Clinical and Anatomical Variation During Assessment of Maximum Glottic Angle.

INTRODUCTION: Quantitative measurement and analysis of glottic abduction is used to assess laryngeal function and success of interventions; however, the consistency of measurement over time has not been established. This study assesses the consistency of glottic abduction measurements across visits in healthy patients and anatomic factors impacting these measurements. METHODS: Review of patients with two sequential flexible stroboscopic exams over seven months from 2019-2022. Images of maximal glottic abduction were captured and uploaded into and measured with ImageJ. Cadaver heads were used to assess the impact of visualization angles on glottic measurements with a monofilament inserted into the supraglottis of each cadaver as a point of reference. Comparisons were done with a paired T-test, T-test, or Mann-Whitney U test as appropriate. RESULTS: Fifty-nine patients and twenty-six cadaveric exams were included. Absolute change in maximum glottic abduction angle (MGAA) was 6.90° (95% CI [5.36°, 8.42°]; p < 0.05). There were no significant differences in change in MGAA by gender or age. Twenty percent of patients had a change of at least 25% in their MGAA between visits. Absolute differences in glottic angle between nasal side for cadaveric measurements was 4.77 ± 4.59° (p < 0.005)-2.22° less than the change in MGAA seen over time (p = 0.185). CONCLUSION: Maximal glottic abduction angles varied significantly between visits. Factors considered to be contributing to the differences include different viewing windows between examinations due to the position and angulation of the laryngoscope and changes in patient positioning, intra- and inter-rater variations in measurement, and patient effort. LEVEL OF EVIDENCE: N/a Laryngoscope, 134:2793-2798, 2024.

Stroboscopic assessment of unilateral vocal fold paralysis: a systematic review.

PURPOSE: To review the relevant basic stroboscopic evaluations in unilateral vocal fold paralysis (UVFP). Our aim was twofold: (1) to determine the frequency of use of stroboscopic parameters in outcome evaluation after surgical treatment of UVFP using a Pareto diagram; and (2) to select the most relevant parameters in terms of a significant difference between pre- and post-surgical intervention for UVFP. METHODS: A systematic review in PUBMED includes studies on stroboscopic evaluation in combination with UVFP and surgical treatment. The review was limited to English studies published between 1990 and March 2018. The most frequently used stroboscopic parameters were identified using a Pareto diagram. Then, 'the percentage of significance' for the most frequently stroboscopic parameters was identified by comparing the number of studies that showed a statistically significant change in pre- and post-treatment results with the total number of studies using the same parameters. RESULTS: Seven stroboscopic parameters were nominated using the Pareto diagram. In decreasing order of citation frequency, periodicity, edge bowing, mucosal wave, glottic gap, position of vocal fold, amplitude, and symmetry have respective percentages of significance of 87.5%, 83.3%, 77.7%, 64.5%, 60%, 57.1%, and 50%. Five pertinent scales were selected for the most frequent and significant stroboscopic parameters. CONCLUSIONS: The results indicate that periodicity, edge bowing, mucosal wave, glottic gap, and position of vocal fold represent the five most frequently used and relevant stroboscopic parameters in UVFP evaluation. The current review outlines a proposal scale of these stroboscopic parameters. PROSPERO REGISTRATION NUMBER: CRD42019126786.

Preliminary Assessment of Dynamic Voice CT in Post-Airway Reconstruction Patients.

Objectives To compare the ability of the dynamic voice computed tomography (CT) scan to characterize laryngeal function in airway reconstruction patients vs bedside endoscopic nasopharyngolaryngoscopy and videolaryngostroboscopy. Study Design Case series with chart review. Settings Pediatric tertiary care center. Subjects and Methods Retrospective case series of children and young adults with a history of complex airway surgeries with subsequent dysphonia. We analyzed clinical data for all patients who underwent an airway reconstruction procedure between January 1, 2010, and April 30, 2016, and also had a dynamic voice CT and bedside endoscopic exam during the same period. Results Twenty-four patients were analyzed (4 male, 20 female) with a mean age of 15.1 years (95% confidence interval [CI], 12.9-17.22). Patients had a mean of 2.2 airway surgeries (95% CI, 1.8-2.6), with 62.5% of them being open procedures. Laryngotracheoplasty with a cartilage graft was the most common procedure (40.0%). The pattern of laryngeal closure could be detected in all cases with the dynamic CT scan (n = 24/24, 100%) compared to 87.5% (21/24) with the standard endoscopic examination ( P = .04). The location of gap closure could be detected in all cases (24/24) with the dynamic voice CT while 20.8% (5/24 patients) could not be rated with standard endoscopy/stroboscopy ( P = .02). Dynamic voice CT was able to assess the vertical closure pattern of the glottis 100% (24/24) while it could be detected in 83.3% (20/24) cases with endoscopic study ( P = .04). Conclusion Dynamic voice CT shows promise as an additional tool for evaluation of patients with a history of complex airway procedures by providing complementary information.

The predictive value of videostroboscopy in the assessment of premalignant lesions and early glottis cancers.

OBJECTIVE: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds. MATERIAL AND METHODS: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated. RESULTS: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively - 90.7%, 31.4%, 78.9%, 84.1% and 45.8%. CONCLUSIONS: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.

Assessment of acoustic characteristics of voice in patients after injection laryngoplasty with hyaluronan.

BACKGROUND: Glottal incompetence is one of the most common contributing factors in patients who suffer from dysphonia. One of the different treatment approaches is injection laryngoplasty. The aim of the study was to assess the quality of voice in patients who were treated with hyaluronic acid injection into the vocal fold in the long-term follow-up. MATERIAL AND METHODS: The material included 39 patients with dysphonia who were referred for injection augmentation. The studied group included patients with presbyphonia, scar, sulcus, unilateral vocal fold paralysis and with atrophy of the vocal fold. Preoperative and postoperative examination was based on laryngovideostroboscopy. Patients' voice was assessed using the subjective GRBAS scale, and objective evaluation provided by Multidimensional Voice Program (MDVP) was applied. All the patients underwent injection laryngoplasty with hyaluronic acid into the vocal folds. Follow-up examinations were conducted 6, 12 and 24 months postoperatively. RESULTS: Perceptual voice quality assessed with the GRBAS scale was improved and the results were stable in the long-term follow-up periods. MDVP showed a significant statistical improvement within the group of frequency, amplitude and noise parameters. The differences in value between follow-up periods were not statistically significant. CONCLUSIONS: Acoustic analysis of voice is a reliable method for objective assessment of voice quality after applied treatment. Injection of the hyaluronic acid into the vocal fold improves the quality of voice in patients suffering from glottic insufficiency.

Update on pediatric voice and airway disorders: assessment and care.

PURPOSE OF REVIEW: To investigate the status of the recent literature focused on studying the assessment and treatment of pediatric voice and airway disorders using both established and novel techniques. RECENT FINDINGS: Recent research regarding voice assessment and treatment reveals the use of systematic and innovative approaches when collecting instrumental and perceptual voice data. There are recent advancements in certain surgical interventions designed to minimize complications. Wider use of functional endoscopic imaging of the pediatric larynx is improving our understanding of childhood voice production and airway management. There is also an important emerging focus on quantifying the impact of having a childhood voice disorder through the use of new tools. Although there is an increase in pediatric voice and airway research, many studies tend to be entirely descriptive rather than quantitative. There continues to be little specific research that uses prospective, longer-term and formal voice outcomes before and after behavioral and surgical interventions. SUMMARY: Pediatric voice and airway disorders are an important childhood health problem. Voice assessment in children should include formal perceptual and instrumental evaluations, including sophisticated acoustic, aerodynamic and imaging modalities. The care of these children requires a collaborative approach that includes systematic and innovative treatment methods.

[Stroboscopic assessment of chronic laryngitis]. / Valoración estroboscópica de laringitis crónicas.

INTRODUCTION: The laryngostroboscopy allows analysis of the vocal fold vibrations during phonation. Disruption of normal viscoelastic properties of the superficial lamina propria results in aberrant vocal fold vibration and mucosal wave propagation. Therefore, an investigation was performed to relate the stroboscopic results with the anatomopathologic results of chronic laryngitis and glottic cancer. MATERIAL AND METHODS: We performed a retrospective study, which included 30 direct laryngoscopies with biopsy of 25 patients and their corresponding laryngostroboscopies. RESULTS: 60% of the cases of "absence of mucosal wave" displayed severe dysplasia or carcinoma. 20% of the cases of "limited or present mucosal wave" were carcinoma. CONCLUSIONS: The probability of finding severe dysplasia or carcinoma is significantly greater when we find absence of mucosal wave. The presence of mucosal wave does not exclude the possibility of malignant lesion of the vocal fold.

Nódulos vocais: análise anátomo-funcional / Vocal nodules: functional and anatomical analysis

Objetivo: traçar o perfil epidemiológico/clínico de uma população portadora de nódulos vocais diagnosticados e comparar os tipos de fendas glóticas à fonação. Métodos: foram avaliados os registros de 70 pacientes portadores de nódulos vocais diagnosticados através de exame videolaringoestroboscópico no período de junho de 2003 a maio de 2004. As imagens arquivadas foram analisadas por quatro fonoaudiólogos e dois otorrinolaringologistas, conforme os seguintes parâmetros: simetria laríngea, aspecto da lesão, tipo de fenda, onda mucosa, movimento muco-ondulatório, amplitude de vibração, presença de sinais de refluxo e constrição supraglótica. Resultados: os dadosencontrados apontam maior incidência de nódulos vocais em mulheres adultas que utilizavam a voz profissionalmente. Clinicamente, não houve associação significativa entre pacientes fumantes com queixa de refluxo e pacientes portadores de nódulos. Ao exame videolaringoestroboscópico observamos:87,4% de lesões bilaterais e 12,6% unilaterais. O fechamento supraglótico medial ocorreu em apenas 01 caso, sendo caracterizado como unilateral e não participando da fonação. Em 3 pacientes identificou-se a presença de microweb. Todos os pacientes apresentaram fenda glótica, sendo 90,9% delas classificadas como dupla. Conclusão: a amostra foi composta predominantemente por mulheres,com idade média de 34,64 anos, não fumantes, professoras, trabalhando em três turnos, cuja queixa de rouquidão teve duração média de 5,68 meses, apresentando ao exame laringe simétricacom nódulos bilaterais, de igual tamanho. Houve significância estatística apontando proporção maior de fendas duplas.

Purpose: to determine the epidemiological/clinical profile of patients with vocal nodules, and comparetheir glottic closure during phonation. Methods: seventy vocal nodules patients were evaluated by videolaryngostroboscopy at Instituto de Otorrinolaringologia de Minas Gerais, from June 2003 to May 2004. The video images were analyzed by 4 speech therapists and 2 otorhinolaryngologists, according to the following criteria: laryngeal symmetry, lesion aspect, kind of glottic closure, mucous wave, vocalfold vibration ,vibratory amplitude, gastroesophageal reflux signals and supraglottalconstriction. Results: Data showed that the highest incidence was found with adult professional voice user females. Clinically, it was observed that there was no meaningful relationship among smoking patients or the ones withgastroesophageal reflux and those with vocal nodules. The videolaryngostroboscopy showed: 87.4% bilateral lesions and 12.6% unilateral lesions. We noted that medial supraglottal closure was found injust one case, characterized as an unilateral lesion and with no participation during phonation. Threesubjects presented a Microweb. All patients had incomplete glottal closure and 90.9% of them were classified as double. Conclusion: the sample was composed mainly by non- smoking female teachers, about 34 years old, involved in a three journey workday with a 5.68 moths hoarseness complaintpresenting laryngeal symmetry, and bilateral nodules same size. There was a statistically significant proportion of incomplete glottal closure.

[Videostroboscopy assessment in patients with vocal fold hypertrophy underwent microsurgery]. / Ocena wideostraboskopowa w przewleklych stanach przerostowych krtani leczonych chirurgicznie.

Chronic hypertrophic laryngitis concerns many people in our population. Their aetiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of videostroboscopy examination. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness. The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Videostroboscopy examination was done just before microsurgery and 3 months after operation. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The first group consist of patients with minor vocal fold lesions (limited to I of vocal fold length), the second group consist of patients with extensive vocal fold lesions (above I of vocal fold length). The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes. In both groups (with minor and extensive vocal fold lesions) significant improvement in videostroboscopy parameters was observed. The functional results in the group with minor vocal fold lesions were better after microsurgery, but it turned out that results were not statistically significant.

Multidimensional assessment of voice and speech after supracricoid laryngectomy with cricohyoidopexy.

This study was designed: to evaluate the vocal function in the patients with supracricoid laryngectomy (SCL) compared with normal subjects; to determine the factors affecting voice (such as number of arytenoid(s) preserved and movement of larynx and tongue base); and to determine the correlations between videolaryngostroboscopy, acoustic and perceptual parameters. Ten patients who underwent SCL with cricohyoidopexy for primary laryngeal squamous cell carcinoma were included into the study. Vocal function was investigated by means or videolaryngostroboscopy. Voice quality was assessed by means of objective acoustic analysis and subjective perceptual ratings by trained raters. Aberrant, incompetent, and rough mucosal wave was observed in the anterior and superior surfaces of arytenoids(s), the inferior part of tongue base and the lateral walls of the hypopharynx. The acoustic parameters were found to be significantly different from those of normal subjects. The values of perceptual scores were approximately within 50 per cent of normal range. The number of arytenoids spared did not affect acoustic or perceptual measurements. A rough, breathy, unpleasant but intelligible and acceptable voice could be obtained after SCL with cricohyoidopexy.