A Journal of Observational Laryngology
Clinical observations, anecdotes, case series, and conceptual frameworks of laryngology for further exploration.
Babies who cannot burp are in terrible misery. So are their parents. The explanation for why may be found in the story of adults who had this kind of trouble in their infancy—trouble that has continued into adulthood. Adults with a lifelong inability to burp were recently diagnosed with retrograde cricopharyngeus dysfunction, or R- CPD. This condition was successfully treated for the first time on record in November of 2016.
There is a group of people whose inability to burp causes severe daily distress. They are left without a solution (or even explanation) in spite of many doctor visits. Recently a major cause of inability to burp, retrograde cricopharyngeus dysfunction (R-CPD) has been codified for diagnosis and treatment.*
Among those stricken by COVID-19 are those experiencing a lingering cough. Especially early on, this cough may be continuing to clear secretions that accompany resolving lung inflammation. But for some this cough is no longer solving a problem but IS the problem.
Patient has an abrupt sense of smothering or gasping. This can last a few seconds or several hours, and can occur almost weekly. He or she responds by taking a deep breath, but there is no relief and the sensation remains.
By use of the word spasm, we don’t mean a cramp or a charley horse. It is instead sustained hypertonicity of the upper esophageal sphincter, or cricopharyngeus muscle. It is over-contracted. That’s why we become aware of it when this overcontraction gives rise to a feeling of pressure, choking, etc. defined as cricopharyngeus spasm.
Swelling Checks to Detect Vibratory (Overuse) Injury to the Surface Tissue (Mucosa) of the Vocal Cords
These are used to detect acute or chronic vocal fold mucosal injury reliably; Secondarily, they can also detect gaps between otherwise normal folds. They provide persons with a way to detect mucosal trouble for themselves. We are in effect “taking all of the clothes off the mucosa.” The swelling checks are for anyone who uses the voice extensively or vigorously—particularly vocal overdoers.
Four examples of how the term “choking” can mean different things. When asked the reason he was calling for an appointment, a middle-aged man offered that he was “choking.”
We all have experience trying to manage mucus that is causing us a problem. Sometimes, such as during an upper respiratory infection, our bodies over-produce mucus, in which case we cough it up, blow it out, or “dry it up” with decongestants. Other times, mucus may become thick and crusted, in which case we thin it out by drinking more fluids, using a humidifier and Neti pot, or taking over-the-counter
For a voice clinician, it is helpful not only to place each medical disorder in its own unique diagnostic “basket,” but also to search for organizing concepts that might show what certain disorders have in common with each other.
People with sensory neuropathic cough often spend years searching in vain for a correct diagnosis and effective treatment. In a group of 110 consecutive patients diagnosed with sensory neuropathic cough by the author in 2005, the median duration of cough prior to diagnosis was 10 years, ranging from a few weeks to 62 years.
A new clinical insight can be sparked when a physician encounters a series of patients in close succession whose stories overlap in some surprising way. This is an account of that sort, reviewing a trail of patients that led to understanding the clinical entity of sensory neuropathic cough.
Patients who are diagnosed with early vocal cord cancer have two main treatment options to consider: laser surgery or radiation. There are quite a few factors to consider when weighing these two options, which can be confusing for the patient and challenging for the clinician to explain.
After 15 years of laryngology practice, I decided to create a single, codified overview on this subject, to help me teach more clearly and
It has been shown that sensory neuropathic cough (SNC) can be treated with certain neuralgia medications What has not yet been described, however, is the use of capsaicin spray as a possible treatment for SNC patients—an approach that may seem counter-intuitive, given that capsaicin is known in the pulmonary medicine literature as a means for provoking coughing for diagnostic or research reasons.