BVI Now on Twitter!

Bastian Voice Institute is now on Twitter. Follow us at @bastianvoicedoc to receive selected excerpts from our growing set of encyclopedia entries, photos, and videos available at Bastian Medical Media, as well as alerts when we add new entries or multimedia. Our aim is to help more people with voice, swallowing, airway, and cough disorders to work more effectively with their personal physicians.

New Learning Center Content – Hypopharyngeal Stenosis

Persons with larynx or pharynx (voicebox or throat) cancer often undergo radiation therapy as part of their treatment regimen. An uncommon complication is stenosis (narrowing, scarring) of the entrance to the upper esophagus at the junction of throat and esophagus.

We have added a short video clip example of this disorder in our video gallery. You can find it on the video gallery page of our standalone learning website (Bastian Medical Media for Laryngology) or by typing in “hypopharyngeal stenosis” at

Teaching Activities–2011

January brought a trip to Minneapolis to speak before members of the Minnesota Otolaryngologic society meeting; April included sitting on a panel at the American Laryngological Association meeting in Chicago; May was Merida, Mexico for lectures and panel discussions for their national Otolaryngology meetings; June included an invitation to be keynote speaker at the annual Yale Andy Blitzer Voice Symposium, June 4.  June also included a Grand Rounds lecture delivered to the Department of Neurology, University of Tennessee (Memphis).

In September there were two courses taught at the American Academy of Otolaryngology (San Francisco), and responsibility as a faculty member for a regional symposium of the National Spasmodic Dysphonia Association, in Milwaukee.  Topics at the above events included the diagnostic model for voice disorders; spasmodic dysphonia (laryngeal dystonia); office-based laser and other procedures; vocal fold microsurgery; and sensory neuropathic coughing.

High- and Low-Risk HPV Subtypes

Q:  I have a low-risk subtype of HPV.  Can you explain what this means?

A: The human papilloma virus (HPV) comes in 150 or more subtypes.  Think of it like the many models of automobiles that all fall under the designation “Ford.”  Subtypes found most often in the respiratory and genital tracts are 6 and 11.  HPV infection is associated with some degree of risk of stimulating, or converting to, a carcinoma.  Hence the higher risk of cervical cancer in women with HPV infection.  Some subtypes are considered to have a low risk of viral carcinogenesis; others have a high risk.  At BVI, the majority of our many adult patients have 6 or 11, both of which are low-risk subtypes.  We also have one or two who have both 6 and 11.  Then we have a handful of patients with intermediate or high risk for cancer.  A few of these high-risk subtypes have in fact caused cancers in our population of ~150 adult patients  with RRP.  Thankfully, all have responded well to treatment and none to my memory have died from their cancer.

HPV Infection–Subtypes

Q:  HPV apparently has different subtypes.  What can you tell me about them?

A:  Human papilloma virus infection can consist of as many as 150 different subtypes.  Some are related to skin infection (causing warts).  Some are more common in genital or respiratory sites.  Genital lesions are typically called condylomata, or genital warts.  In the airway, the lesions are typically called papillomas.  Commonest subtypes in the airway are types 6 and 11.  These two subtypes comprise the vast majority of our patients at BVI.  We have patients who have also tested positive for types 16, 18, 45, 55, and a few others.

RRP-HPV-Papillomas General

Q:  What is the relationship between the terms RRP, HPV, and Papilloma?

A:  The underlying disorder is HPV (human papilloma virus) infection of the airway, especially the larynx.  The virus “sets up house” chronically inside airway and stimulates a kind of proliferation called papillomas, or papillomatosis.  Because these lesions tend to recur after surgical removal, the clinical syndrome has become referred to as recurrent respiratory papillomatosis (RRP).

Acid Reflux with No Symptoms?

Q:  I’m told I have acid reflux, but how can that be if I don’t have heartburn?

A: It is possible to have an MI (heart attack) without any chest pain.  In the same way, it is possible to have acid reflux up the esophagus without any heartburn.  Beyond this, even if acid comes up into the throat at night, this may not waken you unless it is major.  Think of gentle-to-moderate rain in the night as an analogy.  If you do have the nighttime reflux, however, you may notice symptoms such as a dry or scratchy/sore throat, increased mucus production with throat clearing, a deep morning voice requiring more warmup if you must sing early in the day.  The potential for “silent” reflux explains why physicians may suggest a treatment trial even when you have no awareness of actual acid either during the day, or at night.

Use of BVI’s Medical Information

Q:  How should I use medical information on your website?

A:  We consider information in our website as educational,  not as medical advice.  You should read with special interest material that deals with your symptoms or even about a diagnosis you have been given.  This kind of background reading may make a consultation you have with your personal physician more productive.