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Endoscopic Transcanal Cholesterol Granuloma Surgery | London & Essex

  Endoscopic Transcanal Cholesterol Granuloma Surgery: Advanced Minimally Invasive Ear Care A persistent feeling of fullness in one ear, fluctuating hearing loss, or a deep, dull earache can easily be mistaken for a standard Eustachian tube dysfunction or stubborn middle ear fluid. However, when these symptoms persist despite routine medical treatment, a closer clinical examination may reveal a dark, bluish discolouration glowing behind the eardrum. In many cases, this distinct visual sign points to a Cholesterol Granuloma —an inflammatory, fluid-filled cystic lesion packed with cholesterol crystals. While hearing the term "granuloma" can cause immediate anxiety, these lesions are non-cancerous, benign formations. Historically, accessing and draining a cholesterol granuloma required large incisions behind the ear and extensive bone removal (a mastoidectomy). Today, modern surgical advancements allow skilled otologists to access and drain these lesions using minimally invasive...

LAX VOX

 


LAX VOX is a vocal therapy technique that can help improve voice quality, relaxation, and overall vocal health. It involves using a unique tube to create bubbling sounds while phonating. 


Here are the steps for practising LAX VOX:


Relax and Focus on Posture and Breathing:

    • Maintain a good posture with a long spine.
    • Relax your face, neck, upper back, and chest muscles, allowing them to release toward gravity.


Preparing for Bubbling with Phonation:

    • Place a silicone tube (about 35 cm long and 9-12 mm in diameter) between or in front of your incisor teeth and above your tongue.
    • Keep your tongue relaxed (imagine it as a piece of steak) and slightly touch the tube.
    • Hold the water-filled bottle near your body to avoid using shoulder muscles.
    • Inhale through your nose as if you’re yawning with your mouth closed.
    • Prepare for phonation during exhalation, focusing on abdominal and lower back muscles.



Finding the Target Voice:

    • Create bubbling sounds with your voice: //hhhooooo// (both short and long).
    • Repeat with variations: /hhoo hoo hooo/.
    • Increase your awareness of the process within your body.



Advanced Techniques:

    • Try pitch gliding (melodies on //hhoooo//).
    • Glide pitches up and down.
    • Experiment with different water depths in the tube to observe changes.
    • Practice without the tube: Open your lips and produce /hhoooo/ and /hhmmm/.


Incorporate LAX VOX into Daily Life:

    • Use correct syllables, words, and sentences (e.g., greetings, good morning).
    • Engage in conversational speech (remember to inhale nasally before speaking).
    • Read books or newspapers aloud in various ways.


Remember that LAX VOX can be a valuable addition to voice therapy, especially for individuals seeking improved vocal function and relaxation.




How often should I practice LAX VOX exercises?



LAX VOX exercises can be beneficial for your vocal health and relaxation. The frequency of practice depends on your individual needs and goals. Here are some general guidelines:


Consistency: Regular practice is essential. Aim for at least 5-10 minutes of LAX VOX exercises daily.


Listen to Your Body:

    • Pay attention to how your voice feels during and after the exercises.
    • If you experience any discomfort or strain, reduce the duration or intensity.


Integration into Daily Routine:

  • Incorporate LAX VOX into your daily activities:
      • Practice while showering (the steam can enhance the effect).
      • Use it during your commute or while doing household chores.
    • Include it in your warm-up routine before speaking or singing.


Quality Over Quantity:

    • Focus on proper technique rather than just the duration.
    • Ensure relaxed breathing, gentle bubbling, and a comfortable posture.


Consult a Professional:

    • Consult a speech therapist or voice coach if you have specific voice-related concerns or are recovering from vocal strain.
    • They can tailor recommendations based on your unique needs.

Remember that individual responses may vary, so adjust the frequency based on your comfort level and progress. Happy vocal bubbling! 🎶🗣️

 




Can I combine LAX VOX with other vocal warm-up techniques?


Combining LAX VOX with other vocal warm-up techniques can enhance your overall vocal preparation. 


Here are some ways to integrate it into a comprehensive warm-up routine:


LAX VOX + Lip Trills (Brrrr):

    • Start with LAX VOX to relax your vocal folds and improve resonance.
    • Then transition to lip trills (brrrr sound) by blowing air through your closed lips.
    • Lip trills engage the lips, tongue, and airflow, promoting flexibility and warming up the vocal tract.


LAX VOX + Humming:

    • After LAX VOX, switch to humming.
    • Humming helps activate the vocal folds, improve breath control, and warm up the resonating spaces in your head.


LAX VOX + Tongue Exercises:

    • Perform tongue exercises (e.g., tongue stretches, side-to-side movements).
    • These enhance tongue flexibility, crucial for clear articulation during speech or singing.


LAX VOX + Yawn-Sigh:

    • Yawn deeply to open up the throat and stretch the vocal folds.
    • Follow the yawn with a gentle sigh (sustain an “ah” sound).
    • This combination helps release tension and encourages relaxed phonation.


LAX VOX + Vocal Range Exploration:

    • Use LAX VOX to transition smoothly between different pitch ranges.
    • Glide from low to high notes and vice versa.
    • Explore your full vocal range while maintaining a relaxed throat.


LAX VOX + Resonance Exercises:

  • Combine LAX VOX with resonance-focused exercises:
    • Nasal Resonance: Produce LAX VOX sounds while focusing on nasal resonance.
  •             Oral Resonance: Shift the resonance to the mouth and oral cavity.

Remember that warming up your voice gradually and gently is essential. Listen to your body, stay hydrated, and adjust the warm-up routine based on your needs. Happy vocalizing! 🎵🗣️



Can you explain more about resonance exercises for the voice?


Voice resonance exercises are essential for improving your voice's quality, projection, and overall effectiveness. 

Let’s explore some techniques:


Yawn:

    • Yawning helps open up the back of the throat, adding warmth and loudness to your voice.          Try this:
      • Breathe deeply as if about to yawn.
      • Sing with that same feeling, lifting the soft palate and imagining an egg stuck in the back of your throat.
    • Start with lower notes and gradually move to higher ones while maintaining the open feeling.


Humming:

    • Humming accesses the natural brightness of your voice, contributing to nasopharynx resonance.
    • Focus on singing in the “mask” of your voice (the bridge of your nose).
    • Hum on a pitch that feels comfortable for you, noticing the buzzing feeling on the bridge of your nose.


Sing the Vowel ‘E’:

    • Singing the vowel ‘E’ (or IPA ‘i’ as in “feed”) engages nasal resonance.
    • Listen for the ringing sound of efficient resonance as you sing it on a five-note scale going up and down.
    • Allow yourself to explore different levels of nasal resonance.


Use Plosive Consonants ‘B’ and ‘P’:

    • Plosives (sounds produced by building air pressure behind the lips) can help focus attention forward.
    • Sing notes using ‘p’ or ‘b’ followed by a vowel (e.g., bi, bÉ‘, pi, pÉ‘).
    • This draws emphasis away from throaty singing and encourages forward resonance.


Explore Vibrations in Facial Bones:

    • Humming helps you feel vibrations in your facial bones.
    • Try sirens (sliding your voice up and down through your range) to explore different types of resonance.

Remember to listen to your body, practice consistently, and seek guidance from a voice coach or speech therapist. 


Happy vocal resonance exploration! 🎵🗣️



What are some common voice problems related to resonance?


Resonance disorders are distinct from voice disorders, although they can impact speech quality. 

Let’s explore common issues related to resonance:


Hypernasality:

    • Description: Abnormal sound energy in the nasal cavity during production of voiced, oral sounds.
    • Cause: Often related to structural factors (e.g., cleft palate) or functional issues.
  • Symptoms:
      • Speech sounds “nasal” or “muffled.”
      • Too much nasal resonance.
    • It may occur in conditions like cleft lip and palate.



Hyponasality:

    • Description: Reduced nasal resonance or energy associated with nasal sounds.
    • Cause: Typically due to blockage or obstruction in the nasopharynx or nasal cavity eg nasal septum deviation,nasal polyps
  • Symptoms:
      • Speech lacks expected nasal quality.
      • Too little nasal resonance.
    • Can be related to neurological conditions or structural issues.


Other Resonance Disorders:

    • Mixed Resonance: Combination of hypernasality and hyponasality.
    • Articulation Errors Misinterpreted as Resonance Disorders: Mislearning may lead to misinterpretation.
    • Structural Causes: Cleft palate, submucous cleft palate, enlarged adenoids.
    • Functional Causes: Neurogenic factors, mislearning, or other issues.


Remember that speech-language pathologists (SLPs) use differential diagnosis to determine the underlying cause of resonance issues. Treatment plans vary based on the specific aetiology. If you experience any voice-related concerns, consult a professional for personalized evaluation and guidance.



Mr Gaurav Kumar

Consultant Ear Nose Throat Surgeon

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07494914140


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