Thomas James P MD

Information may not be reliable

Welcome to Voicedoctor.net where you can find medically oriented information about your vocal cords, the voice and hoarseness.
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Diagnose describes one very accurate method for sorting out the cause of a voice problem.
Therapy discusses suggested treatments for hoarseness ranging from vocal cord polyps and nodules to spasmodic dysphonia.
Surgery covers procedures done on the vocal cords to restore function or change the voice in some way.
Media includes photos, video and audio recordings of the vocal cords and of disorders causing hoarseness.
Links refers you on to other interesting sites.
Physician is information about the author of the site. Contact Dr. Thomas
Study with Dr. Thomas

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James Thomas performing a microlaryngoscopy in the operating room to correct a vocal cord disorder.
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Voice - a definition:
Voice is sound - vibration. For a pure, clear voice, the vocal cords come together and vibrate, allowing pulses of air to leave the voice box and create a pure musical tone. That musical tone we describe in terms of pitch and volume. It comes from the larynx and we use it mainly to carry speech over a distance and we use it for emotion.
Speech is the modification of sound by the pharynx, palate, tongue, mouth and lips. Speech is information, information that is carried by the voice.
Hoarseness - a definition:
Hoarseness is a common term for a voice problem. It is important to understand what the word hoarsness represents. Hoarseness is "unwanted air leak". Any disorder that disrupts that flow of air, allowing a leak, causes hoarseness. There are two basic disruptions.
When the vocal cords do not come together completely there is a continuous leak of air - turbulent airflow, making a "white noise". Think of a whisper where the vocal cords are held apart with no vibration of the vocal cords. A whisper is pure white noise. There is only turbulent air flow. Add an unwanted air leak to vocal cord vibrations and that is hoarseness.
The other type of hoarsness is the irregular, unwanted leak of air. When something changes the weight or tension of one vocal cord relative to the other vocal cord, they no longer vibrate at the same pitch and that creates a hoarseness (or dysphonia) that can range from pure diplophonia (two separate notes) to a very fractured sound as the vocal cords crash into each other and irregularily disrupt the vibrations of each other.

Fungal laryngitis added 4/24/2008. Potent inhaled steroids are causing this issue more and more frequently.
Singers nodules added 5/22/2007

A close laryngeal exam - How to obtain a detailed view of the vocal cords. 3/7/2010

Vocal Cord Stripping - What happens when vocal cords are stripped. 2/3/2010
My vocal cord polyp - Mustafa's polyp. 1/27/2010
Laryngoscopy - The art of seeing the vocal cords. 1/20/2010
Anesthesia of the larynx - How to get a better laryngeal exam with anesthesia. 12/23/2009
Reflux Laryngitis - A video examining the concept of reflux laryngitis. 11/5/2008
Medialization Laryngoplasty - A video on how Dr. Thomas performs the surgical procedure. 10/29/2008
Vocal nodules - A video explaining the effects of vocal nodules. 10/22/2008
Hyperfunction - What does it mean? 1/24/2007
Surgical Pitch Change given at the Voice Foundation meeting on 6/4/2005.
Bilateral Vocal cord paralysis given at the Voice Foundation meeting on 6/5/2005.
Feminization Laryngoplasty given at the HBIGDA meeting on 4/8/2005.
Diagnosis of vocal cord paralysis given at the Oregon Academy of Otolaryngology meeting on 2/20/2004.
Think of this site as a medical text book that you have been able to look at in a medical library. You are free to browse. If you have a medical background you may be able to digest the information. If you don't have medical training then you may wish to use it with your own physician.

All content on this website (including text, photographs, audio files, video files and any other original works), unless otherwise noted, is licensed under a Creative Commons Attribution-Noncommercial 3.0 United States License.
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Am I getting good advice from my doctor? Is there a significant difference between an examination that my family doc does and an ENT doctor? Is a voice doctor, laryngologist or phonosurgeon somehow different from an ENT? What should I expect from an examination of my voice?
Reflux is the most overdiagnosed cause of voice disorders…
My upcoming lectures:

Jul 16 -Vocal micro-lesions, Choice for Voice, London, England
Jul 16 -Vocal cord imaging, Choice for Voice, London, England
Jul 19 -Feminization Laryngoplasty, London, England
Sep 10 -Performing Arts Medicine Vocal Health, Performing Arts Medicine Coalition, Portland, OR
Sep 10 -Feminizing your voice, Southern Comfort, Atlanta, GA

If your group would like a lecture, please contact me
Recent lectures in past year:

Jun 4 - Reflux, IFOS, Sao Paulo, Brazil
Jun 7 - Screaming, Voice Foundation, Philadelphia, Pa
Jun 19 - FemLar surgery, WPATH, Oslo, Norway
Sep 25 - FemLar & Laser surgery, Southern Comfort, Atlanta
Oct 3 - Laser treatment of Voice Disorders, Cleveland Laser course, Middlesbrough, England
Oct 5 - Diagnosis of Voice Disorders, Royal National Throat, Ears & Nose Hospital, London, England
Nov 21-22 - Reflux laryngitis doesn't exist, Feminization laryngoplasty, Vocal paralysis, Congreso Latinoamericano de Rinologa, Panam