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White noise occurs with vocal swellings at low pitch because of air leak
Diplophonia occurs with vocal swellings at high pitch because of air leak

Specifying pitch and volume when looking at vocal cords is essential. If we take the example of vocal swellings, voice may be clear at some pitch and volume combinations. Yet with the same pathology at other pitch/volume combinations, vocal swellings often have combined sonic elements of air leak and polyphonia.

Stroboscopic exam at pitch G3 (maximum closed phase). The dark areas are where the vocal cords never close at this pitch and represent air leak and likely turbulent airflow. The dark areas are the reason she is husky at her comfortable speaking pitch.
On the same exam her vocal cords are recorded during stroboscopy at a higher pitch – C5, and this still photo is extracted from the most closed phase at C5. Again, there are large dark areas representing continuous air leak and likely turbulent airflow generating white noise or huskiness.
Vocal Capabilities at pitch G3
Vocal Capabilities at pitch G3 & C5
Air leak at pitch G3 & C5 corresponds to the black area on strobscopy

Case study History Gabriella is a performer with nightly shows for another 4 weeks. She is having difficulty with her voice giving out by the end of each performance.  Even while I listen to her tell me her history, I can hear a husky quality to her voice. Vocal Capabilities

Physics Music and Laryngology

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. Recurrent laryngeal nerve paresis

Gender Affirmation - Medical & Surgical Perspectives published by Thieme

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)

Villa Lo Zerbino, Genoa, Italy

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.  

Vocal Capabilities Lecture

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.

High Definition Laryngology Lecture

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.

Full moon over Dubai, mosque tower

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.