Videostroboscopy

Question 1

When was videostroboscopy first used?

Answer 1

1878; lack of standardized voice evaluation procedures in U.S.

Question 2

Who has developed tentative standardized procedures for voice evals?

Answer 2

Japan Society of Logopedics & Phoniatrics

Question 3

Two Major Principles of Videostroboscopy

Answer 3

1. Observations from unaided eye are limited: VFs may appear normal even when vibratory pattern is abnormal
2. Stroboscopy produces an optical illusion: object moving rapidly appears to stand still or move slowly
   * *Equipment is very expensive ($25000-30000)
   * *Hospitals getting them (some private practices)

Question 4

Major clinical exams related to voice:

Answer 4

1. Neurophysiological exams: looking at neuro input to VFs
2. Aerodynamic tests: looking at airflow (lungs & lungs powering VFs)
3. Exams of VF vibration
4. Psycho-acoustic eval of voice
5. Exams of phonatory ability
   (4 & 5 are what we’re doing: what can the voice & what it can’t do)

Question 5

Diagnostic Procedures for Voice D/O’s

Answer 5

1. To determine cause of voice d/o
2. To determine degree & extent of causative disease (affects prognosis)
3. To evaluate degree of disturbance in phonatory fx
4. To establish therapeutic program
5. To monitor results of tx’s
   Insurance companies will expect you to be knowledgeable in when to discharge/continue therapy

Question 6

Videostroboscopy is 1 part of clinical exam of voice that ____

Answer 6

1. Presents a sharp clear image of VF edge
2. Illustrates fine details of laryngeal activity: mucosal abnormalities & amplitude
3. Provides means of observing shape, movement, vibratory pattern, time relationships b/t opening & closure
4. Provides visual observation of max opening & closure of VFs during phonation
5. Provides means to determine speed quotients
6. Provides visual observation of VF vibration in apparent slow motion
7. Differentiates physiologic & structural abnormalities of larynx
8. Provides documentation of change resulting from therapy
9. Provides means for teaching & demonstrating VF behavior to large audiences
10. Provides means for repeated observation of same event (Unless nasendoscopy is hooked to camera, there isn’t opportunity to watch repeatedly)
11. Provides means for more than 1 specialist to review larynx at same time

Question 7

Temporary Paralysis:

Answer 7

thyroid surgery (isolate recurrent laryngeal nerve)
	Surface EMG—is there neural innervation there?—is it coming back—neurology does this

Question 8

Videostroboscopy is able to differentiate things not visible to unaided eye:

Answer 8

1. Non-vibrating segments of VFs
2. Stiffness of mucosa
3. Beginning return of typical mucosal pattern in cases of laryngeal paralysis

Question 9

Videostroboscopy facilitates choice of therapy:

Answer 9

1. Can identify if changes in pitch, tension, or intensity alter abnormal pattern of vibration
2. Generally easy to distinguish between edematous nodule & fibrosed node

Question 10

Videostroboscopy provides a means to examine VF vibration

Answer 10

1. Provides visual explanation of d/o
2. Provides quantitative data
3. Provides means for repeated viewing of same event
4. Documents changes resulting from voice tx or surgery
5. Documents abnormal vibratory patterns & site of lesion

Question 11

Set-up Procedures

Answer 11

1. Pt seated upright in front of examiner w/ neck slightly extended & head tilted slightly back
2. Microphone placed on pt’s neck
3. Pt asked to sustained /i/
4. Pt asked to extend tongue & hold it w/ 2x2 gauze pad
   Say name, address, today’s date; tell about self; count to 10; what bothers you most about voice, what do you notice is problem, etc.
   May rest elbows on knees & look up slightly

Question 12

Procedure Once Larynx is Visualized

Answer 12

1. pt. is asked to phonate /i/ @ normal pitch & loudness
2. Phonation should be sustained for 2 seconds+ (4-5 seconds)
3. Pt asked to repeat /i/ @ normal pitch & loudness gradually increasing loudness & pitch (Will see VFs at lowest pitch & see them stretch out as person gets higher)
4. To check for glottal attack, pt asked to produce chain of /i/ repetitions (/i/ take a breath, /i/ take a breath, etc.: want to see VFs close then return to open position)
   Tell them this all ahead of time (what they should do)

Question 13

With Videostroboscopy, looking at Fundamental Frequency:

Answer 13

1. adequate intensity

2. 1 second duration

Question 14

Parameters to be rated:

Answer 14

1. Stiffness
2. Amplitude
3. Symmetry
4. Phase
5. Mucosal wave
6. Glottic closure
7. Supraglottal movements
8. Periodicity

Question 15

Stiffness

Answer 15

1. Immobility of soft tissue during phonation

2. Normal pitch & loudness no stiffness (b/c we have good vibration)

Question 16

Increased stiffness with increased ______

Answer 16

Pitch & tension

Strained voice will show up on strobe as increased tension

Question 17

Non-Vibrating Portion Rating:

Answer 17

1. None
2. Partially
3. Entirely
4. Occasionally
5. Always

Question 18

Amplitude

Answer 18

1. Extent of horizontal excursions
2. Each fold rated independently
3. Rate during normal pitch & loudness
4. 4-pt. equal appearing interval scale

Question 19

Amplitude Ratings

Answer 19

1. Great
2. Normal
3. Small
4. Zero
   (1 is more flaccid (hypotone or breathy))
   (3 is more tense (hypertone, harsh and strained))

Question 20

Shorter the vibratory portion of VFs ____

Answer 20

Smaller the amplitude

Question 21

Stiffer the VF ____

Answer 21

Smaller the amplitude

Question 22

Greater the mass of the VF ______

Answer 22

Smaller the amplitude

Question 23

Existence of an obstacle results in a _____

Answer 23

Decrease of amplitude

Question 24

Greater the subglottal pressure _____

Answer 24

Greater the amplitude

Question 25

Symmetry of VFs

Answer 25

Degree to which two folds provide mirror images of one another

Question 26

Rate regarding symmetry of phase & amplitude:

Answer 26

Phase relates to timing characteristics | Amplitude concerns magnitude of lateral excursions

Question 27

Symmetry Ratings:

Answer 27

1. Symmetrical | 2. Asymmetrical

Question 28

Mucosal Wave

Answer 28

Observation of movement of "cover" of VF Absent to great Normal pitch & loudness cover movement easily seen

Question 29

Mucosal Wave Movement Decreases with ______ in Pitch

Answer 29

Increase

Question 30

Mucosa Wave Movement Increases with _____ in Loudness

Answer 30

Increase

Question 31

Mucosal wave _____ with increase in stiffness or tension

Answer 31

Decreases

Question 32

Mucosal wave _____ with hypofunctional & hyperfunctional dysphonias

Answer 32

Decreases

Question 33

Hyperfunctional wave is reduced because of _____

Answer 33

Tight nature of closure

Question 34

Hypofunctional wave is reduced because of _____

Answer 34

Low subglottal pressure & reduced tension

Question 35

The stiffer the mucosa ____

Answer 35

The less marked the mucosa wave

Question 36

When the mucosa is only partially stiff ____

Answer 36

The wave stops travelling at the stiff portion

Question 37

The greater the subglottal pressure ____

Answer 37

The more marked the mucosal wave

Question 38

Hyperkinetic

Answer 38

1. Reduced amplitude of vibration 2. Reduced edge deflection 3. Restricted glottal length 4. Compression of ventricular folds 5. Increased closed phase (no breathiness, all "hyper"--all restricted; "purse-string" closure)

Question 39

Mucosal Wave Ratings:

Answer 39

1. Great 2. Normal 3. Small 4. Absent

Question 40

Glottic Closure Ratings ______

Answer 40

Include opening-closing phase & superior configuration

Question 41

Glottic Closure

Answer 41

Extent of VF approximation during close phase of vibration @ normal pitch & loudness Slight slit @ top of VFs with high pitch is normal

Question 42

Glottic Closure: W/ increases in pitch closed phase _____

Answer 42

Decreases

Question 43

Glottic Closure: W/ increases in loudness closed phase _____

Answer 43

Increases

Question 44

Glottic Closure: W/ hyperfunction closed phase _____

Answer 44

Increases

Question 45

Glottic Closure: Superior Configuration

Answer 45

1. Complete 2. Partially Incomplete 3. Entirely Incomplete

Question 46

Complete Superior Configuration

Answer 46

Closed | Closed/complete with posterior chink (Posterior chink is normal with females)

Question 47

Partially Incomplete Superior Configuration

Answer 47

1. Irregular gap or shape 2. Mid-portion gap 3. Anterior gap 4. Anterior-posterior gap

Question 48

Entirely Incomplete Superior Configuration

Answer 48

Doesn't close at all

Question 49

Glottic Closure Rating

Answer 49

1. Complete 2. Incomplete (Might be bowed VFs)

Question 50

Bowed VFs

Answer 50

Example: Breathy voice, mid 1/3 incomplete, posterior 1/3 incomplete closure, increased breathiness with increased pitch, incomplete anterior 1/3 closure; bowed VFs False cord coming over—and phonation with back of cords (not supposed to happen—they’re straining)—can’t produce a voice otherwise—pull the back part together Periods of aphonia May eventually develop contact ulcer: glottal fry Tx: (get them to phonate more anteriorly and raise pitch)—actual tx would be: (problem is bilateral bowing—prognosis is worse)—strengthening is impt too plus other things earlier; have to elevate pitch & closure of VFs: falsetto staccato /i/; or work from lower pitch up If nodules were there, strengthening would make it worse b/c of banging nodules together

Question 51

Periodicity

Answer 51

Regularity of successive apparent cycles of vibration

Question 52

Determine aperiodicity by ____

Answer 52

Observation of irregular movements | Can have regular, irregular, or inconsistent

Question 53

Regularity (periodicity) Rating:

Answer 53

1. Regular | 2. Irregular

Question 54

Other Findings-Detailed Description

Answer 54

1. Movement of arytenoid 2. Compensatory movements 3. Hyperfunctions of supraglottal structures 4. Hyperadduction 5. Absence of any of the laryngeal structures 6. Inability to complete requested tasks 7. Vibration of other structures