Core laryngology clinical and educational posts
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…
Announcement of book chapter published in Gender Affirmation Medical and Surgical Perspectives (Thieme, eds. Salgado, Monstrey, Djordjevic). Chapter pages 31–50 covers multiple surgical approaches for male-to-female voice modification with complete photographic documentation of Feminization Laryngoplasty and surgical technique details. Available from Thieme and Amazon. Migration note: Should link from Feminization Laryngoplasty and Publications pages.
Presentation at 23rd WPATH Symposium, Amsterdam, July 20, 2016. Describes the five procedures then utilized to alter pitch: (1) Cricothyroid approximation (Thyroplasty Type I), (2) Vocal cord webbing / VFSAAC / Wendler Glottoplasty, (3) Laser reduction — CO2 (LAVA / Laser Glottoplasty), (4) Laser vocal cord tuning — KTP, (5) Feminization Laryngoplasty.
Letter to editor submitted to JAMA Otolaryngology Head & Neck Surgery in response to Shonka & Terris (2016). Argues that current AAO-HNS and ATA guidelines are insufficient — vocal capability recording before and after any thyroid/parathyroid surgery is the gold standard. Vocal functions reviewed: SLN = tension (high pitch, volume increase); RLN-ant = adduction for…
Abstract submitted to Fall Voice Conference, San Antonio. Individuals undergoing tracheal shave (Adam’s apple reduction) are at risk for anterior commissure detachment — presenting as lower comfortable speaking pitch, reduced vocal range, loss of volume, increased effort. Visually: convex vocal cords (often misattributed to smoker’s polyps or reflux). Hoarseness >7–14 days = likely detachment, not…
How natural compensation hides voice disorders during examination, both audibly and visually. Two examples: (1) TA muscle weakness — CT muscle compensates by raising pitch. Examiner removes compensation by asking patient to progressively lower pitch, revealing the bowing/flutter of the weak cord. (2) Mucosal swellings — patient raises volume at high pitch to compensate; examiner…
Accessible anatomy introduction. Three functions of the larynx: regulate breathing, create sound, keep food out of lungs. Describes thyroid cartilage (Adam’s apple), cricoid cartilage, hyoid bone, and how testosterone thickens/elongates vocal cords lowering pitch. Written from a café observation scene with a Japanese-speaking couple. References the book. Migration note: Part I “Anatomy of the Voice…
Story of patient Mary Marlboro — larynx removed for cancer, used electrolarynx then developed esophageal phonation. Voice = sound source + amplifying resonator (no vocal cords required). The two fundamental characteristics of voice: pitch and volume. Wind chimes metaphor. References the book. Migration note: Part I “What is Voice?” or “Voice without Vocal Cords” page…
Patient empowerment post. Three questions to assess diagnostic quality: Do I understand the explanation? Do I understand why the intervention should work? Do I understand what my physician is uncertain about? The larynx obeys the laws of physics — a mechanical valve and vibrating string. Accurate diagnosis should be translatable into non-medical terms. Warning: “If…
Introduces Faith N. Metsan story (recurring character from the book). Core definition: hoarseness = (1) unwanted air leak through vocal cords, or (2) irregular leak of air through vocal cords. “That is it. That is the essence and foundation of my entire book.” Every hoarse patient has one of these two problems or a combination….
