Zenker’s diverticulum (ZD)

An outpouching or in effect a hernia of the swallowing passage just above a non-relaxing [intlink id=”113″ type=”post”]cricopharyngeus muscle[/intlink] or [intlink id=”615″ type=”post”]upper esophageal sphincter [/intlink](UES). In essence, the forces of swallowing are delivered against a somewhat unyielding muscle, and this causes the wall of the swallowing passage just above the UES to balloon outward. Though unknown to many, the ZD is only the reflection of the main problem, which is [intlink id=”111″ type=”post”]cricopharyngeus dysfunction[/intlink]. Myotomy of the [intlink id=”113″ type=”post”]cricopharyngeus muscle[/intlink] tends to resolve symptoms, even though the ZD is left in place and not removed.


An anesthetic medication used for topical or for local (infiltrational) anesthesia. See also [intlink id=”319″ type=”post”]lidocaine[/intlink].

Working diagnosis

A term used to refer to the leading contender in a list of two or more potential diagnoses. Infrequently, at the conclusion of the initial consultation, we have two fairly strong diagnostic possibilities, and begin with treatment for one of them, now termed the working diagnosis, as the next step in finalizing a diagnosis. If a working diagnosis is relatively certain, we may begin treatment for that diagnosis. In other cases, additional testing is in order to try to solidify the working diagnosis into a final diagnosis.

Wegener’s Granulomatosis

A rare inflammatory disease of small arteries and veins (vacuities) that classically involves vessels supplying the tissues of the lungs, nasal passages (sinuses), and kidneys. At BVI, we see a large population of persons with presumed Wegener’s granulomatosis causing subglottic and tracheal [intlink id=”526″ type=”post”]stenosis[/intlink].

Voice therapy

As delivered by a speech pathologist, this is a comprehensive process that includes teaching the patient concerning the diagnosis; review of occupational and other life demands and problems posed by a voice deficit; and establishing and implementing a comprehensive plan for remediation. A significant component of voice therapy may include work on [intlink id=”683″ type=”post”]voice production[/intlink].

Voice production

Refers to the act of making voice, and the details of the use of breathing (power supply), larynx (sound source), and resonators (mouth and throat) to create a specific voice quality. Using different strategies of voice production, the same person may bring forth various voices: one may be clear and normal-sounding; another may be harsh and unpleasant; a third may be [intlink id=”33″ type=”post”]air-wasting[/intlink], or [intlink id=”67″ type=”post”]breathy[/intlink].

Voice fatigue syndrome

A clinical scenario that, when seen, almost always accompanies the [intlink id=”671″ type=”post”]vocal under doer syndrome[/intlink]. Typically such individuals report that with any significant amount of voice use, the voice seems effortful and tight; they may also complain of paralaryngeal discomfort. Most often seen in vocal under doers whose job requirements for voice use have increased due to a promotion to a management level.

Voice evaluation

Can refer to the second part of the [intlink id=”245″ type=”post”]integrative diagnostic model[/intlink] as performed by the [intlink id=”285″ type=”post”]laryngologist[/intlink], or to an initial assessment of the [intlink id=”627″ type=”post”]vocal capabilities[/intlink] and [intlink id=”650″ type=”post”]vocal limitations[/intlink] as carried out by the [intlink id=”514″ type=”post”]speech pathologist[/intlink]. Should be distinguished from other things that are sometimes confused with laryngeal examination and also from [intlink id=”394″ type=”post”]“objective”[/intlink] measures.

Voice building*

The process of adding strength to the voice by utilizing a variety of tasks that tax its strength capabilities. The idea is that over time the larynx will rise to the challenge and adapt to increased demands, much as might happen to the arms as a result of a weight-lifting regimen. Sometimes the voice building regimen is very simple and “do-it-yourself”; other times it is more sophisticated and requires the assistance of a [intlink id=”514″ type=”post”]speech pathologist [/intlink]who is [intlink id=”503″ type=”post”]singing voice qualified[/intlink].