Inho Bae

Efficacy of Two-dimensional Scanning Digital Kymography in Evaluation of Atrophic Vocal Folds

OBJECTIVE The purpose of this study was to evaluate the clinical feasibility and diagnostic accuracy of two-dimensional scanning digital kymography (2D DKG) in patients with vocal cord atrophy before and after treatment. MATERIALS AND METHODS We analyzed the characteristics of vocal fold vibration in five patients with unilateral vocal fold paralysis and five patients with presbyphonia. In patients with vocal cord paralysis, the status before and after intracordal injection was compared. Furthermore, in patients with presbyphonia, we compared the status before and after voice therapy (Seong-Tae Kims laryngeal calibration technique). Quantitative parameters such as amplitude and phase symmetry indices, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time and qualitative parameters such as Voice Handicap Index, glottal gap, amplitude, and phase difference were used to evaluate the pre- and post-treatment status. RESULTS In cases of vocal cord paralysis, vibratory changes of the vocal folds before and after intracordal injection could be identified immediately using 2D DKG. In overcorrection cases, all of the measured parameters were poor except for improvement of the glottal gap. In addition, 2D DKG showed appropriately the changes in vocal cord vibration before and after voice therapy in patients with presbyphonia. CONCLUSION Two-dimensional DKG may be a useful diagnostic tool in evaluation of the vibratory characteristics of entire vocal cords. In addition, it may also play a role in providing a decision for treatment modalities.

Usefulness of Two-Dimensional Digital Kymography in Patients With Vocal Fold Scarring

OBJECTIVE Although laryngeal videostroboscopy is widely utilized in the analysis of vocal fold vibrations, it is often difficult to identify patterns of vocal fold vibrations in patients with aperiodic voice signals due to failure of synchronization during laryngeal videostroboscopy examination. Therefore, the present study aimed to compare the usefulness of simultaneous two-dimensional digital kymography (2D DKG) and traditional DKG for the detection of changes in the pattern of vocal fold vibrations in patients with vocal fold scarring (VFS). METHODS Seven patients with VFS and one normal subject underwent high-speed videoendoscopy (HSV). DKG and 2D DKG evaluations of vocal fold vibrations were performed simultaneously, following which both qualitative and quantitative analyses were performed. RESULTS Simultaneous DKG and 2D DKG enabled observation of vibratory patterns as well as amplitude and phase symmetry. DKG revealed and provided temporal information regarding the pattern of vocal fold vibrations at sites of VFS. In contrast, 2D DKG provided real-time information regarding the pattern of vibrations for the whole vocal fold region and regions of increased stiffness, as well as spatial information regarding changes in this pattern. CONCLUSION Our findings indicate that 2D DKG enables the assessment of overall vocal fold vibrations, regardless of periodicity, and that simultaneous DKG and 2D DKG can be used to confirm abnormal patterns of vocal fold vibrations in patients with impaired flexibility and elasticity of the vocal folds.

Clinical Practicability of a Newly Developed Real-time Digital Kymographic System

BACKGROUND A digital kymogram shows real images of vocal fold vibration. However, DKG is difficult to use in clinical practice because the recorded image cannot be seen instantaneously after examination, as considerable encoding time is required to visualize a digital kymogram. In addition, frame-by frame analysis should be implemented to evaluate high-speed videoendoscopy data, but is time- and labor-intensive. PURPOSE The purpose of the study was to validate the clinical practicability of a real-time multislice digital kymographic system developed by the authors. We analyzed the promptness and accuracy of the examination before and after intracordal injections in patients with unilateral vocal fold paralysis. METHODS To assess the clinical applicability of this system, six patients with unilateral vocal fold paralysis were selected. Real-time DKG was performed before and immediately after intracordal injection. We observed changes in the digital kymogram after the intracordal injection. RESULTS Using this system, 10 scanning lines and up to five vertical pixel row could be obtained in real time, and the maximum acquisition time for the DKG image was 10 seconds. A digital kymogram of the patients could be instantaneously acquired, and whether the intracordal injection was appropriate or not. CONCLUSION This article is the first validation study after the development of the real-time multislice digital kymographic system. Our system may be a promising tool in clinical practice for immediate assessment of the vibratory patterns of the vocal cords. More research is necessary for further clinical validation.

The Effect on Intervention Program and Auditory-Perceptual Discrimination Feature of Postlingual Cochlear Implant Adults about Pathological Voice

In the present study, we investigated ability of recognition of auditory perception with regards to the quality of voice in postlingual CI adults and proposed a training program to improve within subject reliability. A prospective case-control study was conducted in adults with 7 postlingual deaf who received a CI surgery and 10 normal hearing controls. The pre and post test and training program included parameters of consensus auditory-perceptual evaluation of voice(CAPE-V) with pathological voice sample by using Alvin. In results of pre-post test for monitoring improvements of internal reliability for listeners via the training program, there was statistically significant difference in both test and group. There was statistically significant difference in internal reliability between pre-post test in the normal hearing group, the result was no significant in the CI group. The present study found that CI adults showed less ability in awareness of voice quality compared to normal hearing group. Also the training program improved pitch and loudness in CI adults.