A Journal of Observational Laryngology
Clinical observations, anecdotes, case series, and conceptual frameworks for further exploration
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 … Continue reading
Covid-19 has intruded into our lives in innumerable ways. Worst of all for some, is that they contracted the virus. Among those stricken by the virus are surely a number of persons who are some weeks or even months past … Continue reading
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. Continue reading
By Robert W. Bastian, MD The information found below is a Q&A supplement to a teaching video on the same subject found at: http://laryngopedia.org/cricopharyngeal-spasm/#videos Tell me more about the cricopharyngeus muscle. Where is it, and what is it for? It is … Continue reading
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 … Continue reading
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 mucolytics. And, if mucus becomes purulent, we treat it with antibiotics. Continue reading
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 three distinct diagnoses that could be found in three different people. Yet these “different” diagnoses can be understood and addressed better when placed together under a common banner: the vocal overdoer syndrome. That is, since each of these kinds of vocal fold injuries arises from excessive voice use (along with other injuries like capillary ectasia and epidermoid cyst), it is most helpful, when dealing with such an injury, to view the vocal overdoer syndrome as (almost always, but not exclusively) the primary diagnosis and the resultant injury as the secondary diagnosis.
Although it is now widely understood that many types of vocal fold injuries are caused by excessive voice use, it remains less clear to many voice clinicians that disorders can also occur because of vocal underuse. A person might underuse one’s voice for a variety of reasons: a personality that limits voice use; a false conclusion one has jumped to about his or her voice, triggering inappropriate, self-imposed voice rest; well-intentioned but misguided medical advice to conserve the voice; or a combination of these. All of these scenarios, when they lead to a voice problem, fall under the banner of what we call the vocal underdoer syndrome. Continue reading
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