Laryngeal Examination Techniques

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary purpose of stroboscopy in the examination of vocal folds?

To visualize the shape of the epiglottis

To evaluate mucosal disease and its impact on vocal fold vibration (correct)

To identify vocal fold paralysis

To assess laryngeal structure abnormalities

Which of the following is NOT a noted effect of laryngeal irritation as observed through laryngeal videoendoscopy?

Cobblestoning of the posterior pharyngeal wall

Increased vocal fold mass (correct)

Edema of the posterior larynx

Pseudosulcus formation

The term 'omega-shaped epiglottis' refers to a common variant observed primarily in which demographic?

Women

Men (correct)

Elderly individuals

Children

What is a significant concern regarding the intra-rater and inter-rater reliability of findings during laryngeal examinations?

Variability in fiberoptic laryngoscopy ratings Signup and view all the answers

What does laryngeal high-speed videoendoscopy (LHSV) primarily analyze?

Vocal fold vibration patterns Signup and view all the answers

What is a limitation of videostroboscopy in assessing vocal fold vibration?

It works poorly with irregular vibration. Signup and view all the answers

Which technique is noted to have sufficient temporal resolution for observing vocal fold vibration?

LHSV60-62 Signup and view all the answers

What is a primary function of linking multiple stroboscopy units to a central server?

To provide access to videos from remote locations. Signup and view all the answers

Which procedure is NOT suitable for videostroboscopy?

Evaluating disordered voice production Signup and view all the answers

What aspect of vocal fold function is specifically challenged by irregular vibrations during assessments?

The onset and offset of phonation. Signup and view all the answers

Which of the following is a technological advancement in documenting stroboscopic findings?

Digital Imaging and Communications in Medicine standard. Signup and view all the answers

What is typically done to help keep a patient calm during an examination?

Discussing the examination process in a calming voice. Signup and view all the answers

Which tool aids in documenting endoscopic findings by allowing images and videos to be archived electronically?

High-speed video endoscopes Signup and view all the answers

What is the primary limitation of observation of structural details in vocal fold assessment?

It cannot visualize vibratory patterns accurately. Signup and view all the answers

What is the rate of vocal fold vibration typically described in cycles per second?

Hundreds of cycles per second. Signup and view all the answers

Which of the following techniques is highlighted as particularly valuable in assessing vocal fold conditions?

Videostroboscopy Signup and view all the answers

What percentage of patients diagnosed with flexible endoscopy had their diagnoses changed by stroboscopic assessment?

30% to 47% Signup and view all the answers

What additional detail does videostroboscopy provide in vocal assessments?

It identifies vocal fold movement patterns in real-time. Signup and view all the answers

What underlying issue may lead to hyperfunction during phonation as identified by stroboscopy?

Underlying pathology. Signup and view all the answers

Which vocal fold condition can stroboscopy help to detect?

Small vocal fold lesions. Signup and view all the answers

To adequately visualize vocal fold vibration, what type of equipment is needed?

Specialized lighting or cameras. Signup and view all the answers

Understanding normal vocal fold physiology is crucial for which aspect of vocal assessment?

Interpreting stroboscopic examinations. Signup and view all the answers

What aspect of vocal fold assessment can stroboscopy help monitor post-phonosurgery?

Tissue healing. Signup and view all the answers

What is one primary advantage of using a flexible endoscope during examinations?

It allows viewing of the larynx during natural functions. Signup and view all the answers

Which component is crucial for assessing arytenoid mobility during examinations?

Electroglottograph Signup and view all the answers

How does flexible endoscopy compare to rigid endoscopy in terms of its applications?

Flexible endoscopy is superior for movement-related evaluations. Signup and view all the answers

What is an essential feature of stroboscopy systems that can enhance examination efficacy?

High-definition recording capabilities Signup and view all the answers

Which of the following factors does NOT affect the result of the examination when using topical anesthesia?

Presence of stroboscopy systems Signup and view all the answers

What aspect of voice disorders is particularly noticeable using flexible endoscopy?

Voice changes during connected speech Signup and view all the answers

Which type of endoscope is specifically mentioned as being available in a variety of forms?

Flexible and rigid endoscopes Signup and view all the answers

For which type of evaluation is flexible endoscopy particularly useful?

Reviewing mobility during voice function Signup and view all the answers

What is a potential limitation of high-definition cameras in stroboscopy?

They require additional specific image processors. Signup and view all the answers

What is the implication of using benzocaine topical spray during an examination?

Its effects on examination results are negligible. Signup and view all the answers

What is the primary purpose of stroboscopy in vocal assessment?

To determine glottal closure and mucosal pliability Signup and view all the answers

Which of the following statements about high-speed videoendoscopy (LHSV) is accurate?

It allows for quantification of vibratory details Signup and view all the answers

What does narrow-band imaging (NBI) primarily utilize for its function?

Absorption characteristics of light for vascular analysis Signup and view all the answers

Which technique is used to observe arytenoid mobility during vocal assessments?

Rapid pitch gliding from lowest to highest notes Signup and view all the answers

In identifying laryngeal lesions, which advantage does NBI provide?

It helps in recognizing high-yield areas for biopsy Signup and view all the answers

What condition can be indicated by tilting of the petiole during a pitch glide?

Superior laryngeal nerve weakness Signup and view all the answers

Which aspect of arytenoid position is NOT typically evaluated?

Presence of nodules Signup and view all the answers

What role does mucus play in vocal fold assessment?

Thickened mucus can signal laryngeal issues Signup and view all the answers

Which of the following is NOT an advantage of endoscopic imaging techniques?

Comprehensive assessment of auditory function Signup and view all the answers

Which aspect of stroboscopy is most critical for effective vocal assessments?

Synchronization with vocal fold vibration Signup and view all the answers

Study Notes

Visual Documentation of the Larynx

Laryngeal endoscopy, using flexible or rigid endoscopes, is used to examine vocal fold structure and gross function.
Videostroboscopy examines vocal fold vibration patterns and the relationship between the body and the cover.
Laryngeal high-speed videoendoscopy complements endoscopy and stroboscopy, showing details of short and aperiodic vibration and quantifying vibration parameters.
Narrow-band imaging uses tissue light absorption characteristics to show vascular detail.
Each vocal fold visualization tool contributes uniquely to assessment.

Endoscopy: Assessment Using Continuous Light

Endoscopic examination with continuous light provides information about structure and gross movement.
Laryngeal structure abnormalities and asymmetries (valleculae, piriform sinuses, epiglottis, aryepiglottic folds, ventricular folds, posterior glottal rim) are observed.
Pitch changes during sustained sounds (e.g., "ee") can aid in visualization.
Signs of irritation or laryngopharyngeal reflux (edema, erythema, cobblestoning, interarytenoid bar, pseudosulcus) are noted.

Arytenoid and Vocal Fold Motion

Arytenoid movement and position assess cricoarytenoid joint and recurrent laryngeal nerve integrity.
Mobility and symmetry are described, and immobile arytenoids are further categorized by position and axis.
Observing patients during "ee"-sniff or cough, or rapid pitch glides, helps assess symmetry of posterior and lateral pharyngeal wall bulging.

Mucus

Thickened mucus often adheres to vocal fold edges or the superior surface.
Presence of thick mucus can relate to lack of hydration or chronic irritation.
Mucus in the pyriform sinuses can indicate poor laryngeal sensation, weak lateral pharyngeal walls, or swallowing issues.

Supraglottal Activity

Supraglottal activity refers to motion above vocal folds.
Supraglottal constriction can be a normal variant or a sign of disordered voice.
Sustained supraglottal constriction can indicate muscle tension dysphonia.

Vocal Fold Edges

The degree of vocal fold smoothness and regularity is described.
Irregularities related to lesions or convex/concave ("bowed") edges are noted.
Bowing is a descriptive term, not a disorder.

Protocol and Limitations

Endoscopic examination protocols include rest and deep breathing, easy cough, sustained "ee," rapid pitch glides, quiet/loud phonation, and sentence/conversation.
Endoscopic observations offer limited information for understanding voice disorders, as they don't show vibratory patterns.

Assessment With Stroboscopy

Videostroboscopy assesses vocal fold vibration patterns.
Healthy vocal folds consist of a pliable cover (epithelium and superficial lamina propria) and a stiffer body (intermediate and deep lamina propria, and thyroarytenoid muscle).
Muscle contraction positions and shapes vocal folds (adduction/abduction, lengthening/shortening/bulging) for vibration.

Glottal Closure

Closure patterns (complete or incomplete; gap shape) are noted at the most closed point of vibration.
Different patterns (complete, posterior gap, anterior gap) of gap shapes are common in men and women respectively.
Assessment focuses on vocal fold contact at MCPL.

Mucosal Pliability and Stiffness

Amplitude of vibration (excursion from midline) is assessed.
Normal excursion is approximately one-third of the vocal fold width.
Decreased amplitude indicates increased stiffness, lesions (polyps, cysts, papillomas, scarring, hyperfunction).
Increased amplitude represents decreased tonicity (paresis or atrophy).

Laryngeal High-Speed Videoendoscopy (LHSV)

LHSV provides temporal resolution to view vocal fold vibration regardless of the duration or severity of dysphonia.
LHSV allows observing vocal fold vibration at rates of up to 20,000 frames per second.
LHSV offers assessment of onset and offset, ventricular folds, asymmetries between right and left vocal fold vibration, and frequency differences.

Narrow-Band Imaging (NBI)

NBI uses light absorption differences to highlight vascular structures.
Blue light is absorbed better by hemoglobin, highlighting vascular patterns.
NBI improves detection of recurrent respiratory papillomatosis and screens for malignancies.
NBI is useful for distinguishing between suspicious and benign tissue, helping in clinical decision-making.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers various techniques for examining the larynx, including laryngeal endoscopy, videostroboscopy, and high-speed videoendoscopy. Each method offers unique insights into vocal fold structure and function, contributing to comprehensive vocal assessment.