Professional Voice Care
Dr. Reena Gupta, MD FACS is the director of the Division of Voice and Laryngology at the Osborne Head and Neck Institute in Los Angeles, CA. She is board-certified in otolaryngology and fellowship-trained in Laryngology/Care of the Professional voice. Dr. Gupta specializes in the care of injuries that occur in singers and actors. She tailors treatment to the particular diagnosis, with care taken to be conservative and respectful of the patient’s wishes. In cases of vocal nodules or other voice-use related pathology, this often includes voice therapy and other non-surgical adjunctive therapies to speed up recovery.
Other pathologies, such as vocal cysts and vocal polyps, may require surgical intervention. State-of-the-art techniques including sophisticated microlaryngeal instrumentation and laser technology are utilized for the most vocally-protective results. These techniques are particularly useful in complicated cases of vocal paralysis, throat cancer, and voice box (larynx) tumors. Vocal hemorrhage cases may require advanced care and her experience in these cases has resulted in superior vocal results. Her skills have resulted in voice improvement for her patients with minimal downtime.
Dr. Gupta has been honored with numerous awards and is involved in many musical conservatories as a guest lecturer and preferred care provider. She is widely recognized as a top voice doctor for professional voice users.
Dr. Reena Gupta
Dr. Reena Gupta
Dr. Reena Gupta is the director of the Division of Voice and Laryngology at the Osborne Head and Neck Institute. She is an Ear, Nose, and Throat physician and laryngologist/voice specialist who has devoted her career to caring for professional voice users. Her practice is located in Los Angeles, California.
Voice Disorder Diagnosis
Vocal Nodules / Nodes
Nodules are thickenings or callouses that form on the vocal folds. They are a result of vocal trauma.
Laryngopharyngeal reflux is the backwards flow of stomach contents into the pharynx and larynx.
A vocal hemorrhage is blood that has leaked into the vocal fold from an injured blood vessel.
Vocal paralysis is the total absence of movement of a vocal cord due to nerve damage.
A papilloma is a warty growth that occurs on the vocal cords due to infection with HPV.
Voice Case of the Week
Happily Ever After (a Hemorrhage)
An earlier Voice Case of the Week described a severe vocal hemorrhage, which occurred after a patient choked and coughed while eating.
The follow up to this included a discussion of the consequences of hemorrhages. Small hemorrhages (or bruising) of the vocal fold will lead to injuries if they are not identified.
The case included the following points:
- A diagnosis of severe right vocal fold hemorrhage was made
- In the day since onset of her symptoms, by pushing through this hemorrhage to speak she has started to form a polyp on the right vocal fold
- Treatment has been implemented and follow up will determine if the polyp persists.
This article is a follow up from the severe hemorrhage. It highlights the importance of close follow-up, accurate diagnosis and management, and not simply using steroids when you are hoarse. Had this patient used the steroid treatment that their prior doctor had advised without an examination, permanent injury would have been inevitable. Ignoring hoarseness, as she was inclined to do, would have resulted in a polyp forming, thereby necessitating vocal surgery. It is easy to see where the polyp was starting to form.
After 3 weeks of management and treatment, she is left with a dilated blood vessel, which is what likely ruptured to cause her hemorrhage. There is mild fullness on the edge of the vocal cord but she is not symptomatic from this. Ongoing vocal therapy has resulted in resolution of voice symptoms.
Early treatment of susceptible blood vessels can prevent small and large hemorrhages, thereby preventing long term injuries. The recommendation at this point is to laser treat this vessel, to prevent it from hemorrhaging again. The time she lost to performing from this hemorrhage makes this the most reasonable strategy. Singers find that this preventative measure saves them the stress of wondering if they will hemorrhage again and the accompanying need to miss and cancel performances. It is a safe procedure with significant long term gain, but should only be undertaken by a laryngologist with experience in laryngeal laser surgery. Rehabilitation after surgery includes working with a skilled vocal therapist to optimize healing and ensure there are no behaviors that will precipitate recurrent vessel formation.
The Carson Daly Show
The Doctors TV Show
The Naked Vocalist Program
Frequently Asked Questions
1. How can I take better care of my voice?
Caring for your instrument as a vocalist is the best way to ensure the longevity of your career. It is important to become knowledgeable about the voice and how it works. This ensures you can play an active role in your own care.
When you manage your general health, your voice usually will follow suit. This includes:
Not Smoking (anything)
Managing Weight and Reflux
However, there are a multitude of things that may affect your voice that may be difficult to identify without expert evaluation. Having a laryngologist on your team when you are feeling well is the best way to identify problems early and have a resource when you need one. Your laryngologist should obtain a baseline videostroboscopy, discuss any issues that may be affecting your voice (nasal airflow, allergies and sinus issues, muscular approach to voice, tightness in the neck, etc) and help you resolve them early, before they result in injury.
2. How can I know if I have nodules?
This feared diagnosis is often the reason singers delay evaluation in the first place. The only true way to know this is through videostroboscopy. This advanced endoscopy modality allows for accurate diagnosis of vocal issues when used by an expert laryngologist.
However, you may consider checking the following things to gauge the likelihood of your having nodules:
- Does your speaking voice sound normal?
- Is your singing range normal?
- Can you sing quietly?
If you answered “yes” to these questions, you probably do not have nodules.
Nodules may result in neck pain and pain with voice use. They will also cause a decrease in vocal range as well as a widened vocal break (passaggio). Vocal fatigue will often also be present. It is typical for singers to have all of these symptoms when they have nodules.
However, there are other injuries that will result in vocal symptoms and warrant evaluation. Any singer who is hoarse for more than one day should seek evaluation with a laryngologist.
3. What should I look for in a voice doctor?
The most important basic criterion that a singer should look for is that their physician is a board-certified, fellowship-trained laryngologist, rather than a “voice doctor,” which is a generic term that does not connote any advanced training in voice medicine.
Your laryngologist should be passionate about the care of the voice, which usually means their practice is restricted to the care of the voice. Your visit should include
- A careful history of your voice problem
- Voice analysis
Laryngologists will also have a vocal therapist in their office to ensure optimal care of their voice patients. As vocal therapy is a critical part of voice medicine, it is advisable to make an appointment with the therapist as well. A skilled vocal therapist will identify vocally-damaging behaviors and also work on breathing and muscular issues that may be affecting your voice.
4. What should I know about vocal surgery?
Vocal surgery does not have to be career-ending. Most injuries that are surgically treated result in full recovery of the singing voice.
It is important to select your surgeon carefully, and have them be someone you trust with your instrument. Collaboration with a vocal therapist and vocal coach are vital to rehabilitation as well.
Voice Therapy & Rehabilitation
Laryngeal Myofascial Adjustment
Laryngeal Myofascial Adjustment (LMATM) is a combination of mobilization, manipulation, voice therapy, and massage of the laryngeal and paralaryngeal area. Patients must first have an examination with palpation by both a laryngologist and speech pathologist to determine candidacy and appropriateness of therapy. LMA is performed in the medical setting to ensure patient safety and a high quality of care. LMA is often used in the professional voice user for:
- reducing throat and laryngeal pain
- reducing throat and laryngeal tension
- increasing mobility and range of motion (ROM)
- eliminating inflammation
- improving soft tissue repair
- improving vocal function
- increasing vocal range
- reducing recurrence of vocal lesions (i.e., polyps, nodules, cysts, etc.)
- improving vocal stamina and endurance
- improving swallowing
- reducing tongue pain and tension
- improving jaw mobility (ROM) and pain
LMA should only be done by a clinician with a license to touch such as a physician, speech-language pathologist, physical therapist, or specially trained registered massage therapist
Becoming a Patient
Your Vocal Consultation
As a singer, your voice is your livelihood. Researching and finding the right doctor to evaluate you, diagnose you, and treat you is the most vital component to your recovery. It is very difficult to find a qualified laryngologist, rather than a general “voice doctor” who truly understands the voice, how it works, and how it responds to injury. Remember, most ENT doctors have little to no training in voice medicine, unless they complete a fellowship in laryngology. We believe it is always in your best interest to get a second opinion. Dr. Gupta has extensive experience in the evaluation and treatment of voice disorders. Most of the second opinions she has performed are found to be misdiagnoses due to inadequate training, endoscopy equipment, or a poor understanding of voice function. We understand that it is often inconvenient, time-consuming and expensive for patients to fly to our Los Angeles office for a consultation, and then fly back again a few weeks later for surgery. We have designed a program to facilitate your experience that will allow you to determine the best options available to you from the comfort of your home.
Contact Us Now For Your Consultation
The first step is to call or e-mail our patient care consultant, and request a preliminary Phone, Skype, or In-Office Consultation with Dr. Gupta regarding your vocal concerns.
Send Photos and Video
Please provide clear, recent close-up photos of your vocal cords. Ideally, this would be accompanied by a video of your stroboscopy. However, we do understand that ENTs do not generally perform this procedure and that you may therefore not have this. Any images you can provide of an exam you have had will help in the consultation.
Our patient care coordinator will provide you with the specific forms you need to fill out before your visit. For more information, please contact our patient coordinator at (310) 657-0123.
Obtain an Evaluation
Dr. Gupta will review your history, physical exam findings, all reports, films and images before your consultation. It is very important that we have all available information prior to your consultation. If you are having difficulty obtaining your records, you may contact us and we can facilitate and/or expedite the process for you. We will need you to sign a release of medical records to our office prior to us contacting your physician or hospital. After reviewing your information, Dr. Gupta will speak with you. This may include vocal task testing; having a song available that demonstrates your difficulty will help. Some singers also choose to have their vocal coach on the call, to allow for more complex task testing. After a completion of a release form, we will arrange this as well. Together, you will come up with a customized treatment plan. For surgical consultations, our Patient Care Consultant will contact you to discuss pre-operative care, costs, recovery, local accommodations and any questions related to your procedure.
Osborne Head & Neck Institute
Osborne Head & Neck Institute
8631 West 3rd Street
Los Angeles, CA 90048