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James Thomas performing a microlaryngoscopy in the operating room to correct a vocal cord disorder.
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Voice - a definition:
Voice is sound - vibration. For a pure, clear voice, the vocal cords come together and vibrate, allowing pulses of air to leave the voice box and create a pure musical tone. That musical tone we describe in terms of pitch and volume. It comes from the larynx and we use it mainly to carry speech over a distance and we use it for emotion.
Speech is the modification of sound by the pharynx, palate, tongue, mouth and lips. Speech is information, information that is carried by the voice.
Hoarseness - a definition:
Hoarseness is a common term for a voice problem. It is important to understand what the word hoarsness represents. Simply put, hoarseness is "unwanted air leak". Any disorder that disrupts that flow of air, allowing a leak, causes hoarseness. There are two basic disruptions.
When the vocal cords do not come together completely there is a continuous leak of air - turbulent airflow, making a "white noise". Think of a whisper where the vocal cords are held apart with no vibration of the vocal cords. A whisper is pure white noise. There is only turbulent air flow. Add an unwanted air leak to vocal cord vibrations and that is hoarseness.
The other type of hoarsness is the irregular, unwanted leak of air. When something changes the weight or tension of one vocal cord relative to the other vocal cord, they no longer vibrate at the same pitch and that creates a hoarseness (or dysphonia) that can range from pure diplophonia (two separate notes) to a very fractured sound as the vocal cords crash into each other and irregularily disrupt the vibrations of each other.
Case Histories
Fungal laryngitis added 4/24/2008. Potent inhaled steroids are causing this issue more and more frequently.
Singers nodules added 5/22/2007
Unusual foreign body added 5/7/2007
Video lectures
Reflux Laryngitis - A video examining the concept of reflux laryngitis. 11/5/2008
Medialization Laryngoplasty - A video on how Dr. Thomas performs the surgical procedure. 10/29/2008
Vocal nodules - A video explaining the effects of vocal nodules. 10/22/2008
Hyperfunction - What does it mean? 1/24/2007
Surgical Pitch Change given at the Voice Foundation meeting on 6/4/2005.
Bilateral Vocal cord paralysis given at the Voice Foundation meeting on 6/5/2005.
Feminization Laryngoplasty given at the HBIGDA meeting on 4/8/2005.
Diagnosis of vocal cord paralysis given at the Oregon Academy of Otolaryngology meeting on 2/20/2004.
Think of this site as a medical text book that you have been able to look at in a medical library. You are free to browse. If you have a medical background you may be able to digest the information. If you don't have medical training then you may wish to use it with your own physician.

All content on this website (including text, photographs, audio files, video files and any other original works), unless otherwise noted, is licensed under
a Creative Commons Attribution-Noncommercial 3.0 United States License.
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Contact information for Dr. Thomas. |
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Vocal cord photos
Find a laryngologist near you.
Am I getting good advice from my doctor? Is there a significant difference between an examination that my family doc does and an ENT doctor? Is a voice doctor, laryngologist or phonosurgeon somehow different from an ENT? What should I expect from an examination of my voice?
Reflux is the most overdiagnosed cause of voice disorders
My upcoming lectures:
Feb 27-28 - Paralysis, Pacific Voice, Los Angeles, Ca
Mar 11 - Paralysis, Mexico City, Mexico
Mar 27 - Pitch change, Colo Gold Rush, Denver, Co
Apr 3 - Pitch change, Ca Dreamin, San Jose, Ca
May 2 - Pitch change, Transgender Conf, Philadelphia, Pa
Jun 3 - Paralysis, IFOS, Sao Paulo, Brazil
Jun 4 - Reflux, IFOS, Sao Paulo, Brazil
Jun 7 - Screaming, Voice Foundation, Philadelphia, Pa
Jun 19 - FemLar surgery, WPATH, Oslo, Norway
Oct 3 - Voice Disorders, Cleveland, England
Oct 7 - Voice Disorders, San Diego, Ca
If your group would like a lecture, please contact me
Recent lectures in past year:
April 19 - Cal Dreamin, San Jose, Ca
May 16 - Esprit, Port Angeles, Wa
May 29 - Trans-Health, Philadelphia, Pa
June 21 - Voice Diagnosis, Mumbai, India
June 22 - Voice Diagnosis, Kolkata, India
June 24 - Voice Diagnosis, Bangalore, India
June 28 - Voice Diagnosis, New Delhi, India
Sept 1 - Gender Odyssey, Seattle, Wa
Oct 3 - Southern Comfort, Atlanta, Ga
Oct 17 - UCSF Voice, San Francisco, Ca
Nov 20-23 - Voice Conf, Pune, India
Dec 7 - Armed service Voice conf, Delhi, India
Jan 17, 2009 - First Event, Boston, MA
Jan 21 - AOICON , Jaipur, India
Feb 14 - Diagnosis, Oregon ENT, Timberline, OR
Voicedoctor.net represents the opinions of its author - James P. Thomas, M.D. It is my attempt to inform you, the web-surfer, about the vocal cords, voice problems or what causes hoarseness from a physicians perspective. It is specifically not meant to establish a doctor patient relationship with you. It may be used to support the existing relationship that you have with your present physician. I have an office in Oregon where patients who wish to be seen and establish a relationship may reach me. The information on this site represents my understanding of the voice and comes primarily from my study with other physicians, most particularly laryngologists (doctors specializing in voice problems). Journal references are provided where appropriate. This site has not been peer reviewed as a medical journal might be. This site is funded entirely by James P. Thomas, MD. There is no advertising on the site. Please understand the contents of this site and probably most sites with medical information in this light. |