Videolaryngoscopy. A comparison of fiberscopic and telescopic documentation

Prevalence of Presbyphonia in Older Adults With Dysphonia: A Systematic Review and Meta-Analysis

PURPOSE

This study aims to investigate the prevalence of presbyphonia among older adults who report voice complaints.

METHOD

We conducted a systematic search of five medical databases to identify studies that reported on presbyphonia as the cause of voice disorders in older adults. The pooled prevalence was calculated using random-effects models and presented as percentages with 95% confidence intervals (CI). The degree of heterogeneity among studies was assessed using I2 statistics. Subgroup analyses were performed to identify the sources of heterogeneity.

RESULTS

Out of 764 abstracts from five libraries, 11 studies were included in this systematic review. The pooled prevalence of presbyphonia among older adults with voice disorders is 17.78% (95% CI [12.69, 23.51]). We conducted a subgroup analysis on studies that used laryngeal visualization to confirm the diagnosis for all patients and found that the prevalence of presbyphonia was lower in studies with unrestrictive inclusion criteria (12.84%, 95% CI [8.38, 18.08]) compared to studies with restricted inclusion criteria (22.59%, 95% CI [14.49, 31.88]).

CONCLUSIONS

This study suggests that voice disorders in older adults have multiple causes, not predominantly presbyphonia. Overestimation of presbyphonia prevalence occurs if certain diagnoses are excluded at recruitment. This study emphasizes the importance of recognizing the diverse underlying etiologies of dysphonia in older adults; therefore, comprehensive examination and accurate diagnosis are crucial.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24263029.

A Preliminary Case Report of a High-Quality Cost-effective Rigid Laryngoscopy Setup

OBJECTIVE

To evaluate a cost-effective modified rigid laryngoscopy setup with a portable light source and high-resolution commercially available digital camera for use in smaller otolaryngology and family practice clinics.

METHODS

The modified setup was used to obtain images of the larynx using both a traditional light source and a portable light source. Varying shutter speeds and ISOs were evaluated, and the optimal settings were determined for the modified setup.

RESULTS

Picture quality was adequate, and the portable light source was bright enough. ISO from 640 to 1600 with shutter speeds ranging from 1/60 to 1/160 are ideal under the normal light source, while it is better to set the ISO between 4000 and 10 000 with shutter speeds from 1/60 to 1/100 under the portable light source. Picture quality was adequate with a resolution of 2768 pixels × 1848 pixels with 350 dpi × 350 dpi.

CONCLUSIONS

Results show that the modified setup obtains images of adequate quality for use in the clinic. Additionally, since the larynx requires the most illumination for endoscopic imaging, a similar setup would work for imaging the ear and nose. This setup may make laryngoscopic exams more accessible to patients at smaller laryngoscopy clinics or family practice providers.

Pediatric Videonasoendoscopy for Speech and Voice Evaluation

Many otolaryngologists and speech clinicians have found videofiberoptic evaluations to be invaluable for assessment of velopharyngeal and laryngeal function in adults. However, many professionals question the feasibility of routine use of these procedures in the pediatric population. This article describes a method for successful completion of videonasoendoscopic speech and voice evaluations of children as young as 3 years of age. The importance of the ENT/speech team is emphasized in both the collection and interpretation of data. In addition, contributions of videonasoendoscopic observations to diagnosis, medical treatment, and therapy for speech and voice disorders are discussed.

Prevalence of laryngeal irritation signs associated with reflux in asymptomatic volunteers: impact of endoscopic technique (rigid vs. flexible laryngoscope)

OBJECTIVES

The objectives of this study were to 1) determine the prevalence of ENT findings in the normal asymptomatic population and 2) to compare findings between flexible and rigid laryngoscopes in an attempt to increase specificity of diagnosis of reflux in endoscopic laryngeal examinations.

STUDY DESIGN

Prospective study.

METHODS

Fifty-two nonsmoker volunteers (24 male, 28 female), mean age of 42.7 years, with no history of ENT abnormalities or gastroesophageal reflux disease, underwent both rigid and flexible videolaryngologic examinations with a digital endoscopic unit. A group of three expert judges reviewed the oral and transnasal examinations blindly and independently for physical signs of irritation/inflammation commonly associated with reflux.

RESULTS

Atleast one sign of tissue irritation was detected in 93% and 83% of the population when using a flexible and a rigid laryngoscope, respectively. Results showed a high incidence of posterior commissure bar (53.2% and 51.9%), arytenoid complex edema/erythema (76.3% and 53.2%), and pseudosulcus (37.2% and 7.7%). Most signs were more frequently detected on flexible transasal examinations than with rigid transoral examinations: posterior pharyngeal wall (<0.01), interarytenoid irritation (<0.01), arytenoids complex irritation (<0.01), ventricular obliteration (<0.01), and pseudosulcus (<0.01).

CONCLUSIONS

Several signs of posterior laryngeal irritation (e.g., interarytenoid bar, erythema of the medial wall of the arytenoids), which are generally considered to be signs of laryngopharyngeal reflux, are present in a high percentage of nonsymptomatic individuals, raising question about their diagnostic specificity. In addition, these signs were more often detected with flexible than with rigid laryngoscopes, suggesting that flexible laryngoscopy is more sensitive but less specific in identifying laryngeal tissue irritation.

Estudo comparativo da deglutição com nasofibrolaringoscopia e videodeglutograma em pacientes com acidente vascular cerebral

Os distúrbios da deglutição são bastante freqüentes nos pacientes neurológicos e naqueles com doenças ou seqüelas de cirurgia de cabeça e pescoço, sendo causa de importante morbidade e mortalidade. Apesar do videodeglutograma (VD) ser considerado o exame de escolha para a avaliação dos distúrbios da deglutição, este exame apresenta limitações em algumas situações clínicas, além de expor o doente à radiação e ao risco de aspiração do contraste. Em anos recentes, têm sido também utilizadas fibras ópticas flexíveis para avaliar os pacientes com disfagia e outras queixas relacionadas à deglutição. OBJETIVO: Análise comparativa entre os dados obtidos pela NFL e VD em relação a parâmetros estudados por ambos métodos. FORMA DE ESTUDO: Caso controle. MATERIAL E MÉTODO: Foram avaliados prospectivamente 12 pacientes com seqüela de acidente vascular cerebral isquêmico, no período de janeiro a maio de 2002, por meio do estudo dinâmico da deglutição com nasofibrolaringoscopia (NFL) e VD, sendo os resultados comparados estatisticamente. RESULTADOS: Enquanto o VD permite a análise da fase preparatória oral e oral da deglutição e o início da fase faríngea, a NFL permite estudo da sensibilidade e mobilidade faringo-laríngea, além da visualização direta do alimento. Através do teste estatístico McNemar, nenhum dos parâmetros analisados apresentou divergência estatisticamente significante (p<0,05) quando comparados os resultados na NFL e VD. CONCLUSÕES: A análise comparativa entre os dados obtidos pelo NFL e VD em relação a parâmetros avaliados por ambos métodos, em pacientes com disfagia, mostraram não haver diferenças significativas entre eles.

Diagnostic laryngeal endoscopy

Diagnostic laryngeal endoscopy is a crucial part of the evaluation of patients with dysphonia. Multiple methods are available, and often several are required to provide a comprehensive physiologic and anatomic evaluation. The pros and cons of each method are discussed and the development of a standardized examination protocol is reviewed.

Stroboscopic videolaryngoscopy: a comparison of fiberscopic and telescopic documentation

The clinical value of stroboscopic videolaryngoscopy (SVL) for the evaluation of laryngeal disorders has been emphasized. Some investigators advocate the use of a flexible fiberscope, while others recommend the use of a rigid telescope for SVL. In order to determine which procedure is more useful for clinical diagnosis, the senior author (E.Y.) performed both fiberscopic and telescopic SVL on 120 consecutive patients who complained of hoarseness. Equipment used included the Olympus ENF-P3 fiberscope, the Nagashima SFT-1 rigid telescope, the Nagashima LS-3A laryngostroboscope, and color video cameras. Our study indicated that stroboscopic images produced by telescopic SVL were superior to those from fiberscopic SVL in the majority of cases. The purpose of this paper is to compare fiberscopic and telescopic SVL, to evaluate the advantages and disadvantages of fiberscopic and telescopic SVL, and to present the authors' recommendations.

Normal laryngeal valving patterns during three breath-hold maneuvers: a pilot investigation

Synchronized videonasendoscopy and respiratory recordings were conducted in six healthy male subjects to evaluate activity of the arytenoid cartilages, true vocal folds, false vocal folds, and epiglottis during repeated trials of three breath-hold maneuvers: EASY hold, INHALE HARD hold, and INHALE/EXHALE HARD hold. Five of the six subjects demonstrated maximal laryngeal valving on the HARD breath-hold conditions. One subject showed maximal laryngeal valving on the EASY hold condition, and rarely demonstrated any medial displacement or contact of the laryngeal valves on either effortful breath-hold maneuver. Arytenoid approximation and true vocal fold closure were produced consistently by the majority of subjects on all breath-hold maneuvers, but false vocal fold approximation and anterior arytenoid tilting were accomplished by the majority of subjects only during the effortful breath-hold conditions. Intratrial and intersubject variation indicated that presence or degree of laryngeal valving cannot be assumed during a breath-hold maneuver. We conclude that videonasendoscopy has merit in assessing a patient's laryngeal valving ability and progress in effectively using a breath-hold maneuver for safe swallowing function.

A comparison of vocal fold closure in rigid telescopic and flexible fiberoptic laryngostroboscopy

Fifteen normal speakers (7 women and 8 men), ranging in age from 21 to 35 years, were examined consecutively with rigid telescopy and flexible fiberscopy during sustained phonation at 3 loudness levels. The endoscopes were connected to a stroboscope and video equipment. The purpose was to investigate whether the two laryngeal examination procedures affect vocal fold closure differently. The degree of closure was judged from video tapes by 5 experienced voice clinicians who used a rating form. Intra- and interjudge reliabilities were satisfactory. The estimated degree of incomplete closure was significantly higher during rigid telescopy than during flexible fiberscopy and the difference was especially evident in soft phonation. The degree of incomplete closure decreased significantly with increased loudness, regardless of method. The importance of relating laryngoscopic findings to the loudness of phonation as well as to possible effects of the method of examination is obvious from the results.

Bedside videolaryngoscopic assessment of intubation trauma

Telescopic laryngoscopic examination was performed at the bedside after extubation in 29 consecutive surgical intensive care unit patients who required endotracheal intubation for more than 16 hours. The examinations were documented with a portable video recording system. The majority of patients exhibited evidence of acute endolaryngeal trauma. Vocal fold ulceration and vocal fold motion abnormalities were the most common lesions. Patients with abnormal larynges were followed up after discharge from the intensive care unit. Most of the identified injuries resolved without intervention. However, silent aspiration was identified frequently in patients with vocal fold paresis and was thought to be a significant factor in postoperative pulmonary complications. Early identification of significant laryngeal trauma and/or vocal fold paresis in critically ill patients is important for both postoperative pulmonary care and voice rehabilitation. This pilot study demonstrated that documentation of the laryngeal examination is feasible in critically ill patients in an intensive care unit setting.

Pediatric videonasoendoscopy for speech and voice evaluation

Many otolaryngologists and speech clinicians have found videofiberoptic evaluations to be invaluable for assessment of velopharyngeal and laryngeal function in adults. However, many professionals question the feasibility of routine use of these procedures in the pediatric population. This article describes a method for successful completion of videonasoendoscopic speech and voice evaluations of children as young as 3 years of age. The importance of the ENT/speech team is emphasized in both the collection and interpretation of data. In addition, contributions of videonasoendoscopic observations to diagnosis, medical treatment, and therapy for speech and voice disorders are discussed.

Videophotolaryngography using a new low cost video printer. Instant electronic filmless photography

We introduce a new concept of electronic videophotography of the larynx on the television screen using a new Mitsubishi video printer. With this method no standard film or chemical processing are used. Black and white prints of the television image can be electronically reproduced in less than 15 seconds by pressing a button on the video printer. This method is of great value for documentation of the progression of disease and comparison of the preoperative and postoperative appearances of the larynx. The printout of the black and white television image of the larynx can be attached to the patient's chart as a permanent pictorial record. Such prints can also be given to the patient or can be sent to the referring physician, the radiotherapist, and others involved in management of the patient. This method is also useful for demonstration of a pathological condition and for teaching at head and neck tumor conferences.

Clinical use of the pediatric flexible fiberscope

Office examination of the ears, nose, nasopharynx, hypopharynx, and larynx of the child has been simplified with the advent of flexible fiberoptic nasopharyngolaryngoscopes. The superior optics of recent generation fiberscopes permit excellent visualization of these structures for both diagnosis and assessment of the efficacy of medical and surgical treatment. The Machida ENT-3L pediatric model has a distal tip diameter of 3.3 mm, making it the narrowest standard production fiberscope available in the U.S.A., and is totally waterproof. The author reviews a large clinical experience with the Machida ENT-3L and compares it with the Machida ENT-4L (standard adult), and the Olympus ENF-P models. Comparisons will be made of the optics, ease of passage through the upper aerodigestive tract of younger and older children, ease of handling, and ability to permit taking endoscopic photographs (both still and video).

Oral endoscopy in prosthodontic management of the soft palate defect

Telescopic oral endoscopy is an effective aid in the construction and modification of a speech aid prosthesis. The method is noninvasive and easy to perform, permits the prosthodontist to achieve the goal of functional effectiveness in prosthesis construction while keeping the weight and size of the pharyngeal extension at a minimum, decreases the number and length of patient visits required for modification, and when coupled to a fiberoptic teaching arm or a video camera and recording system, it becomes an excellent aid in teaching, patient education and orientation, and record keeping.

Voice analysis of the partially ablated larynx. A preliminary report

This study attempts to obtain a data base of objective formation on the phonatory characteristics of the partially ablated larynx. Twenty patients who had previously undergone partial laryngectomy with glottic reconstruction underwent videolaryngoscopy. The visualizations obtained revealed that the mechanism of voice production was due in part to sphincterization and compensatory hypertrophy of glottic and supraglottic remnants. Aerodynamic and phonatory function tests together with acoustical and perceived voice quality analyses of these partially ablated larynges tend to corroborate the videotape impressions in many instances. However, data accumulated thus far only reveal trends that cannot yet be subjected to definitive interpretations. With the incorporation of other methods of evaluation, augmented by the inclusion of more patient material, it is hoped that the information obtained can be used to improve reconstructive techniques, monitor surgical results, and enhance methods of voice rehabilitation in these patients.