The hyoid bone (top yellow) is connected to the tongue and jaw muscles above and the thyroid cartilage below. The thyroid cartilage (central blue) is also known as the Adams Apple and protects the vocal cords which are attached on the backside in the middle. The cricoid cartilage (lower green) is a complete ring supporting the bottom of the larynx.

Sipping espresso in Ken’s Boulangerie & Cafe, I hear the background noise of the espresso grinder mingling with the murmur of voices. The couple next to me are chatting in Japanese, drinking coffee and downing a pastry. I don’t understand a word, but I can hear that each person’s voice box, or more technically the larynx, is functioning well.

Wind Chimes

I have a set of wind chimes hanging from an arbor that catch my attention whenever I am out in the garden and the breeze kicks up. They were given to me by Mrs. Mary Marlboro’s niece. Mary had purchased them while in hospice with instructions for her niece to give them to me after she passed on. I had cared for Mary for several years after I removed her larynx because of a cancer.

Laryngology 101 with Dr. Thomas

Even if you are willing to faithfully believe in your surgeon’s technical skills (based on his description to you of his own technical prowess), how can you assess his diagnostic skills and his error rate, when even he cannot?

Dr. James P. Thomas explaining what voice is

Faith N. Metsan felt something begin to change in her throat one autumn afternoon. Over the next few hours, her voice just seemed to disappear. She didn’t have any other symptoms. By evening, when she tried to speak, her voice was nothing more than a whisper. Thinking this was just the beginning of laryngitis, and because work was busy, she waited for a week. When she didn’t seem to be getting better she called her primary care physician, Dr. Marcus Goodew, and made an appointment.

An air leak in the vocal cords, specifically a split gap.

Faith N. Metsan showed up at Dr. Goodew’s office saying she was hoarse. Like Faith, most of us have a general idea about hoarseness, though perhaps without really knowing what it is in any detail. A performer often knows when her voice is not working well because the change is sudden. She has thousands of hours hearing her own voice for comparison. Yet, singers and performers stake their entire careers on their voice and many have never seen nor had any concrete visual concept of what was transpiring inside their necks.

Below the speech line, sound is created, above, sound is modified into language.

Mr. Heim Stillear, at 70-years-old, seems older and less intelligent to his family, since he was hospitalized for a stroke about two months ago. They come to the appointment with him and help him into the exam chair. When I ask Heim what is going on with him, the long pause before his strained answer begins makes his family uncomfortable. His daughter interjects, “We are having a very difficult time understanding him.”

A rigid endoscope through the mouth to view the vocal cords

If you are hoarse, almost certainly you will benefit from a video recording of your vocal cords. Most vocal events happen too fast for you to perceive, without some capability to slow and review the images of a video recording. Even video needs some help from a stroboscope or high-speed recording to catch events well.

Voice Doctor, Dr. James P. Thomas, MD

Physicians who specialize in voice are known around the world by various names: laryngologist, phonosurgeon, voice doctor, phoniatrist and there are probably others. Essentially these words mean that the person has a special interest in the voice beyond what a general doctor has; beyond even what a typical ear, nose and throat physician has. They are focused to some degree on the voice. There is not a formal degree for a laryngologist and anyone may use the name. Quite likely, over time the training for this subspecialty will become more formalized.

Why is there a Frog in my Throat? A Guide to Hoarseness book cover

When something goes wrong with your voice, you might simply say, “I am hoarse.” Your funny best friend might ask with a smile, “Got a frog in your throat?” Then what? Do you rest your voice? Do you gargle? Do you eat chicken soup? Do you see a doctor? Do you pick up a pill at the pharmacy? Which doctor do you see? What if you are a doctor? Is it simple or difficult to discover the cause of a hoarse voice? What do you need to do to make a diagnosis? Do you look in the mouth? Do you guess? Do you write a prescription for a pill?


20th World Congress IFOS - Seoul, Korea The international Federation of Otolaryngology Societies (IFOS) met in Seoul, Korea this spring. The scientific program for laryngology was broad-based and excellent. I particularly enjoyed meeting my colleagues across the world who are working on gender voice surgery techniques. Participating in the energy of Gangnam with an evening dance in the conference hall was one way to sample the flavors of Korea.     They have selected Paris as their next meeting location in 2017.