Voice and Swallowing Clinic

Voice and Swallowing Clinic

Voice and swallowing disorders refer to any condition that adversely affects voice and swallowing ability. Many different types of voice and swallowing disorders can affect the larynx and its ability to function properly. There are many reasons people develop vocal and swallowing disorders for - ranging from vocal abuse to allergies to cancer.

The Voice and Swallowing Clinic at Kokilaben Dhirubhai Ambani Hospital, Indore delivers top notch medical service for voice and swallowing disorders. Our physicians use advanced diagnostic tools to help determine the reasons behind these disorders.

Voice disorders occur when the vocal cords get inflamed, become paralysed, or develop growths. These cause changes in the voice, preventing people from being able to use their voice normally. This may range from an inability to form speech to a subtle difference in the quality of voice of a singer.

Causes of a Voice Disorder

Voice disorders may occur due to lifestyle choices (social vocal demands or occupational), medical issues, or a combination of the two. A variety of medications can lead to problems in voice and they are often slow in onset. The commonest cause of voice difficulties and hoarseness of voice include acute laryngitis, allergies, advanced ageing, asthma, chronic laryngitis, benign vocal cord lesions like polyps, nodules, and cysts, head and neck cancers, gastroesophageal and laryngopharyngeal reflux disease, laryngeal cancer, medications, parkinson’s disease, muscle tension dysphonia (MTD), poor speaking technique, rheumatoid arthritis, reinke’s edema, smoking, throat cancer, spasmodic dysphonia, upper respiratory tract infections, vocal cord lesions, vocal cord haemorrhage, voice misuse and overuse, and vocal cord paralysis and paresis.


Laryngitis refers to vocal cord swelling that occurs due to an infection. The most common cause of infection of the voice box is a viral infection. When the vocal cords swell, hoarseness occurs as they vibrate differently. The ideal treatment for this condition is to rest or reduce the use of your voice and stay well hydrated. As most of these infections occur due to a virus, antibiotics are not effective. Being cautious with your voice during a laryngitis episode is important as the swelling of the vocal cords increases the risk of injuries such as formation of nodules, cysts, or polyps in the vocal cords, or collection of blood in the vocal cords.

Vocal Cord Lesions

Benign vocal cord growths occur due to voice misuse or overuse and from traumatic injury to the vocal cords. These lesions interfere with the vibration of the vocal cord. This aberrant vibration leads to chronic change in one’s voice quality such as hoarseness, roughness, and an increased effort required to talk.

The commonest lesions of the vocal cord include vocal nodules called singer’s nodes which are similar to vocal cord “calluses”. They usually occur on both vocal cords opposite each other. The treatment for the lesions is usually speech therapy and voice rest. Vocal cord cysts or polyps are other common lesions of the vocal cords that frequently require surgical resection after failure of treatment with nonsurgical options.

Gastroesophageal and Laryngopharyngeal Reflux Disease

Reflux of the stomach acid into the throat can cause a diverse range of symptoms in the throat as well as in the oesophagus. Swallowing problems, hoarseness of voice, foreign body sensation, or pain in the throat are common symptoms of gastric acid irritation in the throat, called laryngopharyngeal reflux disease (LPRD).

Diagnosis of LPRD is challenging as most of the patients with this disorder have no symptoms of heartburn which traditionally accompany gastroesophageal reflux disease (GERD). The gastric acid can move up to the throat at any time. The hardest to diagnose is the at-night aspect of LPRD as there are usually no specific symptoms while the reflux occurs. A throat examination by an ENT physician will help to find out if the stomach acid is causing irritation of the voice box and the throat.

Poor Speaking Technique

Poor or improper speaking technique occurs due to speaking at an uncomfortable pitch, either too low or too high and causes hoarseness of voice and a variety of other speech problems. Examples of this condition are when in a work environment, young adult females consciously or unconsciously choose to speak at a pitch that is lower than appropriate and with a heavy voice.

Speaking in a voice too loud (percussive speaking) or focusing on the first syllable of each work is another wrong speaking technique that may cause trauma or injury to the vocal cords and muscles, resulting in “vocal fatigue”. Other factors causing improper speaking technique include improper or insufficient breathing when talking, especially breathing from the neck area or shoulders instead of from the abdominal area or the lower chest. This practice’s consequence is increased tension in the neck and throat muscles, which can result in hoarseness of voice and a variety of symptoms, especially fatigue and pain associated with talking.

Problems with voice can also result from using your voice in an unnatural position like talking on the phone cradled into the shoulder. This puts excessive stress on the laryngeal muscles, which changes the speaking technique and results in a voice problem.

Vocal Cord Paralysis

Hoarseness of voice and other disorders can happen secondary to the problems in the muscles and nerves within the larynx or voice box. The commonest such condition is a weakness or paralysis of one or both vocal cords. Involvement of both the vocal cords is not that common and usually manifests in the form of noisy breathing or difficulty getting in enough air while talking or breathing. However, one vocal cord can undergo weakness or paralysis after a viral infection of the throat, post-surgery in the cheek or neck, or for unknown reasons.

The paralysed or immobile vocal cord usually causes a soft, weak, breathy voice due to poor closure of the vocal cord. Majority of these paralysed vocal cords recover spontaneously within several months. The paralysis is likely to become permanent, which may even require surgical treatment. Unilateral vocal cord paralysis surgery involves positioning of the vocal cord is improve its vibration. Variety of surgical techniques are employed to reposition the vocal cord. In some cases, speech therapy may be used before or after surgery. In other cases, it may be used as the sole treatment. The treatment modalities used depend on the patient’s voice demands as well as the vocal cord paralysis.

Throat Cancer

Throat cancer is a serious condition that requires immediate medical care and attention. When cancer affects the vocal cords, the quality of the voice changes, assuming the characteristics of roughness, chronic hoarseness, or raspiness. These symptoms can occur at any age in the development of cancer. Prompt attention to voice changes facilitates early diagnosis. Therefore, early and successful treatment of the cancer can be attained.

Persistent change in voice or hoarseness for more than 2-4 weeks in a smoker should be discussed with an ENT specialist. Different treatment modalities for the cancer of the voice box include surgery, chemotherapy, and/or radiotherapy. When vocal cord cancer is diagnosed early, usually only surgery or radiation therapy is needed. The cure rate is high. Hoarseness or roughness in the voice often occurs due to a medical problem.

Symptoms of Voice Disorders

Patients may notice any of the following symptoms associated with voice disorder including:

  • Hoarseness or other changes in the timbre, pitch, or quality of voice.
  • Breathlessness while speaking.
  • Decreased range of speaking or singing.
  • Difficulty making the voice sufficiently soft or loud.
  • Difficulty with register transitions of the singing or speaking voice.
  • Sensation of “something” in the throat
  • Increased throat clearing
  • Discomfort, tightness, or a burning sensation in the throat.
  • Vocal fatigue or pain on phonation.
  • Tremor quality or abrupt starts and stops that are involuntary

Patients with voice problems due to benign lesions of the vocal cord such as polyps, nodules, or cysts may face problems with hoarseness, limitations in range, pitch, and volume— need to cough or clear the throat frequently, shortness of breath, or vocal fatigue.

Professional voice users like attorneys, teachers, receptionists, salespeople, singers, sports coaches and participants, and actors are at an increased risk of developing voice disorders. This is due to the increased stress their jobs put on their voices.

Depending on your symptoms, the doctor may perform one of more of the following diagnostic tests to determine if you have a voice disorder:

  • Flexible Laryngoscope
    It is a flexible tube that contains a camera and a light and is introduced through the nose.
  • Rigid Laryngoscope
    A rigid viewing tube is introduced into the mouth.
  • Videostroboscopy
    A camera connected to a flashing light to offer a slow-motion view of the vocal cords is used.

Looking for the best voice disorder specialists in Indore? The ENT specialists in Indore work closely with the patient to understand their concerns and formulate a personalised treatment plan to suit their needs and lifestyle. Majority of voice disorders are easily treatable and are not life-threatening. Voice disorders are usually treated with:

  • Allergy Treatments
    For some patients, too much mucus is created in the throat due to allergies. So, testing is recommended to determine the allergen and formulate a subsequent treatment plan.
  • Botox Injection
    An injection of botox is inserted in the neck to control the muscle spasms or aberrant movements affecting the vocal muscles of the larynx.
  • Medication
    Medications can help deal with inflammation, prevent blood vessel regrowth, and treat gastroesophageal reflux. They can be injected into the vocal cords, taken orally, or applied topically during surgery.
  • Surgery
    The decision to go for a surgery usually depends on the diagnosis and the severity of the disease. It may include removal of lesions like nodules, polyps, and cysts from the vocal cords using carbon-dioxide laser surgery, microsurgery, or potassium titanyl phosphate (KTP) laser treatment.
  • Voice Therapy
    Speech therapists can teach you how to make use of your voice more efficiently. Voice therapy involves exercises of the vocal cords and physical exercises coupled with behavioural changes. If one of the vocal cords becomes paralysed, two procedures can be performed to push the paralysed vocal cord towards the middle of the windpipe so that they can vibrate closer together. This helps improve the voice and allows the closure of the larynx when you swallow.
  • Fat or Collagen Injection
    Synthetic collagen or body fat is injected through the mouth or the skin of the neck to that bulk can be added to the paralysed vocal cord or weakness of the vocal cord can be treated.
  • Thyroplasty
    During this procedure, a small opening from outside of the larynx is created and an implant is introduced through it and pushed against the paralysed vocal cord so that it moves closer to the other vocal cord.

Dysphagia or swallowing difficulties are common among people of all age groups, especially elderly people. Dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may occur due to many factors, the majority of which are temporary and not life-threatening. Swallowing difficulties rarely represent a more complicated disease, such as progressive neurological disorder or a tumour.

We normally swallow many times a day to drink liquids, eat solids, and swallow the normal mucus and saliva produced by the body. The swallowing process has four stages:

  • Oral preparation stage
    It is the first stage, where the liquid or food is chewed and manipulated so that it is ready to be swallowed.
  • Oral stage
    It is the second stage, where the tongue propels the liquid or the food to the back of the mouth so that the swallowing response is started.
  • Pharyngeal stage
    It is the third stage that starts as the liquid or food quickly passes through the pharynx, the part of the throat that connects the mouth with the oesophagus.
  • Esophageal stage
    It is the final stage, during which the liquid or the food passes into the stomach through the oesophagus.

Although the first and second stage is under voluntary control, the third and fourth stage are not. Those occur involuntarily, without conscious input.

Swallowing disorders may occur due to a wide range of problems, including poor teeth, common cold, or ill-fitting dentures. Gastroesophageal reflux is one of the commonest causes of dysphagia. It occurs when the stomach acid goes up to the pharynx via the oesophagus, resulting in discomfort. Other causes may include diabetes, hypertension, stroke, thyroid disease, progressive neurologic disorders, a paralysed or unmoving vocal cord, presence of a tracheostomy tube, a tumour in the throat, mouth, or oesophagus, or surgery in the head, neck, or oesophagus. Swallowing difficulty can also be associated with certain medications.

If you are experiencing any of the following systems, you should get yourself checked for a possible swallowing disorder, including:

  • Choking or coughing by bits of liquid, food, or saliva not passing comfortably during swallowing
  • Chest or throat discomfort
  • Drooling
  • Feeling that food or liquid is sticking in the throat
  • Frequent choking on food
  • Pain when swallowing
  • Recurring pneumonia
  • Voice change
  • Foreign body sensation or lump in the throat

If someone has dysphagia and the cause is unknown, our ENT specialists discuss the history of their problem and examine the throat and mouth. This may be done by placing a small tube called a flexible laryngoscope into the nose and the patient is given food to eat while the scope is placed in the throat. These procedures allow visualisation of the back of the throat, tongue, and larynx. These are also called FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing) or FEES (Fibre optic Endoscopic Evaluation of Swallowing). If needed, any esophageal examination called TransNasal Esophagoscopy (TNE) may be performed by an ENT specialist. If you face difficulties while swallowing, seeking treatment to avoid dehydration and malnutrition is important.

Other investigations that may be performed include:

  • Cineradiography
    An imaging test during which a camera is employed to film the internal structures of the body. During the test, you will be directed to swallow a barium preparation, an X-ray machine that can videotape will be used to visualise the barium preparation movement through the oesophagus. This test is usually performed under the guidance of a speech therapist who is specialised in swallowing and speech evaluation.
  • Upper GI Endoscopy
    A narrow, flexible tube called an endoscope is passed into the oesophagus to project images of the internal structures of the oesophagus and the pharynx on a screen for assessment.
  • Manometry
    This test measures the strength and timing of esophageal contractions and relaxations of the muscular valve.
  • Impedance and pH Test
    This test can be used to know if acid reflux is causing a swallowing problem.

Most swallowing disorders can be treated conservatively with medications. Muscle relaxants, drugs that slow the production of stomach acids, and antacids are some of the medications used. Treatment is usually personalised and designed to meet the particular cause of the swallowing disorder. Here are some steps you can take:

  • Eliminate tobacco, alcohol, and caffeine.
  • Eat a bland diet with smaller, more frequent meals.
  • Avoid food within 2 hours of bedtime.
  • Reduce weight and stress.
  • Elevate the head of the bed at night.

If these steps don’t help, antacids between meals and at bedtime may provide relief.

Many swallowing disorders can be treated with direct swallowing therapy. Special exercises can be provided by a speech pathologist for coordinating the swallowing muscles or stimulating the nerves that trigger the reflex of swallowing. You might also be taught simple methods to place food in the mouth or position the head and body to help the swallowing occur successfully.

Some patients who have swallowing disorders face difficulties while feeding. A speech-language pathologist or an occupational therapist can help the patient and their family with some feeding techniques. These techniques will help them become as independent as possible. A nutrition expert or a dietitian can help determine the amount of liquid or food to sustain an individual and whether there is a need for supplements.

After determining the cause, swallowing disorders can be treated with swallowing therapy, medications, and surgery. Surgery can fix certain problems. If there is a narrowing in the throat or the oesophagus, the part may need to be dilated or stretched. If a muscle is too tight, it may need to be surgically released or dilated. This procedure is referred to as myotomy and can be performed by an ENT specialist. Swallowing disorders usually occur secondary to many diseases. If you are experiencing a persistent swallowing disorder, you must visit an ENT specialist. If you are located in Indore, you can visit the Kokilaben Dhirubhai Ambani Hospital, Indore and seek an appointment with an expert who can guide you to the next step.

Some patients fail to realise they have a swallowing problem and just decide to eat foods that are feasible to eat or they eat more gradually. If a swallowing disorder is left untreated, however, it increases your chances of choking or having large pieces of food lodged in your oesophagus.

The Voice and Swallowing Clinic at Kokilaben Dhirubhai Ambani Hospital, Indore offers a wide range of services to cover voice and swallowing disorders, including medical, surgical, therapeutic and counselling interventions. Meet the best doctors for swallowing disorders in Indore at our hospital. We are dedicated to aiding patients suffering from these disorders, as well as any other disorders related to the throat and larynx, and vocal cords. We understand that voice and swallowing difficulties are hard to deal with socially, emotionally, as well as professionally, so we work hard to help patients overcome these maladies through proper diagnosis, treatment and/or rehabilitation.

Equipped with state-of-the-art machines and pioneering technology, the Department of ENT at Kokilaben Dhirubhai Ambani Hospital, Indore offers comprehensive services to treat simple and complex conditions of the head and neck, nose, throat, and ear under one roof.

  • International standard medical care and treatment for individuals with simple and complex ENT disorders
  • Delivery of the highest possible education to trainees such as medical and paramedical professionals
  • Provision of high-quality treatment at reasonable cost to individuals from economically weak sections of the society through community service activities.