Vocal Fold Paralysis/Paresis

Summary of Daily Practice

Morning: 5 minutes of Wall Push exercises.
Afternoon: 5 minutes of Head Turn practice with vowels.
Evening: 5 minutes of Breathing exercises (Sustain "ssss").

1. Effort Closure Techniques (Pushing & Pulling)

The goal here is to recruit the accessory muscles of the body to force the vocal folds to close tighter.

The Chair Pull: Sit on a sturdy chair. Grip the seat with both hands. While saying a sharp /a/ (like in "up") or /i/ (like in "eat"), pull up on the chair seat with your arms. The physical tension helps the vocal folds adduct (close).
The Wall Push: Stand facing a wall. Place your palms against it at chest level. Push hard against the wall while shouting a short, sharp "AH!".
Locked Hands: Clasp your hands together at chest level. Pull them apart (without letting go) to create tension in your chest and shoulders. Sustain a vowel sound while maintaining this tension.

2. Hard Glottal Attacks

Usually, we tell patients to avoid this, but in paralysis, we want to bang the cords together to stimulate movement and compensation from the healthy side.

Vowel Blasts: Pronounce vowels with a hard, abrupt start. Imagine you are lifting a heavy weight as you say them.
- Ah!
- Eh!
- Oh!
The Cough-Phonation: Cough sharply, and immediately follow it with a vowel sound. The cough forces the cords together; we want to ride that closure into a voice.
- Cough -> "Oh"

3. Head Positioning Strategies

This is a compensatory strategy to use while speaking or eating to improve voice quality and safety.

Head Turn (The Lateral Turn): Turn your head to the left or right while talking.
- Rule of thumb: Usually, turning your head towards the paralyzed side helps. It physically pushes the weak vocal fold closer to the middle, allowing the healthy fold to meet it.
Digital Manipulation: Gently place your fingers on the side of your larynx (voice box) and push slightly while speaking. This can sometimes manually help the vocal folds meet.

4. Respiration Training (Diaphragmatic Breathing)

Because the vocal folds are not closing, air escapes rapidly (this is why you feel out of breath after talking for 10 seconds). We must maximize your breath support.

Abdominal Breathing: Lie flat on your back (or sit straight). Place a hand on your stomach. Inhale so the stomach rises (not the chest).
Controlled Exhalation: Inhale deeply, then exhale on a hiss ("sssss") for as long as possible. Time yourself.

5. Vocal Function Exercises (VFE)

These are standard exercises (often associated with Dr. Joseph Stemple) to strengthen the laryngeal musculature without causing damage.

Warm-up: Sustain the vowel /i/ (as in "knee") as softly as possible on the note F (for women) or F below middle C (for men). Aim for a forward, buzzy focus in the nose.
Stretching: Glide from your lowest note to your highest note on the word "Knoll".
Contracting: Glide from your highest note to your lowest note on the word "Knoll".
Power: Sustain the musical notes C-D-E-F-G on the word "Old" for as long as possible.

Important Lifestyle Advice

Avoid Whispering: Whispering forces the vocal folds apart and strains the muscles. It is better to use a normal, albeit breathy, voice.
Swallowing Safety: If you choke on water (which is common because the airway isn't closing tight), use a "Chin Tuck" posture (tuck chin to chest) when swallowing liquids.
Hydration: Mumbai is humid, but AC environments dry out the throat. Drink plenty of room-temperature water.

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