A Journal of Observational Laryngology
Clinical observations, anecdotes, case series, and conceptual frameworks of laryngology for further exploration.
Individualization of Botulinum Toxin Injections for Spasmodic Dysphonia
Introduction Spasmodic dysphonia (SD) is a neurological voice condition that diminishes voice/speech intelligibility and markedly increases the effort to talk. The impact on social life and occupation can be devastating. Untreated patients may even lose their jobs. There are two primary variants—adductory SD (~90%) and abductory SD (~10%). For the
You May Not Have to Live with that Chronic Cough
Introduction Imagine . . . coughing for 10 years. That’s what has happened to “Susan.” When an attack hits during a phone call, friends have learned to say, “Uh-oh, well, call me back when your cough is over.” If a bad spell happens in public, she feels humiliated when all
What your Insurance Company might ask about R-CPD (Inability to Burp, No-Burp)
The information below is offered to both patients and their physicians. It can be sent to their insurers or may help them explain the proposed procedure to payors during the pre-authorization process. What is the diagnosis for which this procedure is to be done? Retrograde cricopharyngeus dysfunction (R-CPD) causing lifelong
Sensory Neuropathic Cough Need Not Be a Diagnosis of Exclusion
Complexification is easy; simplification is the greater challenge. Introduction Sensory neuropathic cough (SNC) has been a topic in medical literature since 2006, but it remains for many clinicians a (last resort) diagnosis of exclusion. However, it can be a prima fascia (on the face of it) first diagnosis, made during
An Open Letter to Gastroenterologists about R-CPD
Introduction Many patients with inability to belch and severe associated gastrointestinal distress struggle for years to find the recently established diagnosis of retrograde cricopharyngeus dysfunction (R-CPD). This disorder has received a lot of exposure, including in peer-reviewed journals, yet even when they bring peer-reviewed articles to their doctors, many say
Why Is Constipation Often a Symptom of Retrograde Cricopharyngeus Dysfunction (R-CPD)? A Thought Experiment
Introduction Retrograde cricopharyngeus dysfunction is also known by three other names: R-CPD; inability to burp and associated symptoms, or “no-burp.” Because of the inability to burp, the normal air that everyone swallows with food, liquid, or saliva can only be released as flatulence. (Gas formed during digestion of food such
Botox Placement for Treatment of Spasmodic Dysphonia in the “Fortress Larynx”
Introduction Spasmodic dysphonia (SD) is what happens to the capabilities, limitations, and aberrations (vocal phenomenology) of the voice as the result of a rare neurological disorder called laryngeal dystonia. The prefix dys- essentially means “abnormal.” And so dystonia (abnormal tone in laryngeal muscles) causes dysphonia (abnormal sound of the voice).
Suction Drains as Treatment Tools in Head and Neck Surgery
Common Usage Suction drains are used routinely to evacuate blood and serum from under skin flaps in the early days after surgical procedures. When drainage diminishes to 30 ml or less in 24 hours, drains can be removed, most often within the first 3 or 4 postoperative days. At that
Laryngitis & Sore Throats from Acid Reflux
Introduction The lower esophageal sphincter (LES) is a muscular “one-way” valve between the stomach and esophagus, whose purpose is to keep stomach contents, especially acid, from refluxing (going backward) up the esophagus towards the mouth. Yet, millions of people have a malfunctioning LES. This opens the way to a condition
Post-Treatment for AD-SD: What to Expect?
(the “strained-strangled” SD variant) Robert W. Bastian, M.D. — Published September 10, 2023 Introduction You have just undergone an injection with botulinum toxin (Botox) for the “strained-strangled” voice caused by your adductory spasmodic dysphonia. For a few days you may notice slight soreness in the area of your larynx, and