In a discussion with a colleague about vocal cord weakness, I reviewed video for how to identify Lateral cricoarytenoid paresis by focusing on the movement and positions of the vocal processes.

Practice guideline articles seem like they should carry a lot of weight given the number of authors and their collective fame and recognition. Yet one of the pitfalls of writing by consensus is publishing something that is effectively the lowest common denominator. Since the article may be frequently quoted, let’s take a closer look at: Dhillon VK, Randolph GW, Stack BC Jr, et al. Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment. Head & Neck. 2020;1–16.

In lieu of travelling these next few months, I have placed online one of my favorite lectures about identifying a voice disorder by sound - Phonogram.  You could reasonably ask, Why should the examiner listen to the voice? Seeing sound. I am a visual person you say. I went into a surgical speciality for my talent to see something and remove it, yet, my ear isn’t well trained. I can’t carry a tune, but I specialize in laryngology and my patient is hoarse, a complaint about sound. Sound is created by the movement of air and I can’t see air, how do I visualize sound?

Vocal capabilities pattern matching Reviewing the four Vocal Capabilities Pattern examples, we can begin to visually see that combining loudness and pitch reveal patterns. Clear sound is coded in green. Roughness is encoded Red and Breathiness is encoded in Blue. Vocal cord margin swellings With impairments at low volume and high pitch we see a graph with audible pathology on the lower right side and that points toward vocal swellings.

Thieme published a chapter on Voice modification in "Gender Affirmation  Medical and Surgical Perspectives", edited by Christopher Salgado, Stan Monstrey and Miroslav Djordjevic. This chapter, from pages 31-50, covers several different approaches to modifying the male to female voice surgically. It has a complete set of photographs of Feminization Larynoplasty along with details about the surgical technique. The textbook is available from the publisher and on Amazon.com.

I presented a short description of some of the work I am doing to modify the comfortable speaking pitch and pitch range of transgender individuals wishing to sound more feminine at the 23rd WPATH Symposium in Amsterdam, The Netherlands on July 20, 2016. It included thoughts on the five procedures currently utilized to alter pitch: Cricothyroid approximation (aka Thyroplasty Type I) Vocal cord webbing (aka " Vocal Fold Shortening with Anterior Commissure Advancement" or VFSAAC, Wendler Glottoplasty)

An outstanding meeting just finished in Genoa, Italy for the 11th European Laryngological Society meeting hosted by president Giorgio Peretti on June 8-11. I found a bit of time to recap the meeting in photos. with the full set available for download on Flickr.  There were many great presentations. It was extremely educational, particularly the discussions between and after the meetings. Some members found time for recreation in the form of eating, swimming, singing and dancing. In particular, the evening spent up on the hill at the Villa Lo Zerbino was spectacular. See you in 2018.

This short video was produced for the European Laryngology Society's meeting in Genoa, Italy. It was limited to 10 minutes and briefly covers the rationale behind listening to the voice in order to make a diagnosis.The premise is that it is necessary to alter pitch and volume while listening to the voice in order to establish the pattern which is characteristic and different for each type of voice disorder.

Lecture given at the 2016 European Laryngologic Society meeting on the topic of High-Definition Laryngology.Essentially I describe the way that a combination of technique and equipment lead to the most pixels on the pathology. The more pixels there are on the problem, the better the resolution and understanding of the person performing the diagnostic examination. The video equipment tends to be expensive. Indeed, at this conference Olympus has been showing their Ultrahigh definition 4K video, the setup which cost about $80,000.

My first impression of Dubai is the cosmopolitan life of the city. All colors and styles of clothing wind through the streets. English is the linga Franca, but feel free to speak Arabic if you desire. You can use Hindu, Tagalog, even French at times. 

An article in the Journal of the American Medical Association's Otolaryngology journal (The American Thyroid Association Guidelines on Voice Assessment-Have We Done Enough?) suggests that physicians performing thyroid surgery could improve their surgical outcomes if they examined the laryngeal function before and after surgery in the region of the laryngeal nerves.

We just wrapped up the excellent 3rd meeting of the Combined European OtoRhinoLaryngological Society (CEORL) in the city of Prague, Czech Republic. CEORL 2015.

My presentation at the 3rd CEORL conference in Prague, Czech Republicon 8 June 2015. It details my thoughts on how the combination of high technology and low technology, when merged, lead to a high definition examination of the larynx.

Attending “AOICON 10th South Zone & 32nd Karnataka State Annual Conference 2014” in Bangalore, October 10-12, 2014 as faculty, the meeting is fascinating for many interesting ideas. In particular, the internal approach to repositioning of the arytenoid by Paul Castellanos opened my eyes to a new method of laryngeal framework surgery. Paul’s idea for altering the larynx consists of entering the vocal cord by a microlaryngeal incision through the aryepiglottic fold - false cord junction.

There is a practical course on functional diagnosis of voice disorders coming up in Barcelona, Spain - Voice Course Barcelona. The speakers are a great group of presenters!  Ferran Ferran Vilà,  ENT and phonosurgeon. Barcelona (Course director) Cori Casanova, Phoniatrician. Barcelona (Course director) Bruno Coulombeau, Phoniatrician. Lyon Romain Perouse, ENT and phonosurgeon. Lyon Markus Hess, ENT, phonosurgeon and phoniatrician. Hamburg Nieto, P. Phoniatrician. Valencia Dalmau, J. ENT and phonosurgeon.