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

Botulinum toxin injection into the interarytenoid muscle appears to be a safe and effective modality for treating recalcitrant vocal process granuloma.

This is the first report describing a dislodged inflated balloon in the subglottis as a complication of dilation for idiopathic subglottic stenosis. Awareness of this possibility, as well as preparedness with the proper instruments, is vital for prevention of a catastrophic emergency during an otherwise low-risk procedure.