Comparison between the acoustic fundamental frequency of the voice and the vibration frequency of the vocal folds analyzed by digital kymography. / Comparação entre a frequência fundamental acústica da voz e a frequência de vibração das pregas vocais analisada pela videoquimografia digital.

PURPOSE: To compare the frequency of vocal fold opening variation, analyzed by digital kymography, with the fundamental voice frequency obtained by acoustic analysis, in individuals without laryngeal alteration. METHODS: Observational analytical cross-sectional study. The participants were forty-eight women and 38 men from 18 to 55 years of age. The evaluation was made by voice acoustic analysis, by the habitual emission of the vowel /a/ for 3 seconds, and days of the week, and digital kymography (DKG), by the habitual emission of the vowels /i/ and /ɛ/. The measurements analyzed were acoustic fundamental frequency (f0), extracted by the Computerized Speech Lab (CSL) program, and dominant frequency of the variation of right (R-freq) and left (L-freq) vocal fold opening, obtained through the KIPS image processing program. The mounting of the kymograms consisted in the manual demarcation of the region by vertical lines delimiting width and horizontal lines separating the posterior, middle and anterior thirds of the Rima glottidis. In the statistical analysis, the Anderson-Darling test was used to verify the normality of the sample. The ANOVA and Tukey tests were performed for the comparison of measurements between the groups. For the comparison of age between the groups, the Mann-Whitney test was used. RESULTS: There are no differences between the values of the frequency measurement analyzed by digital kymography, with the acoustic fundamental frequency, in individuals without laryngeal alteration. CONCLUSION: The values of the dominant frequency of the vocal folds opening variation, as assessed by digital kymography, and the acoustic fundamental frequency of the voice are similar, allowing comparison between these measurements in the multidimensional evaluation of the voice, in individuals without laryngeal alteration.

OBJETIVO: Comparar a frequência da variação da abertura das pregas vocais, analisada pela videoquimografia digital, com a frequência fundamental da voz, obtida através da análise acústica, em indivíduos sem alteração laríngea. MÉTODO: Trata-se de um estudo observacional analítico transversal. Participaram 48 mulheres e 38 homens, de 18 a 55 anos. A avaliação foi composta por análise acústica da voz, obtida pela emissão habitual da vogal /a/ durante 3 segundos, e os dias da semana, e pela videoquimografia digital (DKG), obtida pela emissão habitual das vogais /i/ e /ɛ/. As medidas analisadas foram a frequência fundamental acústica (f0), extraída pelo programa Computerized Speech Lab (CSL), e a frequência dominante da variação de abertura da prega vocal direita (D-freq) e esquerda (E-freq), obtidas através do programa de processamento de imagens KIPS. A montagem dos quimogramas constou na demarcação manual da região, compostas por linhas verticais que delimitaram largura da prega vocal e linhas horizontais que marcaram os terços posterior, médio e anterior da rima glótica. Na análise estatística, o teste Anderson-Darling foi utilizado para verificar a normalidade da amostra. Os testes ANOVA e Tukey foram realizados para a comparação das medidas entre os grupos. Para a comparação da idade entre os grupos, foi utilizado o teste Mann-Whitney. RESULTADOS: Não existem diferenças entre os valores da medida de frequência analisada pela videoquimografia digital, com a frequência fundamental acústica, em indivíduos sem alteração laríngea. CONCLUSÃO: Os valores da frequência dominante da variação de abertura das pregas vocais, avaliada pela videoquimografia digital, e a frequência fundamental acústica da voz são similares, permitindo uma comparação entre estas medidas na avaliação multidimensional da voz, em indivíduos sem alteração laríngea.

Visual-perceptive assessment of glottic characteristics of vocal nodules by means of high-speed videoendoscopy.

OBJECTIVE: Visual-perceptive assessment of glottic characteristics of vocal nodules by means of high-speed videoendoscopy. METHODS: Descriptive observational research with convenience sampling of five laryngeal videos of women with an average age of 25 years. The diagnosis of vocal nodules was defined by two otolaryngologists, with 100% intra-rater agreement and 53.40% inter-rater agreement and five otolaryngologists as judge assessed the laryngeal videos based on an adapted protocol. The statistical analysis calculated measures of central tendency and dispersion, as well as percentage. The AC1 coefficient was used for agreement analysis. RESULTS: In high-speed videoendoscopy imaging, vocal nodules are characterized by amplitude of the mucosal wave and muco-undulatory movement with magnitude between 50% and 60%. Non-vibrating segments of vocal folds are scarce, and the glottal cycle does not show a predominant phase, it is symmetric and periodic. Glottal closure is characterized by the presence of a mid-posterior triangular chink (double chink or isolated mid-posterior triangular chink), without movement of supraglottic laryngeal structures, with irregular contour of the free edge of vocal folds, which are vertically on-plane. CONCLUSION: Vocal nodules present mid-posterior triangular chink and irregular free edge contour. Amplitude and mucosal wave were partially reduced. LEVEL OF EVIDENCE: Level 4 (Case-series).

Experimental model for controlled endoscopic subepithelial vocal fold injury in rats.

PURPOSE: To present a detailed, reproducible, cost-efficient surgical model for controlled subepithelial endoscopic vocal fold injury in the rat model. METHODS: Six male Sprague Dawley rats were enrolled in the experiment. The left vocal folds were used to carry out the injury model, and the right vocal fold served as control. After deep sedation, the rats were placed on a custom operating platform. The vocal fold injury by subepithelial stripping was carried out using custom-made microsurgical instruments under endoscopic guidance. Data were analyzed for procedural time and post-procedural pain. Microcomputed tomography (micro-CT) scan and histologic images were obtained to assess the length, area, and depth of injury to the vocal fold. RESULTS: The mean procedural time was 112 s. The mean control vocal fold length was 0.96 ± 0.04 mm. The mean vocal fold injury length was 0.53 ± 0.04 mm. The mean vocal fold surface was 0.18 ± 0.01 mm2 with a mean lesion area of 0.05 ± 0.00 mm2. Mean vocal fold injury depth was 375.4 ± 42.8 µm. The lesion length to vocal fold length ratio was 0.55 ± 0.03, as well as lesion area to vocal fold surface area was 0.29 ± 0.02. CONCLUSIONS: Our described experimental vocal fold injury model in rats is found to be fast, safe, cost-efficient, and reproducible with a rapid learning curve.

Ultrasonido como complemento en el manejo de la vía aérea / Ultrasound as a complement in the management of the airway

OBJECTIVE: To analyze the usefulness of ultrasound (US) as a complement to airway management. An overview of how to obtain a real-time airway ultrasound at the bedside is reviewed and the support for its use is checked against the evidence. MATERIALS AND METHODS: The search was carried out in Pubmed and Medline, yielding 722 articles of interest with different levels of evidence. The literature search was limited to studies conducted in humans, published in English and Spanish between August 2011 and August 2021.35 articles were included in this review. DISCUSSION: The usefulness of ultrasound in the evaluation and management of the airway is analyzed: predictors of difficult airway; cervical airway access; confirmation of tracheal intubation; calculation of endotracheal tube (ETT) size and depth. CONCLUSIONS: Airway ultrasound could be a useful tool for anesthesiologists, emergency physicians and intensivists, which could help improve patient care and safety. However, more research is needed to validate its use.

OBJETIVO: Analizar la utilidad del ultrasonido (US) como complemento al manejo de la vía aérea. Se revisa una descripción general de cómo obtener una ecografía de la vía aérea en tiempo real a la cabecera del paciente y se coteja el respaldo de su utilización con la evidencia. MATERIALES Y MÉTODOS: La búsqueda se realizó en Pubmed y Medline, arrojando 722 artículos de interés con distinto nivel de evidencia. La búsqueda bibliográfica se limitó a estudios realizados en humanos, publicados en inglés y español entre agosto de 2011 y agosto de 2021. Se incluyeron 35 artículos en esta revisión. DISCUSIÓN: Se analiza la utilidad del ultrasonido en la evaluación y manejo de la vía aérea: predictores de vía aérea difícil (VAD); acceso cervical de la vía aérea; confirmación de intubación traqueal; cálculo de tamaño de tubo endotraqueal (TET) y profundidad de éste. CONCLUSIONES: El ultrasonido en la vía aérea podría ser una herramienta útil para anestesiólogos, emergenciólogos e intensivistas, que podrían ayudar a mejorar la atención y la seguridad del paciente. Sin embargo, se necesitan más investigaciones para validar su uso.

Kymographic characteristics of voice in women with Polycystic ovary syndrome.

PURPOSE: Polycystic ovary syndrome (PCOS) is heterogenous condition with commonly associated symptoms include irregular menstrual cycle, hirsutism, baldness, adult acne, and weight gain There have been few attempts at profiling the voice characteristics of women with polycystic ovary syndrome. Videokymography enables to detect even subtle variationsin vocal fold vibrations. The aim of the present study was to study the videokymographic characteristics among women with PCOS. METHODS: A cross-sectional study was carried out among 50 women with and without PCOS diagnosed on ultrasonography. Videokymography was carried out and the characteristics were perceptually analyzed using a vocal fold kymographic rating scale. The analysis of the kymogram was done for the following characteristics; presence of vocal fold vibration,interference of surroundings, Cycle to cycle variability, left-right asymmetry,cycle aberrations and shape of lateral peaks. The kymographic images were obtained for all the participants of both the groups and a subjective consensus evaluation was done by two clinicians. The percentage of participants with the listed kymographic characteristics were tabulated. Chi Square test was also done to decide if there was a significant difference between the two groups for different kymographic features of vocal fold vibration. RESULTS: Six of the 25 women with PCOS were found to have abnormal kymographic features such as surrounding structural interference, presence of cycle to cycle variability and the shape of lateral peaks. CONCLUSION: Early detection of the vocal abnormalities in individuals with PCOS would help in the vocal rehabilitation especially for professional voice users.

High speed digital videolaringoscopy: evaluation of vocal nodules and cysts in women.

PURPOSE: To evaluate and compare the parameters of Digital kymography obtained through the High-speed Videolaryngoscopy of women without laryngeal disorders, of women with vocal fold nodules and of women with vocal cysts. METHODS: A cross-sectional observational study in which 60 women aged 18 years and 45 years were selected. Three study groups were formed: 20 women without laryngeal disorder forming the control group (Group 1), 20 women with diagnosis of vocal fold nodules forming Group 2 and 20 women with diagnosis of vocal cysts forming Group 3. Subsequently the participants were evaluated by High-speed Videolaryngoscopy for analysis and comparison of laryngeal images using Digital kymography. The laryngeal parameters processed by the program KIPS® were: minimum, maximum and mean opening; dominant amplitude of the left and right vocal folds; dominant frequency of the right and left vocal folds; and close. RESULTS: The analysis of Digital kymography suggests that the presence of the vocal fold nodules and the vocal cysts tend to restrict more to the maximum and minimum opening of the vocal fold and the dominant amplitude of the opening variation in the middle region of the glottis. CONCLUSION: Digital kymography parameters were similar in the presence of vocal fold nodules and vocal cysts lesions.

Correlação de padrões vasculares na imagem de banda estreita com a densidade imuno-histológica de microvasos em lesões de pregas vocais / Correlation of narrow band imaging vascular patterns with immunohistological microvessel density in vocal fold lesions

Resumo Introdução: A microarquitetura dos vasos mucosos e submucosos é crucial para o diagnóstico. A neoangiogênese é um parâmetro biológico confirmado que implica progressão e metástase no câncer de laringe. Objetivo: Investigar a correlação entre as classificações de padrões vasculares por imagem de banda estreita e densidade imuno-histológica de microvasos em diferentes tipos de lesões intraepiteliais da prega vocal. Método: A análise da densidade imuno-histológica de microvasos com o uso de anticorpos CD31 e CD34 foi feita em 77 lesões, inclusive: 20 lesões não displásicas, 20 com displasia de baixo grau, 17 com displasia de alto grau e 20 com câncer invasivo. A avaliação dos padrões vasculares com a imagem de banda estreita, de acordo com as diretrizes de classificação de Ni e da European Laryngological Society, foi feita antes da ressecção cirúrgica. Resultados: O valor médio da densidade imuno-histológica de microvasos com CD31 foi o mais alto para as lesões do Tipo IV de Ni (20,55), enquanto para o padrão longitudinal e perpendicular, de acordo com a classificação da European Laryngological Society, foi de 12,50 e 19,45, respectivamente. O maior valor médio da densidade imuno-histológica de microvasos com CD34 foi identificado nas lesões de Ni Tipo Va (35,43) e nos padrões longitudinal e perpendicular de acordo com a classificação da European Laryngological Society foi de 15,12 e 30,40, respectivamente. Conclusões: As alterações morfológicas microvasculares das lesões laríngeas intraepiteliais observadas na endoscopia por imagem de banda estreita foram positivamente correlacionadas com os índices de angiogênese da avaliação imuno-histológica.

Transcutaneous Laryngeal Ultrasonography for the Assessment of Laryngeal Function After Thyroidectomy: A Review.

OBJECTIVE: This review set out to examine the applicability of transcutaneous laryngeal ultrasonography (TLUSG) for the assessment of laryngeal function after thyroidectomy. METHODS: An integrative review of the literature was performed using Medline/PubMed, LILACS, and SciELO databases. The methodological quality of the studies was analyzed using the appraisal tool for cross-sectional studies. RESULTS: All 8 included articles investigated laryngeal function with regard to the risk of vocal fold immobility after thyroidectomy. The results regarding the diagnostic power of TLUSG for this assessment are controversial, and there is a tendency to use this examination as a screening procedure for subsequent confirmation by flexible laryngoscopy. CONCLUSIONS: Transcutaneous laryngeal ultrasonography is a viable, noninvasive, and useful tool to assess laryngeal function after thyroidectomy, but current available evidence suggests that it does not replace flexible laryngoscopy for the diagnosis of vocal fold immobility.

Correlation of narrow band imaging vascular patterns with immunohistological microvessel density in vocal fold lesions.

INTRODUCTION: The microarchitecture of the mucosal and submucosal vessels is crucial for diagnosis of vocal fold lesions. Neo-angiogenesis is a confirmed biological parameter that implicates progression and metastasis in laryngeal cancer. OBJECTIVE: This study investigates the correlation between vascular pattern classifications by narrow band imaging and immunohistological microvessel density in different types of intraepithelial vocal fold lesions. METHODS: Analysis of immunohistological microvessel density using CD31 and CD34 antibodies was performed in 77 lesions including: 20 non-dysplastic lesions, 20 with low-grade dysplasia, 17 with high-grade dysplasia and 20 invasive cancers. The evaluation of vascular patterns with narrow band imaging according to the Ni classification and European Laryngological Society guidelines was performed prior to surgical resection. RESULTS: The mean value of CD31 microvessel density was the highest for Ni Type IV lesions (20.55), whereas for the longitudinal and perpendicular patterns according to the European Laryngological Society classification it was 12.50 and 19.45 respectively. The highest mean value of microvessel density with CD 34 was identified in Ni Type Va (35.43) lesions and in the longitudinal and perpendicular patterns according to the European Laryngological Society classification was 15.12 and 30.40 respectively. CONCLUSIONS: The microvascular morphological changes of intraepithelial laryngeal lesions observed under narrow band imaging endoscopy are positively correlated with angiogenesis indexes of immunohistological evaluation.

Videolaryngoscopy Quality with Protective Cover of Intraoral Odontologic Camera Evaluation in Vocal Fold Coverage Lesions.

INTRODUCTION: The examination of the larynx with indirect visualization is one of a series of steps in otorhinolaryngological evaluation. In the past this exam was performed more commonly with mirrors and headlights, but for at least the last four decades physicians have resorted to assessing the laryngopharynx with both rigid and fiberoptic instruments. The rigid 70° laryngoscope is the most used in our practice, its main drawback being the time-consuming resterilization process needed between scope usages in different patients. Recently we have been using a disposable protective cover over the rigid scope to obviate instrument contamination and thus the office time delays. OBJECTIVE: To investigate the maintenance of image quality in videolaryngoscopy (VDL), with and without a protective cover of intraoral odontologic camera (PCIOC), in patients with benign lesions of the vocal fold. METHODS: Quantitative and accurate cross-sectional study of VDL images with and without PCIOC. The images were captured by videolaringoscope of digital camera chip-on-the-tip type in an otorhinolaryngological care center. We studied patients presenting with vocal fold nodules, intracordal cysts, polyps, and Reinke's edema. All judges evaluating the images were otorhinolaryngologists. The exams with and without PCIOC were presented in a randomized form. The data of professionals' answers were analyzed by means of descriptive statistics and application of variables association tests. RESULTS: Thirty professionals participated in the study. There was no statistically significant difference between the probability of success in exams performed with or without PCIOC, nor between the perception of image quality and the number of correct answers in the diagnosis. In the polyp lesion without PCIOC there was a statistically significant difference between the confidence level of the diagnosis (and the number of correct answers (P = 0.037). CONCLUSION: There is no difference between VDL diagnoses of vocal fold coverage lesions with and without PCIOC, maintaining image quality in both VDL exams.

High speed digital videolaringoscopy: evaluation of vocal nodules and cysts in women / Videolaringoscopia digital de alta velocidade: avaliação de nódulos e cistos de pregas vocais de mulheres

ABSTRACT Purpose To evaluate and compare the parameters of Digital kymography obtained through the High-speed Videolaryngoscopy of women without laryngeal disorders, of women with vocal fold nodules and of women with vocal cysts. Methods A cross-sectional observational study in which 60 women aged 18 years and 45 years were selected. Three study groups were formed: 20 women without laryngeal disorder forming the control group (Group 1), 20 women with diagnosis of vocal fold nodules forming Group 2 and 20 women with diagnosis of vocal cysts forming Group 3. Subsequently the participants were evaluated by High-speed Videolaryngoscopy for analysis and comparison of laryngeal images using Digital kymography. The laryngeal parameters processed by the program KIPS® were: minimum, maximum and mean opening; dominant amplitude of the left and right vocal folds; dominant frequency of the right and left vocal folds; and close. Results The analysis of Digital kymography suggests that the presence of the vocal fold nodules and the vocal cysts tend to restrict more to the maximum and minimum opening of the vocal fold and the dominant amplitude of the opening variation in the middle region of the glottis. Conclusion Digital kymography parameters were similar in the presence of vocal fold nodules and vocal cysts lesions.

RESUMO Objetivo Avaliar e comparar os parâmetros da videoquimografia digital obtidos pela videolaringoscopia de alta velocidade de mulheres sem alterações laríngeas, de mulheres com nódulos de prega vocal e de mulheres com cistos vocais. Método Estudo observacional transversal, no qual foram selecionadas 60 mulheres com idade entre 18 e 45 anos. Três grupos foram formados: 20 mulheres sem alterações laríngeas formando o grupo controle (Grupo 1), 20 mulheres com diagnóstico de nódulos nas pregas vocais formando o Grupo 2 e 20 mulheres com diagnóstico de cistos vocais formando o Grupo 3. Posteriormente, os participantes foram avaliados por Videolaringoscopia de alta velocidade para análise e comparação de imagens da laringe usando videoquimografia digital. Os parâmetros videoquimográficos avaliados pelo programa KIPS® foram: aberturas mínima, máxima e média; amplitudes da prega vocal direita e esquerda; frequências da abertura da prega vocal direita e esquerda; e fechamento. Resultados A análise da videoquimografia digital sugere que a presença dos nódulos e dos cistos de pregas vocais tendem a restringir a abertura máxima e média da prega vocal e a amplitude dominante da variação de abertura na região média da glote. Conclusão Os parâmetros da videoquimografia digital foram semelhantes na presença de nódulos nas pregas vocais e lesões de cistos vocais.

Kymographic characteristics of voice in women with Polycystic ovary syndrome

ABSTRACT Purpose Polycystic ovary syndrome (PCOS) is heterogenous condition with commonly associated symptoms include irregular menstrual cycle, hirsutism, baldness, adult acne, and weight gain There have been few attempts at profiling the voice characteristics of women with polycystic ovary syndrome. Videokymography enables to detect even subtle variations in vocal fold vibrations. The aim of the present study was to study the videokymographic characteristics among women with PCOS. Methods A cross-sectional study was carried out among 50 women with and without PCOS diagnosed on ultrasonography. Videokymography was carried out and the characteristics were perceptually analyzed using a vocal fold kymographic rating scale. The analysis of the kymogram was done for the following characteristics; presence of vocal fold vibration,interference of surroundings, Cycle to cycle variability, left-right asymmetry,cycle aberrations and shape of lateral peaks. The kymographic images were obtained for all the participants of both the groups and a subjective consensus evaluation was done by two clinicians. The percentage of participants with the listed kymographic characteristics were tabulated. Chi Square test was also done to decide if there was a significant difference between the two groups for different kymographic features of vocal fold vibration. Results Six of the 25 women with PCOS were found to have abnormal kymographic features such as surrounding structural interference, presence of cycle to cycle variability and the shape of lateral peaks. Conclusion Early detection of the vocal abnormalities in individuals with PCOS would help in the vocal rehabilitation especially for professional voice users.

Prenatal diagnosis of laryngo-tracheo-esophageal anomalies in fetuses with congenital diaphragmatic hernia by ultrasound evaluation of the vocal cords and fetal laryngoesophagoscopy.

BACKGROUND: To evaluate the incidence of laryngeal ultrasound (US) abnormalities in fetuses with congenital diaphragmatic hernia (CDH) and to assess the utility of fetal laryngoesophagoscopy for prenatal diagnosis of laryngo-tracheo-esophageal anomalies. STUDY DESIGN: A cohort of CDH fetuses with laryngeal ultrasound abnormalities were selected for diagnostic fetal laringoesophagoscopy in a single fetal surgery center at Queretaro, Mexico. RESULTS: During the study period, 210 CDH fetuses were evaluated. US examination of the vocal cords was successfully performed in all fetuses, and abnormal ultrasound findings were observed in four cases (1.9%). Fetal laringoesophagoscopy was successfully performed in all four cases at a median gestational age of 29.5 (range, 28.1-30.6) weeks. During fetal intervention, a laryngo-tracheo-esophageal cleft (TEC) extending from the larynx to the carina (type IV) was endoscopically visualized in three cases, and laryngeal atresia coexisting with TEC was confirmed in the remaining case. Fetal karyotype was normal in all cases, but abnormal chromosomal microarray analysis was reported in two cases (50%). All cases were delivered liveborn with severe respiratory failure presenting cardiac arrest and immediate neonatal death. CONCLUSIONS: Laryngeal anomalies in CDH fetuses can be presumed by ultrasound evaluation of the vocal cords and confirmed by fetal laryngoesophagoscopy during pregnancy.

Learning curve for endoscopic evaluation of vocal folds lesions with narrow band imaging / Curva de aprendizado para avaliação endoscópica de lesões de pregas vocais com imagem de banda estreita

Abstract Introduction: The endoscopic methods are progressing and becoming more common in routine clinical diagnosis in the field of otorhinolaryngology. Relatively large amount of researches have proved high accuracy of narrow band imaging endoscopy in differentiating benign and malignant lesions within vocal folds. However, little is known about learning curve in narrow band imaging evaluation of laryngeal lesions. Objective: The aim of this study was to determine the learning curve for the narrow band imaging evaluation of vocal folds pathologies depending on the duration of the procedure. Methods: Records of 134 narrow band imaging that were analyzed in terms of the duration of the procedure and the accuracy of diagnosis confirmed by histopathological diagnosis were enrolled in the study. The narrow band imaging examinations were performed sequentially by one investigator over a period of 18 months. Results: The average duration of narrow band imaging recordings was 127.82 s. All 134 studies were divided into subsequent series of several elements. An evident decrease in time of investigation was noticed between 13th and 14th series, when the examinations were divided into 5 elements series, which corresponds to the difference between 65th and 70th subsequent narrow band imaging examination. Parallel groups of 67 examinations were created. Group 1 included 1st to 67th subsequent narrow band imaging examination; Group 2 - 68th to 134th narrow band imaging examinations. The non-parametric U Mann-Whitney test confirmed statistically significant difference between the mean duration of narrow band imaging examination in both groups 160.5 s and 95.1 s, respectively (p < 10−7). Sensitivity and specificity of narrow band imaging examination in the first group were respectively: 83.7% and 76.7%. In the second group, these indicators amounted 98.1% and 80% respectively. Conclusions: A minimum of 65th-70th narrow band imaging examinations are required to reach a plateau phase of the learning process in assessment of glottis lesions. Analysis of learning curves is useful for the development of training programs and determination of a mastery level.

Resumo Introdução: Os métodos endoscópicos estão progredindo e se tornando comuns no diagnóstico clínico de rotina também na otorrinolaringologia. Um número relativamente grande de pesquisas demonstrou alta precisão na endoscopia com imagem de banda estreita na diferenciação de lesões benignas e malignas nas pregas vocais. Entretanto, pouco se sabe sobre a curva de aprendizado na avaliação da de banda estreita de lesões laríngeas. Objetivo: Determinar a curva de aprendizado para a avaliação por imagem de banda estreita das afecções das pregas vocais, de acordo com a duração do procedimento. Método: Foram incluídos no estudo 134 registros de imagens de banda estreita analisadas em termos da duração do procedimento e da acurácia do diagnóstico confirmado pelo diagnóstico histopatológico. Os exames com imagem de banda estreita foram feitos sequencialmente por um investigador por 18 meses. Resultados: A duração média dos registros de imagem de banda estreita foi de 127,82s. Todos os 134 estudos foram divididos em séries subsequentes de vários elementos. Uma evidente diminuição no tempo de investigação foi observada entre as séries 13 e 14, quando os exames foram divididos em séries de cinco elementos, o que corresponde à diferença entre o 65° e 70° exames de imagem de banda estreita subsequentes. Foram criados grupos paralelos de 67 exames. O grupo 1 incluiu o 1° ao 67° exame de imagem de banda estreita subsequente; Grupo 2 - o 68° ao 134° exame de imagem de banda estreita. O teste não paramétrico U de Mann-Whitney confirmou uma diferença estatisticamente significante entre a duração média do exame de imagem de banda estreita em ambos os grupos de 160,5s e 95,1s, respectivamente (p < 10-7). A sensibilidade e especificidade do exame de imagem de banda estreita no primeiro grupo foram, respectivamente: 83,7% e 76,7%. No segundo grupo, esses indicadores foram 98,1% e 80%, respectivamente. Conclusões: Um mínimo de 65 a 70 exames de imagem de banda estreita é necessário para se atingir a fase de estabilização (plateau) do processo de aprendizado na avaliação de lesões de glote. A análise das curvas de aprendizado é útil para o desenvolvimento de programas de treinamento e determinar o n.

The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer / O papel da imagem de banda estreita intraoperatória na microcirurgia transoral a laser para câncer glótico inicial e moderadamente avançado

Abstract Introduction: Trans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer. Objective: The authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins. Methods: Forty-four consecutive T1-T2 glottic cancers treated with trans-oral laser microsurgery Type I-VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section. Results: Our study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively. Conclusion: The intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light.

Resumo Introdução: A microcirurgia transoral a laser é uma técnica bem estabelecida para o tratamento de câncer de laringe inicial e moderadamente avançado. Objetivo: Verificar a utilidade da imagem de banda estreita na avaliação intraoperatória da mucosa laríngea na especificação das margens cirúrgicas. Método: Foram avaliados 44 cânceres glóticos T1-T2 consecutivos, tratados com cordectomia Tipo I-VI, por microcirurgia transoral a laser. As áreas suspeitas (90 amostras/44 pacientes) foram submetidas a biopsia e avaliadas através de imagens de banda estreita e luz branca e enviadas para cortes por congelação. Resultados: Nosso estudo revelou que 75 (83,3%) das 90 amostras apresentaram histopatologia positiva na análise com luz branca e imagens de banda estreita: 30 (40%) foram confirmadas como carcinoma in situ ou carcinoma invasivo e 45 (60%) como displasia moderada a grave. Em seis pacientes, a mucosa apresentou-se suspeita apenas na imagem de banda estreita, sem suspeita sob luz branca. Assim, nesses seis pacientes 18/90 (20%) amostras foram colhidas. Em 5/6 pacientes, 16/18 (88,8%) amostras mostraram resultado positivo na análise de congelação: em 6/18 (33,3%) amostras foi confirmado carcinoma (dois pacientes) e em 10/18 (66,6%) foi confirmada displasia grave (três pacientes). Em um paciente, 2/18 (11,1%) as amostras mostraram resultado negativo na congelação. A análise apresentada mostrou que a sensibilidade, a especificidade e a acurácia da luz branca foram de 79,5%, 20% e 71,1%, respectivamente, enquanto a imagem de banda estreita apresentou como resultados 100%, 0,0% e 85,7%, respectivamente. Conclusão: O uso intraoperatório de imagem de banda estreita provou ser valioso na identificação de áreas suspeitas da mucosa, confirmou as suspeitas verificadas na análise com luz branca e, o que é mais importante, identificou microlesões além do alcance da luz branca.

Learning curve for endoscopic evaluation of vocal folds lesions with narrow band imaging.

INTRODUCTION: The endoscopic methods are progressing and becoming more common in routine clinical diagnosis in the field of otorhinolaryngology. Relatively large amount of researches have proved high accuracy of narrow band imaging endoscopy in differentiating benign and malignant lesions within vocal folds. However, little is known about learning curve in narrow band imaging evaluation of laryngeal lesions. OBJECTIVE: The aim of this study was to determine the learning curve for the narrow band imaging evaluation of vocal folds pathologies depending on the duration of the procedure. METHODS: Records of 134 narrow band imaging that were analyzed in terms of the duration of the procedure and the accuracy of diagnosis confirmed by histopathological diagnosis were enrolled in the study. The narrow band imaging examinations were performed sequentially by one investigator over a period of 18 months. RESULTS: The average duration of narrow band imaging recordings was 127.82s. All 134 studies were divided into subsequent series of several elements. An evident decrease in time of investigation was noticed between 13th and 14th series, when the examinations were divided into 5 elements series, which corresponds to the difference between 65th and 70th subsequent narrow band imaging examination. Parallel groups of 67 examinations were created. Group 1 included 1st to 67th subsequent narrow band imaging examination; Group 2 - 68th to 134th narrow band imaging examinations. The non-parametric U Mann-Whitney test confirmed statistically significant difference between the mean duration of narrow band imaging examination in both groups 160.5s and 95.1s, respectively (p<10-7). Sensitivity and specificity of narrow band imaging examination in the first group were respectively: 83.7% and 76.7%. In the second group, these indicators amounted 98.1% and 80% respectively. CONCLUSIONS: A minimum of 65th-70th narrow band imaging examinations are required to reach a plateau phase of the learning process in assessment of glottis lesions. Analysis of learning curves is useful for the development of training programs and determination of a mastery level.

The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer.

INTRODUCTION: Trans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer. OBJECTIVE: The authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins. METHODS: Forty-four consecutive T1-T2 glottic cancers treated with trans-oral laser microsurgery Type I-VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section. RESULTS: Our study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively. CONCLUSION: The intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light.

A Computerized Tomography Study of Vocal Tract Setting in Hyperfunctional Dysphonia and in Belting.

BACKGROUND: Vocal tract setting in hyperfunctional patients is characterized by a high larynx and narrowing of the epilaryngeal and pharyngeal region. Similar observations have been made for various singing styles, eg, belting. The voice quality in belting has been described to be loud, speech like, and high pitched. It is also often described as sounding "pressed" or "tense". The above mentioned has led to the hypothesis that belting may be strenuous to the vocal folds. However, singers and teachers of belting do not regard belting as particularly strenuous. PURPOSE: This study investigates possible similarities and differences between hyperfunctional voice production and belting. This study concerns vocal tract setting. METHODS: Four male patients with hyperfunctional dysphonia and one male contemporary commercial music singer were registered with computerized tomography while phonating on [a:] in their habitual speaking pitch. Additionally, the singer used the pitch G4 in belting. The scannings were studied in sagittal and transversal dimensions by measuring lengths, widths, and areas. RESULTS: Various similarities were found between belting and hyperfunction: high vertical larynx position, small hypopharyngeal width, and epilaryngeal outlet. On the other hand, belting differed from dysphonia (in addition to higher pitch) by a wider lip and jaw opening, and larger volumes of the oral cavity. CONCLUSIONS: Belting takes advantage of "megaphone shape" of the vocal tract. Future studies should focus on modeling and simulation to address sound energy transfer. Also, they should consider aerodynamic variables and vocal fold vibration to evaluate the "price of decibels" in these phonation types.