Hygiene

• Before exercises, we must manage the environment, which is often humid, dusty, and noisy in our city.

• Hydration is Critical: The vocal folds are stiff in this condition. You need systemic hydration. Drink 2.5 to 3 liters of water daily.

• Avoid "Throat Clearing": The dust and pollution here often make you want to clear your throat. Do not do it; it grinds the vocal cords. Sip water instead.

• Acid Reflux Management: Spicy foods (common in our diet) and late dinners can cause reflux, which irritates the sulcus further. Keep a gap of 2 hours between dinner and sleep.

Phase 2: Semi-Occluded Vocal Tract (SOVT) Exercises

These are the "Gold Standard" for Sulcus Vocalis. They create "back pressure" (impedance) that helps the vocal cords vibrate easily and square up against each other without you having to push.

Phase 3: Resonant Voice Therapy

Patients with Sulcus often speak from the throat (creating strain). We need to move the voice "forward" to the face (The Mask).

Phase 4: Adduction (Closure) Exercises

Caution: Do these only if you do not feel pain. If you feel squeezing in the throat, stop.

Since there is a gap (glottic insufficiency), we need to safely encourage the cords to close.

4. Hard Glottal Attacks (Modified)

Action: Say vowels abruptly and clearly: "Ah," "Eh," "Ee," "Oh," "Oo."

Technique: Imagine you are lifting a mild weight as you say them. This engages the adductor muscles.

Constraint: Do not scream. Just ensure a clean, sharp start to the sound.

5. Pushing/Pulling Technique (Isometric)

Action: Sit in a chair. Place your hands under the seat of the chair and pull up (as if trying to lift the chair while sitting on it).

Voice: While pulling, say a sustained "Ahhhhh."

Why: The physical effort of pulling naturally forces the vocal folds to close tighter. This helps compensate for the gap caused by the sulcus.