Neurolaryngology Study Group (NLSG)

Mark your Calendars…the Neuro Laryngology Study Group presentation at the 139th Annual Meeting of the ALA:

5:00 PM               Neurolaryngology Study Group

                                Speaker:  Christy Ludlow, PhD

                                Topic:  Spasmodic Dysphonia:  Past, Present and Future


History of the Neurolaryngology Study Group

By Roger L. Crumley, MD

Original document 2009, revised 2018

During spring of 1989, Drs. Gayle Woodson and I collaborated to organize a small informal meeting of otolaryngologists and voice scientists interested in neural disorders of the larynx (neurolaryngology).   The term “Neurolaryngology” was not in common usage at the time, and we proposed it at that meeting as a descriptor of a sub-discipline dealing with such problems as laryngeal paralysis, paresis, synkinesis, spasmodic dysphonia, other hyperkinetic laryngeal disorders, hypoesthesia, and anesthesia; e.g. all laryngeal disorders of neural origin.   The meeting was held simply to see whether the group felt there would be interest in meeting annually or bi-annually to discuss such issues.

This initial meeting was held in someone’s hotel room (probably mine) in San Francisco during COSM 1989. It was extremely informal. In fact some participants sat on the floor, some on beds, and some stood the entire time.   A partial list of those attending would include myself, Dr. Woodson, Christy Ludlow, Andrew Blitzer, Chuck Ford, Charles Cummings, Ira Sanders, and a few others.  (maybe Clarence Sasaki?)  At that meeting we discussed the concept, and then agreed that such a study group would be useful to us.  The timing (1989) was such that there was much interest in the newer Botox approaches to treating spasmodic dysphonia, and it was also early in the era of Isshiki medialization laryngoplasty and reinnervation (and Teflon was still available) for unilateral vocal fold paralysis.  There were a number of research laboratories and scientists turning out new and useful data, and this helped our nascent group to grow.

The interest level was high and accordingly it was decided to have a second meeting at the 1989 fall meeting of the American Academy of Otolaryngology-Head & Neck Surgery.     During this second 1989 meeting it was decided by a somewhat larger group to have meetings twice/year (one during COSM, and the second during AAO-HNS).    The format was generally to have a scientific speaker from some related field, generally basic or clinical science related to neurolaryngology, and then to have a roundtable discussion of basic science and clinical issues and problems.   Indeed, with a group of 15-25, the first 4-5 meetings of the NLSG yielded some very high level, occasionally controversial discussions about how to manage certain clinical problems, and demonstrated that there were indeed highly variable opinions regarding management.   This occasionally revolved around the roles of vocal cord injection (now more appropriately called injection laryngoplasty), Isshiki thyroplasty, arytenoid adduction, and laryngeal reinnervation in treatment of unilateral laryngeal paralysis, or whether spasmodic dysphonia was best treated with unilateral or bilateral Botox vocal fold injections.  Another advantage we all appreciated was learning about others’ newest discoveries or innovations, in many instances a year or two before they were presented or published.

The NLSG meetings were generally scheduled by either Dr. Woodson or myself and notification of the meeting time and place was disseminated to the members usually via email, Fax, or word of mouth. Dr. Crumley’s email list for the NLSG grew rather quickly, and came to include many non-U.S. physicians interested in neurolaryngology, such as Jean Abitbol, Mark Remacle, Hans Mahieu, Martin Birchall, Hongliang Zheng, John Rubin, Jean-Paul Marie, Sophie Perie, Berit Schneider, and others.   In addition neurologists such as Mitchell Brin were added, and occasionally attended, as did distinguished speech-language scientists and clinicians, such as Ingo Titze, Tom Murry, David Zealear, Christy Ludlow, James Till, and others.

As the group and meetings enlarged, funding became an issue.   A laptop computer and LCD projector replaced the old 2X2 slides, and we began to incur room rental, food and beverage and other expenses. Initially we paid for our meetings by “passing the hat” at the actual meeting.  Occasionally we were able to procure minor corporate support from such companies as Kay Elemetrics, Allergan, and Xomed-Treace (as they were named at the time).   In approximately 1994 Drs. Woodson and Crumley were able to convince AAO President Richard Farrior for the need for committee representation, and the Neurolaryngology Committee of the AAO was formed.   During the first year however this was converted to a sub-committee of the Speech, Voice, and Swallowing committee, but nonetheless the Neurolaryngology sub-Committee was awarded a mini-seminar time slot every other fall, which allowed for further growth of, and exposure to, neurolaryngological concepts.   A second and even more meaningful happening was the subsequent “adoption” of the Neurolaryngology Study Group by the American Laryngological Association.   This gave the NLSG more official status within the overall structure of Otolaryngology-Head & Neck Surgery societies. Accordingly, the spring COSM version of the NLSG came to be held at the conclusion of the 2nd ALA half-day scientific session, and finding (and funding) a NLSG meeting room was no longer a problem for our Spring meeting.

Al Merati was the first resident to present to the NLSG. His memories are poignant:

In 1994 I was just completing my NIH T32 year while a junior resident in Otolaryngology at UC San Diego. I had spent a year in the lab of Sue Bodine PhD from the Dep’t of Orthopedics Muscle research lab with the guidance of Allen Ryan PhD from Otolaryngology.   Our team had identified a novel myosin (the muscle protein most responsible for determining the characteristics of a muscle fiber) within the larynx and were able to sequence it – no small feat in the early 90s!   The AAOHNS annual meeting was in San Diego that year – and Roger Crumley asked Sue Bodine (who was known to Gayle Woodson from her time at UCSD) to present an update of muscle fiber typing research.  With Dr. Bodine’s guidance, I prepared and presented the work I had done at the “Neurolaryngology Study Group”. When I walked in to the meeting room at the Marriott I was completely blown away – all the key leaders in field were there.  I was excited and terrified – I knew my stuff but I didn’t want to blow it.  Drs Crumley, Woodson, Cummings, Flint, Sanders….you name it, they were all there.  There were barely any laryngology fellowships yet but I had my mind made up.  The opportunity that Dr. Crumley and his colleagues provided for me was a fast-start introduction to the world I wanted very much to be a part of.  It was the absolute best and possibly most important non-clinical hour from my years in training. What a gift the NLSG was to me – a room full of people who wanted to understand the larynx and all of its mystery!  NLSG was welcoming, informative, honest, and hungry to be inclusive.”

Meanwhile we were able to procure excellent speakers who were often from the basic sciences, particularly during the earliest years. Several members, notably Dr. Sulica, made significant financial contributions to pay for speakers, and/or audiovisual equipment. Some memorable earlier study group lectures (and subsequent discussion periods) include Sue Bodine (UCSD), Vince Caiozzo (UC Irvine), Ingo Titze (several times),  Mitchell Brin, Christy Ludlow,  Giuseppe Sant’Ambrogio ,  Jean-Paul Marie, and Hongliang Zheng.

Many of us will never forget a NLSG meeting Dr. Woodson organized in a beautiful and rustic conference room overlooking the Pacific Ocean in LaJolla. Another memorable NLSG meeting was on a fateful morning during the AAOHNS in Denver.  Chuck Ford remembers, “As things were rapidly turning chaotic on September 11, 2001, I was on my way to attend the NLSG meeting at the Academy meeting in Denver.  Pausing to observe the unfolding of horrific events in NY, I was interrupted and asked to preside over the meeting.  While many were glued to the evolving news and others found their way out of town, I found presiding that meeting a welcome short reprieve.”

Dr. Ford was also instrumental in another NLSG meeting in Vail, Colorado (2007). This meeting was focused on objective assessment of the role and value of LEMG and culminated in the OHNS paper: Recommendations of the Neurolaryngology Study Group on Laryngeal Electromyography. Blitzer A, Crumley RL, Dailey SH, Ford CN, Floeter MK, Hillel AD, Hoffmann HT, Ludlow CL, Merati A, Munin MC, Robinson LR, Rosen C, Saxon KG, Sulica L, Thibeault SL, Titze I, Woo P, Woodson GE. Otolaryngol Head Neck Surg. 2009 Jun;140(6):782-793.

Over the years several scientific studies (at least 2 of which were multi-institutional) were launched after discussions at the NLSG, and many others were derived, nurtured, and fostered by the dialogue and rich intellectual milieu engendered by the NLSG.

Dr. Woodson and I chaired the group intermittently until ~2005, when we passed the baton to new director/chair Lucian Sulica.     Lucian did a superb job of lining up speakers, venues, and letting potential attendees know time and place of each meeting.  Then in 2015 Stacy Halum became chair of the Study Group.  As expected Stacy has maintained the quality of excellence of the programs and kept the NLSG on the “cutting edge”.  Through Dr. Halum’s (and her successors’) leadership we look forward to many years of sharing research and surgical advances in the field of Neurolaryngology.