I have posted a new piece, When symptoms of cough and hoarseness might be hidden. It follows a patient — a composite, but a familiar one — who spent ten years being treated for reflux, asthma and vocal cord dysfunction before anyone looked below her vocal cords. Subglottic stenosis hides well, and the reason is…
When a vocal cord doesn’t move well, the doctor’s reflex is to call it a paralysis leading to a next question, which is almost always which side? I think that easily can lead to the wrong conclusion, because it was the wrong question. Paralysis is a conclusion about a whole nerve, yet injuries often may…
History and visual exam are not enough for laryngology. Working the third element — a recorded voice examination — through one case: a 55-year-old coach whose vocal cords looked normal until the ear said where and when to look. My World Voice Day 2025 lecture.
I see a brief note on my desk: you woke up one day with a cold and a hoarse voice. The cold went away, but the voice problem stayed. With just that brief note — that you’re hoarse, and why you think you’re hoarse — I probably have at least a 10% chance of already…
Please reconsider cricothyroid approximation (CTA) as a means of feminizing a male voice. The procedure approximates the thyroid and cricoid cartilages, which disables one of the two muscles responsible for raising pitch (TA & CT). Comfortable speaking pitch often initially rises as intended, but the usable vocal range is typically cut by more than half….
As a response to some recent national decisions let’s think more clearly: Beyond the Checklist: Clinical Judgment, Patient Narrative, and the Surgeon’s Responsibility in Gender-Affirming Laryngology. We can do better. The frameworks still used to select patients for gender-affirming surgery descend from standards written decades ago, when outcomes data were thin and social acceptance was…
I am looking forward to Dr. Jayakumar R. Menon’s 3rd International Neurolaryngology CON 2026 in Thiruvananthapuram this November. It will be a pleasure to present alongside — Prof. Reza Nouraei (UK) and Prof. Markus Hess (Germany) on some of our favorite topics in neurolaryngology. Unilateral vocal cord palsy, from diagnosis to definitive management — three…
A standard taught medical exam has two components: history and visual exam. That’s insufficient for laryngology. A complete exam for hoarseness requires a third element — a voice exam — and most of us aren’t doing it. The voice exam is not just listening to someone talk. Conversational speech actually contaminates voice. When a patient…
At The Voice Foundation’s 55th Annual Symposium, a panel discussed therapy for a vocal polyp—without asking the question that should come first: what kind of lesion is this, and how did it get there?
Challenges traditional cordectomy protocols (Remacle et al. 1999/2000, ELS). Proposes paradigm shift from wide surgical margins to precision “nanomargin” technique using modern HD chip endoscopes, NBI/selective color imaging, and programmable CO2 laser. “Orange peel surgery”: Peeling tumor tissue from underlying healthy structures using CO2 laser. Differential heat absorption between tumor and normal tissue guides surgical…
