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Dynamic Voice Evaluation Using Flexible Endoscopy

Overview

Indirect mirror laryngoscopy is the traditional modality used to perform laryngeal examinations on dysphonic patients.
The rod lens telescope, introduced by Hopkins, has several advantages over the traditional indirect laryngoscope. It produces a magnified, recordable image of the larynx that is superior for the diagnosis of mass lesions and mucosal wave abnormalities, especially when performing stroboscopy. The drawback to rigid laryngovideostroboscopy remains that the larynx is tethered in a nonphysiologic position and subtle changes in laryngeal function cannot always be assessed accurately.

The flexible fiberoptic laryngoscope, introduced by Sawashima and Hirose in 1968, allows visualization of the larynx with the patient in a comfortable, natural position.
More recently, “chip-tip” digital flexible endoscopes have revolutionized the visualization capabilities of indirect laryngoscopy and allow stroboscopy to be performed with near comparable clarity to that achieved with a rigid endoscope. Newer developments in laryngeal imaging and mobile technology are on the horizon.
 This article describes an appropriate method by which a comprehensive dynamic voice evaluation is completed using flexible laryngoscopy. The image below depicts a flexible endoscope.

Flexible endoscope. Image courtesy of Wikimedia Co

Flexible endoscope. Image courtesy of Wikimedia Commons.

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Relevant Anatomy

The larynx is located within the anterior aspect of the neck, anterior to the inferior portion of the pharynx and superior to the trachea. Its primary function is to protect the lower airway by closing abruptly upon mechanical stimulation, thereby halting respiration and preventing the entry of foreign matter into the airway. Other functions of the larynx include the production of sound (phonation), coughing, the Valsalva maneuver, and control of ventilation, and acting as a sensory organ.

The vocal cords are composed of mucous membrane infoldings that stretch horizontally across the middle laryngeal cavity. They are attached anteriorly at the angle on the interior surface of the thyroid cartilage and project posteriorly to the arytenoid cartilages on either side. The vestibular folds, or false vocal cords, are formed by the superior layer of infolded membrane; the vocal folds, or true vocal cords, are formed from the inferior layer of infolded membrane. The laryngeal ventricles extend laterally and are located between the vestibular and vocal folds.

For more information about the relevant anatomy, see Larynx Anatomy and Vocal Cord and Voice Box Anatomy.

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