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Note: For a more complete reference than this glossary, see our new standalone educational website, Bastian Medical Media for Laryngology. Within this glossary, entry titles ending with * were coined or brought into the language of voice disorders by Dr. Bastian, or to our knowledge are used primarily by BVI physicians and Bastian-trained fellows. © 2013 Bastian Voice Institute.

Di-indolemethane (DIM)

This is a phytochemical derived from cruciferous vegetables such as cabbage, broccoli, Brussels sprouts, cauliflower, collards, and kale. Promotes estrogen metabolism to a form that has been shown to be anti-proliferative. Used in treating recurrent respiratory papillomatosis (RRP). See also I3C.

Diagnostic model

The codified tools and sequence used during diagnosis of a disorder. In the realm of voice disorders in particular, different clinics may use different models for diagnosis. For purposes of discussion, at BVI we distinguish somewhat artificially between the traditional diagnostic model, the technology-driven or reductionistic diagnostic model, and what is preferred at BVI, the integrative diagnostic model.

Diagnostic process

See diagnostic model.

Differential diagnosis

Refers to the short list of possible diagnoses based upon the findings of the initial consultation. Sometimes the diagnosis can be narrowed down to only one possibility; in other cases, additional tests are done to distinguish between competing diagnoses. Sometimes the most likely diagnosis of those in the differential diagnosis becomes the working diagnosis and trial treatment for this leading diagnosis is begun.

Dilatation (or Dilation)

This means to stretch an opening to a larger size. For example, one of the options when managing an individual with a stenosis (narrowing) in the trachea or windpipe may be to dilate or stretch that area, to see if durable enlargement of the airway can be achieved, or whether a different approach such as tracheal resection should be tried.


Double pitch phonation. Often seen with vocal fold paralysis, and in submucosal disorders such as epidermoid cyst and glottic sulcus. Except for a type of luffing diplophonia that may be functionally produced, diplophonia tends to be a pathologic vocal phenomenon.


Abnormal swallowing, or inability to swallow. This can result from such diverse causes as surgery on the larynx or neck, stroke, the aging process, tumor, injury to the neck, or radiation, among other things.


Abnormal production of vocal sound; more commonly used as a synonym for hoarseness. Dysphonia may be the result of injury to the mucosa of the vocal folds; or it may be neurogenic, the result of a benign or malignant tumor; or it may be nonorganic.


A benign neurological disorder in which twisting and repetitive or sustained but unwanted muscle contraction occurs in a body part. Dystonia can affect a specific muscle causing focal dystonia, a region of the body (regional dystonia), or even the body as a whole (generalized dystonia). Common focal dystonias include laryngeal (spasmodic dysphonia); ocular (blepharospasm); neck or cervical (torticollis and related neck disorders); and limb dystonia (writer’s cramp). Treatment for focal dystonias is most commonly via Botox™ injection into affected muscles, and occasionally by selective denervation. More regional and generalized dystonias may respond to a variety of systemic medications such as clonazepam and others.