A Journal of Observational Laryngology
Clinical observations, anecdotes, case series, and conceptual frameworks of laryngology for further exploration.
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 as beans and cabbage has only one way to exit
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). Treatment for SD While numerous treatments have been proposed and
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 point, they have served their purpose, and out they come.
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 called gastroesophageal reflux disease (GERD), also referred to as “acid
(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 perhaps a small bruise on the front of your neck.
(the “my voice drops out to a whisper” SD variant) Introduction You have just undergone an injection with botulinum toxin (Botox) for the “intermittent whisper” voice caused by your abductory spasmodic dysphonia. For a few days you may notice slight soreness in the area of your larynx, and perhaps a small bruise on the front of your neck. For the
What Hospital Staff Need to Know About You As a Laryngectomy Patient (Especially if Contemplating Surgery)
Introduction Anesthesiologists, respiratory therapists, and nurses may know the following information if you are in a large hospital. If you are in a small hospital, day surgery center, walk-in urgent care facility, etc., the clinical staff may be unfamiliar with the following information. Understanding your new anatomy Managing your airway is very straightforward as the entrance to the airway is
Background of R-CPD R-CPD causes 4 primary symptoms: inability to belch, gurgling noises, bloating, and flatulence. Less universal symptoms include painful hiccups, nausea after large meals, shortness of breath when very bloated, hypersalivation, and constipation. For more information, see links below. Standard of care This is an injection of botulinum toxin (“Botox”) into the upper esophageal sphincter through the mouth
Robert W. Bastian, M.D. — Published: July 1, 2021 The big picture Babies who cannot burp are in terrible misery. So are their parents. While the child struggles with daily colic, spitting up, sometimes projectile vomiting, and gassiness, the parents must deal with hours of crying each evening and much medical attention may have provided no answers. The explanation for
Robert W. Bastian, M.D. — Published: December 18, 2020 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