Core laryngology clinical and educational posts
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 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…
Standard Laryngeal Examination — An adequate assessment of the human voice, particularly pre- and post-surgery. Ideally two parts: audio recording and visual endoscopic examination including stroboscopy. Audio examination parameters: Speech (10-second standard reading passage), Maximum phonation time at comfortable pitch, Lowest pitch (stepwise glide), Highest pitch (stepwise glide), Loud sounds (at low and high pitch),…
In April 2024, Dr. James Thomas joined Dr. Shiying Hey on The UEP VoiceBox — the podcast of the Union of European Phoniatricians — for a wide-ranging conversation about how laryngologists actually listen to the voice. The episode, titled Identifying Voice Disorders, traces Dr. Thomas’s unusual path into laryngology and distills decades of clinical thinking…
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…
Video post. Discussion with a colleague about vocal cord weakness — reviewing how to identify LCA paresis by focusing on the movement and position of the vocal processes. YouTube link. Migration note: Connects to the Neurolaryngology section (Part II Structural) and Part III Laryngoscopy.
Detailed critical review of: Dhillon VK, Randolph GW, Stack BC Jr, et al. Head & Neck 2020. Takes on flawed terminology (“immediate VFP”) and offers corrected statements for each of the paper’s 5 consensus points. Key arguments: “Vocal fold paralysis” is wrong terminology for surgical nerve injury — it should be “nerve injury/paresis.” Pre- and…
Online lecture released during COVID travel pause. Describes the phonogram — a graphic vocal signature — and how training the ear to recognize pitch/volume patterns of hoarseness allows diagnosis before endoscopy. Discusses “normal-looking larynx” scenario where audio patterns reveal the impairment the endoscope misses. Links to lecture video. Migration note: Core content for the “Vocal…
Vocal capabilities pattern matching — the most substantive blog post. Four patterns: (1) Vocal cord margin swellings (impairment at low volume, high pitch = lower right quadrant), (2) RLN paresis anterior branch (low pitch, low volume = lower left), (3) Vocal cord bowing (impairment at low volume across range), (4) External compression (impairment at all…
