Videolaryngostroboscopy Research Articles

Microsuture after benign vocal fold lesion removal: a randomized trial

PurposeRemoval of benign vocal fold lesions results in small to moderate-sized mucosal defect on vocal fold, which heals by secondary intention. Microsuturing this defect leads to primary wound healing with fastened recovery and less scar. However, its value has not been determined. Materials and methodsThis is prospective, randomized, and controlled study performed in university hospital. Forty adults with vocal polyp, cyst, and Reinke's edema were included. Preoperatively, all patients completed VHI (Voice Handicap Index)–30, had acoustic analysis with continuous /a/ and videolaryngostroboscopy (VLS). The patients were randomly assigned to study group (with 1 or 2 6/0 vicryl suture) (n = 20) or control group (n = 20). Postoperative follow-up was done at the first, second, and fourth weeks. During follow-up examinations, VLS was repeated; the patients completed VHI-30 and had an acoustic analysis again. ResultsAll patients recovered with normal VLS and without complications; all were satisfied with the treatment result. The VHI results and acoustic analysis parameters of the study group were statistically significantly better than those of the control group at the first postoperative week (P < .05) but not at the second and fourth weeks (P > .05). Normal VLS was obtained significantly more early in the study group compared with the control group (P < .05). ConclusionsMicrolaryngoscopic removal of benign vocal fold lesions is a safe, satisfying procedure with excellent to good results if done according to its principles. Microsuturing of the mucosal defect helps to speed up recovery, although final result remains to be clinically unchanged. It may be beneficial for professional voice users by making early return of vocal fold function possible.

Etiology of Dyspnea in Elite and Recreational Athletes

Background: Breathing complaints are common in athletes. Studies have suggested that the prevalence of asthma and exercise-induced bronchoconstriction (EIB) is higher in elite athletes than the general population. Vocal cord dysfunction (VCD) may mimic asthma and EIB as a cause of dyspnea in athletes. However, the majority of studies to date have primarily relied on symptoms to diagnose VCD, and there are limited data on coexistence of asthma, EIB, and/or VCD. It is well established that symptoms alone are inadequate to accurately diagnose EIB and VCD. Our goal was to define via objective testing the prevalence of asthma, EIB, VCD alone, or in combination in a cohort of athletes with respiratory complaints. Methods: A retrospective chart review was done of 148 consecutive athletes (collegiate, middle school, high school, and recreational) referred to a tertiary care center's asthma center for evaluation of respiratory complaints with exercise. An evaluation including medical history, physical examination, and objective testing including pulmonary function testing (PFT), eucapnic voluntary hyperventilation, and video laryngostroboscopy, were performed. Results: The most common symptom was dyspnea on exertion (96%), with < 1% complaining of either hoarseness or stridor. The most common diagnosis prior to referral was asthma (40%). Only 16% had PFTs prior to referral. Following evaluation by a pulmonologist, 52% were diagnosed with EIB, 17% with asthma, and 70% with VCD. Of those diagnosed with asthma before our evaluation, the diagnosis of asthma was confirmed, with PFTs in only 19 of 59 (32%) athletes based on our testing. Vocal cord dysfunction was more common in females and in adolescent athletes. Coexistence of multiple disorders was common, such as EIB and asthma (8%), EIB and VCD (31%), and VCD and asthma (6%). Conclusions: Asthma and EIB are common etiologies of dyspnea in athletes, both competitive and recreational. However, VCD is also common and can coexist with either asthma or EIB. Vocal cord dysfunction may contribute to exercise-related respiratory symptoms more frequently in middle school– and high school–aged athletes than in college athletes. Effective treatment of dyspnea requires appropriate identification and treatment of all disorders. Classic symptoms of stridor and/or hoarseness are often not present in athletes with VCD. Accurate diagnosis of asthma, EIB, and VCD requires objective testing and can prevent exposure of patients to medications that are ineffective and have potential adverse side effects. Furthermore, there is need for increased awareness of VCD as a common cause of respiratory complaints in athletes, either as a single diagnosis or in combination with EIB, especially in females, as well as middle school and high school athletes.

Larenks Kanserinde Videolarengostroboskopi ve Bilgisayarlı Tomografi Bulgularının Histopatolojik Sonuçlarla Karşılaştırılması

Objective: The aim of this study was to investigate which diagnostic method was more efficient and reliable for preoperative T staging of laryngeal cancers by comparing videolaryngostroboscopy (VLS) and computed tomography (CT) findings with histopathologic examination of operation specimens. The main goal was to determine the most rational and accurate approach for preoperative evaluation and staging of larynx cancers. Material and Methods: This retrospective study included 58 patients operated on for larynx cancer. Preoperative VLS and CT findings were compared with histopathologic examination results of the operation specimens. The larynx was divided into 12 anatomical areas for this purpose. In addition, thyroid and cricoid cartilage invasion and extralaryngeal invasion parameters were included in the evaluation. Invasion of the tumor was identified by each evaluation method separately. Mobility of the vocal cords and arytenoids was evaluated with VLS. Results: CT was more effective than VLS in the evaluation of the paraglottic area, preepiglottic area, and subglottic area. CT was superior to VLS for the identification of thyroid involvement, cricoid cartilages and extralaryngeal invasion. VLS was more effective than CT for the assessment of the vocal cords and anterior commissure. Both diagnostic methods were effective for identification of tumor on the epiglottis. Conclusion: Success of VLS and CT changes according to the involvement of different anatomic areas. A combination of VLS and CT together, while taking into consideration the location of the tumor, improves accurate staging and consequently the surgical success.

Assessment of the influence of osteopathic myofascial techniques on normalization of the vocal tract functions in patients with occupational dysphonia

Occupational voice disorders are accompanied by increased tension of the external laryngeal muscle which changes the position of the larynx and consequently disturbs the conditions of functioning of the vocal tract. The aim of the study is to assess the use of osteopathic procedures in the diagnosis and treatment of occupational dysphonia. Study subjects included 40 teachers with chronic diseases of the voice organ (38 women and 2 men) aged from 39 to 59 (mean age: 48.25). Before and after the voice therapy the osteopathic examination according to Libermann's protocol was performed as well as phoniatric examination including laryngovideostroboscopy (LVSS), assessment of the maximum phonation time (MPT) and the Voice Handicap Index (VHI) score. The voice therapy, scheduled and supervised by a laryngologist-phoniatrician and conducted by a speech-language pathologist, was supplemented with osteopathic myofascial rehabilitation of the larynx. The chi-square McNemar test and non-parametric Wilcoxon matched pairs test were applied in the statistical assessment. The applied interdisciplinary treatment including osteopathic and vocal therapy resulted in a statistically significant decrease in tenderness of muscles raising the larynx (cricothyroid ligament, sternocleidomastoid muscles, and pharyngeal constrictor muscles) and in lowering the tonus (geniohyoid muscles, pharyngeal constrictor muscles and sternocleidomastoid muscles). A significant improvement was also observed in the case of dysfunction of the cricothyroid joint examined during glissando and yawning, as well as in asymmetry of the thyrohyoid apparatus. Moreover, the therapy resulted in significantly better normalization of the head position and better control of the centre of gravity of the body. Statistically significant post-therapy improvement was observed in the phoniatric examination, including VHI scores, MPT results and parameters of videostroboscopic examination. The use of osteopathic therapy helps significantly improve the functions of the vocal tract in patients with occupational dysphonia.

Laryngovideostroboscopy in children—Diagnostic possibilities and constraints

Objective The aim of this study was to report our experience with laryngovideostroboscopy (LVS) in consecutively examined children patients. Methods The study included 150 children (2.5–14 years of age) diagnosed with dysphonia. Patients were divided into three age groups: group I – from 2.5 to 6 years of age ( n = 31), group II – from 6 to 10 years of age ( n = 73), and group III – from 10 to 14 years of age ( n = 46). LVS was performed during the second visit. 3.5 mg of dormicum were administered orally 30 min prior to LVS in all children from group I and in some patients belonging to group II. Local anesthesia of the pharyngeal mucosa was not needed in any case. Results In nine out of 150 children, it was not possible to perform LVS during the first attempt. In eight of these children, the examination was performed successfully during another visit with satisfactory LVS images obtained. LVS revealed soft vocal fold nodules in 85 patients along with other organic changes found in five children: congenital laryngeal web ( n = 1), vocal fold cysts ( n = 3), and vocal fold paralysis ( n = 1). Hyper-functional dysphonia was diagnosed in the remaining 60 subjects. Conclusions In order to perform successful LVS in children patient, the purpose and methodology of this examination should be explained to parents on the first visit whereas an attempt to perform LVS should be undertaken during the second visit. Oral administration of dormicum 30 min prior to the examination is advisable, particularly in younger children, and allows us to avoid the use of local anesthetics.

Videokymographic image processing: Objective parameters and user-friendly interface

Videolaryngostroboscopy (VLS) is undoubtedly a first choice examination technique in the diagnosis of several laryngeal pathologies. However, in case of low intensity or strong a-periodicity of the vocal sound, the VLS mechanism becomes ineffective in describing subsequent phases of the vocal cycle. To overcome such limitations, a new technique, called videokymography (VKG), was developed. VKG delivers images and displays the vibratory pattern from a single line selected from the whole VLS image, at the speed of approximately 8000 line-images/s. Despite its usefulness, parameter evaluation has been mostly based on visual inspection and no quantitative analysis of videokymographic images is commercially available at this time.This article presents the VKG-Analyser, a new tool for measuring and tracking quantitative parameters from VKG images. Specifically, the left-to-right period, amplitude and phase ratios and phase symmetry index were evaluated. The case of incomplete glottis closure, the minimum distance between folds was implemented.A digital image processing algorithm was developed and optimised for the analysis of VKG recordings that require intensity adjustment, noise removal and robust techniques for edge detection to avoid fluctuations of the grey levels in regions far from the vocal folds. The VKG-Analyser relies on a user-friendly interface that allows for the storage and retrieval of patients’ data and optimises the image analysis, according to a set of parameters that can be manually adjusted by the user.It was successfully tested on a set of synthetic images and applied to real VKG images, both in the case of complete and incomplete glottis closure.The new software tool aims to provide fast, reliable and reproducible measures. When applied to a large set of data, it can define reference values for normal and pathological cases, providing a valid support for diagnosis and evaluation of surgical effectiveness.

Gardasil® Immunization Effects on Laryngeal Papillomatosis: A Preliminary Study

The potential role of the adjuvant use of Gardasil® vaccine (series of three injections) in the treatment of recurring laryngeal papillomatosis (RRP) was evaluated in an adult population of 18 cases (12 m & 6 f, age range 37-79) being treated by one laryngologist with a long term meticulous CO2 laser removal every two-to-three months and than at double intervals, until no visible papillomas was observed by transoral magnified laryngovideostroboscopy (LVS), and when visual findings were questionable, verification was done by MDL with microscopic visualization. Thus each patient’s history was used as their control. Of the 18 cases, nine (5 m and 4 f) were still positive at the last inthe-office post final vaccination exam, while the remaining nine (7 m and 2 f) were negative for papilloma at the last post final vaccination office visit, within the range of eight to 27 months post final Gardasil® vaccine injection. This indicates a decrease in the recurrence (duration) time. The results also showed a reduction in papilloma clusters size and numbers found on recurrence by either LVS or by MDL.

Diagnostic Contributions of Videolaryngostroboscopy in the Pediatric Population

Videolaryngostroboscopy (VLS) is a standard technique used for evaluating adult patients with dysphonia. However, while pediatric dysphonia affects 5% of children, children with dysphonia are traditionally examined with a flexible nasal endoscope. The purpose of this study was to determine whether VLS provides additional diagnostic yield in children. A retrospective medical chart review was conducted from 2001 to 2006. Tertiary care center. Pediatric patients aged 3 to 17 years (mean age, 11 years) who presented with prolonged dysphonia. All patients were previously examined by flexible laryngoscopy and treated with speech therapy for a presumed diagnosis of vocal cord nodules. Flexible or rigid VLS was performed. The diagnosis per patient established after VLS. Eighty patients were included in the study: 50 underwent rigid VLS; 28 underwent flexible VLS; and 2 did not tolerate either procedure. A total of 132 diagnoses were made, including 68 benign mucosal diseases (41 nodules, 15 polyps, 8 cysts, and 4 sulci), 41 inflammatory disorders, 11 functional disorders, 6 congenital disorders, 4 traumatic injuries, and 2 neurologic disorders. Many patients received more than 1 intervention for their dysphonia, including antireflux medication and speech therapy, but 16 patients also underwent phonomicrosurgery. Patients with a history of prolonged dysphonia for whom treatment has failed should be referred for evaluation by VLS. Videolaryngostroboscopy elucidates subtle features of different disease processes; clarifies the differences between benign mucosal disorders that might require surgical intervention; and helps identify inflammatory processes that contribute to dysphonia. To our knowledge, these findings have not previously been reported in the pediatric population. Although most pediatric dysphonia can be attributed to benign nodules, our results show that inflammatory conditions and benign lesions other than nodules contribute to dysphonia and are often overlooked and undertreated.

Vocal cord dysfunction: Beyond severe asthma

Vocal cord dysfunction (VCD) is the abnormal adduction of the vocal cords during inspiration causing extrathoracic airway obstruction. VCD has been described as a confounder of severe asthma. The influence of VCD among less severe asthmatics has not been previously defined. We retrospectively reviewed the medical records of 59 patients with pulmonologist-diagnosed asthma who were referred for videolaryngostroboscopy (VLS) testing from 2006 to 2007. A total of 44 patients had both asthma and VCD. 15 patients had asthma without concomitant VCD. Females were predominant in both groups. Overall, the majority of patients referred for VLS testing had mild-to-moderate asthma (78%) and 72% of these patients had VCD. Few patients from either group had "classic" VCD symptoms of stridor or hoarseness. Gastroesophageal reflux disease (GERD) and rhinitis were common in both groups. Vocal cord dysfunction occurs across the spectrum of asthma severity. There was a lack of previously described "classic" VCD symptoms among asthmatics. Symptoms were diverse and not easily distinguished from common symptoms of asthma, highlighting the need for a high index of suspicion for VCD in patients with asthma. Failure to consider and diagnose VCD may result in misleading assumptions about asthma control, and result in unnecessary adjustments of asthma medications. The high prevalence of GERD raises the question of the role of acid reflux in the pathogenesis of VCD in asthmatics.

A New Insight Into Postsurgical Objective Voice Quality Evaluation: Application to Thyroplastic Medialization

This paper aims at providing new objective parameters and plots, easily understandable and usable by clinicians and logopaedicians, in order to assess voice quality recovering after vocal fold surgery. The proposed software tool performs presurgical and postsurgical comparison of main voice characteristics (fundamental frequency, noise, formants) by means of robust analysis tools, specifically devoted to deal with highly degraded speech signals as those under study. Specifically, we address the problem of quantifying voice quality, before and after medialization thyroplasty, for patients affected by glottis incompetence. Functional evaluation after thyroplastic medialization is commonly based on several approaches: videolaryngostroboscopy (VLS), for morphological aspects evaluation, GRBAS scale and Voice Handicap Index (VHI), relative to perceptive and subjective voice analysis respectively, and Multi-Dimensional Voice Program (MDVP), that provides objective acoustic parameters. While GRBAS has the drawback to entirely rely on perceptive evaluation of trained professionals, MDVP often fails in performing analysis of highly degraded signals, thus preventing from presurgical/postsurgical comparison in such cases. On the contrary, the new tool, being capable to deal with severely corrupted signals, always allows a complete objective analysis. The new parameters are compared to scores obtained with the GRBAS scale and to some MDVP parameters, suitably modified, showing good correlation with them. Hence, the new tool could successfully replace or integrate existing ones. With the proposed approach, deeper insight into voice recovering and its possible changes after surgery can thus be obtained and easily evaluated by the clinician.

Subjective and Objective Evaluation of Voice Quality in Patients With Asthma

To evaluate the voice quality in patients with mild-to-moderate asthma by subjective and objective methods. Comparative, controlled, cross-sectional study. Patients with mild-to-moderate asthma (n=40) and age- and sex-matched healthy controls (n=40) were included. Acoustic analyses were performed by the Multi-Dimensional Voice Program (MDVP; Kay Elemetrics Corporation, Lincoln Park, NJ) and the movements of the vocal cords were examined by videolaryngostroboscopy (VLS). In addition, the duration of illness, maximum phonation time, "s/z" values, and vital capacity were evaluated. Voice Handicap Index (VHI) and GRB scales were used for subjective evaluations. Maximum phonation time values were significantly shorter both in male and female asthma patients compared with controls (P<0.0001). Also, average shimmer values in MDVP were higher for both sexes in the patient group compared with controls (P=0.002 and P=0.04, respectively). There was a significant difference between female patients and sex-matched controls with regard to mean noise-to-harmonic ratio values (P=0.006). Female patients with asthma had higher average jitter values compared with sex-matched controls (P<0.0001). A significant difference was noted between asthma and control groups with regard to GRB scale (P<0.0001, P<0.001, and P<0.0001, respectively). The VHI score was above the normal limit in 16 (40%), and VLS findings were abnormal in 39 (97.5%) asthmatics. In asthmatic patients, maximum phonation time, frequency, and amplitude perturbation parameters were impaired, but the vital capacity and the duration of illness did not correlate with these findings.

Multidimensional assessment of functional outcomes of medialization thyroplasty

Medialization thyroplasty (MT) is the most widely used laryngeal framework phonosurgical procedure for managing glottic incompetence secondary to unilateral vocal fold paralysis (UVFP). The aim of the study was to evaluate the functional outcomes of MT in 32 UVFP patients, comparing multidimensional perceptual and instrumental measures of voice before and after surgery, and to evaluate how close to normal that postoperative voice measure became. Video laryngostroboscopy (VLS), auditory perceptive evaluation of voice, the patients' self-evaluation of hoarseness on the Visual Analogue Scale (VAS) and calculation of the Voice Handicap Index (VHI), analysis of objective acoustic voice parameters, quantitative assessment of phonetograms and measurement of maximum phonation time were conducted. Vocal function was evaluated before the surgery and for the period from 1 month to 3 years (Mo 1.0 month; Me 2.0 months) after MT. VLS confirmed remarkable medialization of the paralyzed vocal fold. As a consequence, hoarseness and breathiness were found to be significantly decreased after MT. Pitch and intensity range and phonetogram area were significantly increased. A significant decrease of jitter, shimmer and normalized noise energy reflected improvement of the stability of acoustic signal and a more efficient pattern of phonation. Thus, the perceptual and acoustic voice parameters studied showed statistically significant differences (P < 0.001) between preoperative and postoperative voices, and these objective measurements of voice changes provided accurate and documentary evidence of the results of surgical treatment. A high degree of patient satisfaction with the MT was confirmed by a significant decrease of VHI and hoarseness on VAS. Thus, results of the present investigation confirm the functionality and effectiveness of MT in patient voice rehabilitation with UVFP. However, the means of acoustic voice parameters measured in the study did not reach normal limits, probably because of the remaining underlying condition of UVFP.

Effects of different electrical parameter settings on the intelligibility of speech in patients with Parkinson's disease treated with subthalamic deep brain stimulation

We evaluated the effects of different electrical parameter settings on the intelligibility of speech in patients with Parkinson's disease (PD) bilaterally treated with deep brain stimulation (DBS) in the subthalamic nucleus (STN). Ten patients treated with DBS for 15 +/- 5 months (mean, SD) with significant (P < 0.01) symptom reduction (Unified Parkinson's Disease Rating Scale III) were included. In the medication off condition, video laryngostroboscopy was performed and then, in random order, 11 DBS parameter settings were tested. Amplitude was increased and decreased by 25%, frequency was varied in the range 70 to 185 pps, and each of the contacts was tested separately as a cathode. The patients read a standard running text and five nonsense sentences per setting. A listener panel transcribed the nonsense sentences as perceived and valued the quality of speech on a visual analogue scale. With the patients' normally used settings, there was no significant (P = 0.058) group difference between DBS OFF and ON, but in four patients the intelligibility deteriorated with DBS ON. The higher frequencies or increased amplitude caused significant (P < 0.02) impairments of intelligibility, whereas changing the polarity between the separate contacts did not. The settings of amplitude and frequency have a major influence on the intelligibility of speech, emphasizing the importance of meticulous parameter adjustments when programming DBS to minimize side effects related to speech.

Pediatric video laryngo-stroboscopy

Laryngo-stroboscopy remains as the clinical gold standard for assessing properties of the glottal phonatory and valvular function. This includes deficits of closure as well as mucosal wave irregularities secondary to abnormal zones of pliability and symmetry. Per-oral stroboscopy has technical limitations in children due to the size of the telescope and issues of patient compliance. However, flexible laryngoscopy is readily performed in newborns and young children. This paper describes the use of a new trans-nasal, digital flexible laryngoscope, which allows for laryngo-stroboscopy in children. A prospective longitudinal series was done on 25 children ages 19 months-13 years (mean age, 7.0 years) with this new technology. All 25 were successfully examined. New technological advancements in the design of digital flexible endoscopes has allowed for laryngo-stroboscopy, and therefore, provides the potential for expanding the population of children with vocal disorders in whom stroboscopic imaging is possible. Larger studies will be necessary to determine its limitations related to age, development, and disease. As the study of pediatric voice disorders continues to evolve, accurate diagnosis is essential to apply state of the art non-operative and phonosurgical interventions. Further longitudinal studies are currently underway to continue to refine techniques of pediatric voice assessment and to define limitations of this new technology.

Videofluoroscopic evaluation of the swallowing function after supracricoid laryngectomy

This study was designed to evaluate the swallowing function in patients with supracricoid laryngectomy (SCL) compared to normal subjects and to search for the factors affecting postoperative aspiration. Ten patients who underwent SCL with cricohyoidopexy (CHP) for primary laryngeal squamous cell carcinoma were included in the study. The control group consisted of 13 normal adult volunteer men with similar ages. The swallowing act of the subjects was evaluated by using videofluoroscopy (VFS) and videolaryngostroboscopy (VLS). The movements of the larynx were measured with regard to the hyoid bone, mandible and vertebral spine. The patients with SCL-CHP, except for two who had slight aspiration, had effective and near normal swallowing regarding the measurements of the movements of the hyoid bone. They could tolerate a near-normal oral diet. We have observed that the preventive precautions for aspiration are preserving the superior laryngeal nerves, suturing and positioning the cricoarytenoid unit as anterosuperiorly as possible, early decannulation and early onset of swallowing rehabilitation; the risk factors for aspiration are advanced stage of cancer, postoperative radiation and shortening of bolus transit time. VFS is useful for the patients with postoperative aspiration, because it is the definitive technique for anatomical and physiological evaluation of swallowing. We consider that the parameters of VLS and VFS, such as tongue base-arytenoid contact, presence of bolus splitting, pseudoepiglottis function, maximal opening of the pharyngoeosophageal sphincter and total movement of hyoid bone are important criteria to evaluate swallowing.

Videolaryngostroboscopic observation of mucus layer during vocal cord vibration in patients with vocal nodules before and after surgery

ObjectiveUnder normal conditions, the vocal fold mucus layer is too thin to permit observation using videolaryngostroboscopy (VLS) during phonation. However, vocal nodules (VNs) typically cause congealed and sticky mucus to appear on the vocal fold. Reports in the literature regarding this phenomenon are limited. The aim of this study was to review VLS recordings of VN patients, analyzing changes that occurred in the mucus layer that covers the vocal fold during vibration following VN surgery.Material and MethodsUsing VLS, we studied the occurrence of, and changes in, vocal fold mucus layers in 160 VN patients before and after surgery.ResultsEighty-eight patients (55%) were found to have a mucus layer during preoperative examinations. Of these mucus layers, 21 (13%) were located on the anterior commissure or anterior third of the vocal fold (A), 58 (36.3%) on the junction of the anterior and middle thirds (M), 1 (0.6%) on the posterior third (P), 5 (3.1%) on both A and M and 3 (1.9%) on both M and P. Fifty-six (35%) cases were found to have a mucus layer during postoperative examinations. Of these, 44 (27.5%) were located on A, 8 (5%) on M, 1 (0.6%) on P and 3 (1.9%) on both A and M. These results indicate that changes in the mechanical force on the vocal fold, alteration of the laryngeal secretory gland and improper aerodynamic airflow result in increased mucus viscosity and aggregation in VN patients and that the combination of these factors further increases the severity of dysphonia.ConclusionsSurgery to remove vocal nodes may be an effective method to eliminate both vocal bumps and aggregated mucus. Based on the present results, it is recommended that future research should compare surgery to remove VN against other mucus layer reduction methods in order to determine which is the most effective.

Pre- and intraoperative assessment of mid-cord erythroleukoplakias: a prospective study on 52 patients.

A pre- and intraoperative evaluation by videolaryngostroboscopy (VLS) and saline infusion (SI) into Reinke's space was prospectively applied to a cohort of 52 patients with mid-vocal cord erythroleukoplakias observed at our institution between January 1997 and June 1999. These tests were done to predict the invasion of the layered structure of the lamina propria and consequently determine the deep extent of the excisional biopsy to be carried out. According to the results of these examinations, carbon dioxide laser resections were performed as follows: 25 Type I, 17 Type II and 10 Type III cordectomies according to the European Laryngological Society Classification. Histopathologic diagnoses were keratosis without atypia in 13 patients, keratosis with mild, moderate or severe dysplasia in 8, 3 and 5, respectively, microinvasive carcinoma in 12 and invasive carcinoma in 11. By comparing the type of resection with the pathologic diagnosis obtained on the specimen and its surgical margins, we estimated the number of under- and overtreatments. In addition, an assessment was made on specificity, sensitivity, positive and negative predictive values and accuracy of VLS and SI, both independently and in combination. Thirty-eight patients (73%) received the correct type of resection, 1 patient (2%) an undertreatment and 13 (25%) an overtreatment. VLS and SI showed a specificity, sensitivity, positive and negative predictive values and accuracy of 82, 100, 94, 100, 97% and 90, 83, 86, 87 and 87%, respectively. The VLS/SI combination raised the values to 89, 100, 88, 100 and 94%. The 4-year overall and disease-free survival and ultimate local control with laser alone were 90, 94 and 100%.

Clinical measurement of mucosal wave velocity using simultaneous photoglottography and laryngostroboscopy.

Simultaneous glottal transillumination or photoglottography (PGG), electroglottography (EGG), and video laryngostroboscopy were used to measure the traveling wave velocity of the vibrating vocal folds during phonation in human subjects. The duration of travel was calibrated from the PGG signal, while the displacement of the upper and lower lips of the vibrating vocal folds was calibrated from parallel laser beams projected onto the vocal folds. The mucosal wave velocity varied with the portion of the glottal cycle. The amplitude of displacement correlated positively with the intensity of phonation and negatively with the fundamental frequency and was decreased for breathy and pressed phonation modes. The velocity of the opening phase segment of the PGG signal directly correlated with the top lip displacement of the vibrating vocal fold, and bottom lip displacement correlated with the closing phase of the PGG signal. Therefore, with suitable calibration, the effects of mucosal lateral displacement may be measured from a PGG signal. Simultaneous measures of PGG, EGG, and stroboscopy provide a three-dimensional representation of glottal vibration that can be numerically analyzed.

Aerodynamic and stroboscopic findings before and after microlaryngeal phonosurgery

Acoustic, aerodynamic, and laryngo-video-stroboscopy (LVS) studies were done on 50 patients before and after microlaryngeal surgery for benign vocal fold lesions. Perceptual pre- and postratings were also obtained. After microlaryngeal surgery, statistically significant differences between pre- and posttreatment conditions included postoperative findings of (a) a lowering of mean flow rate, (b) an increase in glottal efficiency, and (c) an increase in maximum sound pressure level. There was no significant improvement in maximum phonation time. Stroboscopy findings showed changes of glottal configuration, linearity of the vocal fold edge, amplitude of vocal fold vibration, excursion of the mucosal wave, and periodicity. Acceptable perceptual voice quality appeared to depend on a straight vocal fold edge, good vibratory amplitude, and good mucosal wave. Improved understanding of vocal function after phonosurgery should help us refine surgical principles and techniques. The combined use of LVS and phonatory function measures is advocated.

A comparison of four clinical techniques in the analysis of phonation

<h2>Summary</h2> The success of four clinical techniques for voice analysis were compared: videolaryngoscopy, videolaryngostroboscopy (VLS), electroglottography (EGG) for laryngeal adduction, and acoustic perturbation analysis. Two normal and 26 consecutive voice patients were studied. All four techniques were successful with the normals and 42% of the patients. There were difficulties for 23% of the patients for the stroboscopic technique, 46% for the EGG analysis, and 35% for acoustic analysis. These difficulties were due primarily to aperiodicity of the voice signals or, in the case of stroboscopy, to the inability to view the vocal folds because of hypertrophy of tissue. Videolaryngoscopy failed only once due to intolerance by the patient. For the 28 subjects, only three (11%) could not be analyzed by either VLS, EGG, or acoustic techniques. There was a moderate correspondence between VLS and EGG analysis for the estimate of glottal adduction. The results strongly suggest the complementary and overlapping interpretations of these measures and, thus, the usefulness of the battery for clinical voice analysis.