A Journal of Observational Laryngology

Clinical observations, anecdotes, case series, and conceptual frameworks of laryngology for further exploration.

Babies Who Cannot Burp, and Still Cannot as Adults.

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.…

Can’t Burp? Here Are the Symptoms of R-CPD

Robert W. Bastian M.D. 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.* *A constellation of…

Still Coughing After COVID-19?

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.

The Gasping Syndrome

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.

Cricopharyngeus Spasm and What to Do About It

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.

How Do You Choke? Let Me Count the Ways…

By Robert W. Bastian, MD 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.” Staff not unreasonably marked on his chart that swallowing was his primary issue. In the first minutes of our time together,…

Vocal Underdoer Syndrome: When Voice Rest or Restraint Only Hurts

By Robert W. Bastian, MD 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. For example, vocal nodules, vocal polyps, and vocal fold hemorrhage are…

Medical Jadedness and Treatment of Sensory Neuropathic Cough

By Robert W. Bastian, MD 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…

A Trail to Sensory Neuropathic Cough

By Robert W. Bastian, MD 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 cough1. Before the…

Early Vocal Cord Cancer: Remove with a Laser, or Radiate?

By Robert W. Bastian, MD 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…