A Journal of Observational Laryngology
Clinical observations, anecdotes, case series, and conceptual frameworks of laryngology for further exploration.
R-CPD: Pushing the Age of Diagnosis and Treatment…Younger
Introduction The first known successful treatment of retrograde cricopharyngeus dysfunction (R-CPD) was rendered by the author in 2015. The first peer-reviewed publication codifying both the diagnosis and treatment of the disorder followed in 20191. As of June 2026, the Bastian Voice Institute experience has grown to nearly 2,600 treated patients,
Understanding the Distinction Between Essential Voice Tremor (EVT) and Dystonic Voice Tremor (DVT)
Dr. Bastian explains how you distinguish between Essential Tremor and Dystonic Voice Tremor using vocal phenomenology alone.
A Sample Letter In Support of the Little Ones With Retrograde Cricopharyngeus Dysfunction (R-CPD)
One of the most important remaining goals regarding R-CPD is to help very young children with this terrible condition.
Paradoxical Vocal Cord Motion and Vocal Cord Dysfunction: Should These Terms Be Retired?
The author proposes that the phenomenon labeled PVCM/VCD is better understood as a nonorganic, behavioral disorder of laryngeal use…
Arytenoid Dislocation: A Diagnostic Strategy
Arytenoid dislocation is a mechanical injury of the larynx where an arytenoid cartilage becomes displaced from the cricoid
EMG-Guided Injection of Botulinum Toxin for R-CPD
EMG-guided injection of botox for R-CPD is done through the neck while the patient sits upright in an office examining chair.
The Trumpet Maneuver During CT Scanning and Office Videoendoscopy
Introduction At rest, the laryngopharynx (throat and voice box) lie closely against one another. The pharynx essentially “hugs” the laryngeal inlet. Because of this, the point of attachment of a tumor in the laryngopharynx can be difficult to define without operative endoscopy under general anesthesia. This is especially true when
Steroid and Local Anesthetic Injection Strategy for Sensory Neuropathic Cough
What Is the Source of This Idea? The first peer-reviewed publication for steroid and local anesthetic injections we are aware of came from Simpson and colleagues in 20181. As an aside: Our first use of superior laryngeal nerve (SLN) injection with local anesthetic was in 2005, in a patient whose
R-CPD Neck Symptoms and “Throat Nausea”
Persons with R-CPD (Retrograde Cricopharyngeus Dysfunction)—the inability to burp or to burp adequately—experience a constellation of symptoms, each individual’s set drawing from about ten common possibilities. Alongside the inability to burp, these symptoms may include: Audible gurgling Abdominal bloating and distention Excessive flatulence Painful hiccups Nausea after eating Mechanical shortness
Clinical Diagnosis of Sensory Neuropathic Cough (SNC) via Syndrome-Matching
Abnormal narrowing of a passageway in the body. At our practice, stenosis typically refers to narrowing in the breathing passage, such as for narrowing in the glottic, subglottic, or tracheal areas. Stenosis in the airway can be the result of prolonged endotracheal intubation, external trauma such as gunshot wound, crush