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With appropriate selection criteria, TNE yields a high percentage of positive findings and wide range of esophageal abnormalities, directly impacting patient management. Available to otolaryngologists in the outpatient setting, TNE expedites interventions by providing a safe, effective alternative to rigid esophagoscopy under general anesthesia and flexible upper endoscopy with sedation. Patients will benefit from the integration of TNE into otolaryngologists' outpatient diagnostic armamentarium.

Our objective was to describe an injection needle modification for awake in‐office vocal fold injections through a percutaneous transthyrohyoid approach. Two separate 45° angle bends are created at the hub and 1 cm from the needle tip of a 25‐gauge, 1.5‐inch needle. After adequate endolaryngeal anesthesia, the needle is passed via the thyrohyoid membrane into the airway. The needle tip is at a 90° angle to the syringe, providing access to the entire vocal fold surface, regardless of chin position or thyroid cartilage angulation. The bend at 1 cm also serves as a marker to measure the depth of the needle within the soft tissue. The double‐bend needle modification allows for complete access to the entire length of the true vocal fold in one pass as well as a marker to measure depth of the needle in the tissue. Limitations may include bleeding from the injection site, insufficient needle length in patients with a long anterior‐posterior dimension of the larynx, and potential difficulty passing a needle through a calcified thyrohyoid membrane. Laryngoscope, 2012

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