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Flashcards in Videostroboscopy Deck (54):
1

When was videostroboscopy first used?

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

2

Who has developed tentative standardized procedures for voice evals?

Japan Society of Logopedics & Phoniatrics

3

Two Major Principles of Videostroboscopy

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)

4

Major clinical exams related to voice:

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)

5

Diagnostic Procedures for Voice D/O's

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

6

Videostroboscopy is 1 part of clinical exam of voice that ____

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

7

Temporary Paralysis:

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

8

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

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

9

Videostroboscopy facilitates choice of therapy:

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

10

Videostroboscopy provides a means to examine VF vibration

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

11

Set-up Procedures

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

12

Procedure Once Larynx is Visualized

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)

13

With Videostroboscopy, looking at Fundamental Frequency:

1. adequate intensity
2. 1 second duration

14

Parameters to be rated:

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

15

Stiffness

1. Immobility of soft tissue during phonation
2. Normal pitch & loudness no stiffness (b/c we have good vibration)

16

Increased stiffness with increased ______

Pitch & tension
Strained voice will show up on strobe as increased tension

17

Non-Vibrating Portion Rating:

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

18

Amplitude

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

19

Amplitude Ratings

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

20

Shorter the vibratory portion of VFs ____

Smaller the amplitude

21

Stiffer the VF ____

Smaller the amplitude

22

Greater the mass of the VF ______

Smaller the amplitude

23

Existence of an obstacle results in a _____

Decrease of amplitude

24

Greater the subglottal pressure _____

Greater the amplitude

25

Symmetry of VFs

Degree to which two folds provide mirror images of one another

26

Rate regarding symmetry of phase & amplitude:

Phase relates to timing characteristics
Amplitude concerns magnitude of lateral excursions

27

Symmetry Ratings:

1. Symmetrical
2. Asymmetrical

28

Mucosal Wave

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

29

Mucosal Wave Movement Decreases with ______ in Pitch

Increase

30

Mucosa Wave Movement Increases with _____ in Loudness

Increase

31

Mucosal wave _____ with increase in stiffness or tension

Decreases

32

Mucosal wave _____ with hypofunctional & hyperfunctional dysphonias

Decreases

33

Hyperfunctional wave is reduced because of _____

Tight nature of closure

34

Hypofunctional wave is reduced because of _____

Low subglottal pressure & reduced tension

35

The stiffer the mucosa ____

The less marked the mucosa wave

36

When the mucosa is only partially stiff ____

The wave stops travelling at the stiff portion

37

The greater the subglottal pressure ____

The more marked the mucosal wave

38

Hyperkinetic

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)

39

Mucosal Wave Ratings:

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

40

Glottic Closure Ratings ______

Include opening-closing phase & superior configuration

41

Glottic Closure

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

42

Glottic Closure: W/ increases in pitch closed phase _____

Decreases

43

Glottic Closure: W/ increases in loudness closed phase _____

Increases

44

Glottic Closure: W/ hyperfunction closed phase _____

Increases

45

Glottic Closure: Superior Configuration

1. Complete
2. Partially Incomplete
3. Entirely Incomplete

46

Complete Superior Configuration

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

47

Partially Incomplete Superior Configuration

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

48

Entirely Incomplete Superior Configuration

Doesn't close at all

49

Glottic Closure Rating

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

50

Bowed VFs

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

51

Periodicity

Regularity of successive apparent cycles of vibration

52

Determine aperiodicity by ____

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

53

Regularity (periodicity) Rating:

1. Regular
2. Irregular

54

Other Findings-Detailed Description

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