Stephanie R.C. Zacharias

Experimental investigation on minimum frame rate requirements of high-speed videoendoscopy for clinical voice assessment ☆

This study investigated the impact of high-speed videoendoscopy (HSV) frame rates on the assessment of nine clinically-relevant vocal-fold vibratory features. Fourteen adult patients with voice disorder and 14 adult normal controls were recorded using monochromatic rigid HSV at a rate of 16000 frames per second (fps) and spatial resolution of 639×639 pixels. The 16000-fps data were downsampled to 16 other rate denominations. Using paired comparisons design, nine common clinical vibratory features were visually compared between the downsampled and the original images. Three raters reported the thresholds at which: (1) a detectable difference between the two videos was first noticed, and (2) differences between the two videos would result in a change of clinical rating. Results indicated that glottal edge, mucosal wave magnitude and extent, aperiodicity, contact and loss of contact of the vocal folds were the vibratory features most sensitive to frame rate. Of these vibratory features, the glottal edge was selected for further analysis, due to its higher rating reliability, universal prevalence and consistent definition. Rates of 8000 fps were found to be free from visually-perceivable feature degradation, and for rates of 5333 fps, degradation was minimal. For rates of 4000 fps and higher, clinical assessments of glottal edge were not affected. Rates of 2000 fps changed the clinical ratings in over 16% of the samples, which could lead to inaccurate functional assessment.

Comparison of Videostroboscopy and High-speed Videoendoscopy in Evaluation of Supraglottic Phonation

Objectives: To compare clinicians’ ratings of videolaryngoscopy (VLS) and high-speed videoendoscopy (HSV) and assess confidence of ratings with VLS and HSV in patients with supraglottic phonation. Methods: The VLS and HSV video samples were taken from 11 adolescents post airway reconstruction who use supraglottic tissues for voice. The 22 recordings were randomized and presented to 4 clinicians: 2 speech-language pathologists and 2 pediatric otolaryngologists. Additionally, a 5-point Likert scale was used to rate level of confidence of ratings. Results: Clinicians were more likely to rate regularity on HSV versus VLS videos (P = .003). Presence of mucosal wave was rated similarly on both imaging modalities; however, HSV was more likely to identify location (P = .002). Supraglottic phase symmetry (P = .014) and number of vibratory tissues used for phonation were rated more often with HSV versus VLS. Clinicians were more confident with HSV ratings compared to VLS ratings for determining vibration source, vibration pattern, and ability to make treatment decisions (P < .0001). Conclusions: The HSV improves the ability to rate tissue vibratory characteristics when compared with VLS in children with supraglottic phonation. This information may allow better understanding of the underlying mechanisms of voice production in these individuals, leading to improved therapeutic and surgical recommendations.

Surgical management of posterior glottic diastasis in children.

Introduction: The purpose of this study was to report our clinical experience in the surgical management of patients with posterior glottic diastasis (PGD) secondary to prolonged intubation and/or laryngotracheoplasty (LTP) during childhood. Methods: We reviewed the charts of patients with a history of prolonged intubation and/or LTP who had undergone surgical correction for PGD at our institution between 2010 and 2014. We documented demographic data and pertinent information regarding medical and surgical histories. The Pediatric Voice Handicap Index (pVHI) and/or the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) were used to assess patients both before and after undergoing treatment for voice disorders. Results: Six patients met our inclusion criteria. With 1 exception, all patients with complete voice data demonstrated improvements in perceptual, patient-reported, and acoustic voice measures. There were no perioperative complications. Conclusion: Our case series demonstrates that operative intervention can lead to improved voice in carefully selected patients with PGD secondary to prolonged intubation and/or LTP during childhood. Patients exhibited postoperative improvement in loudness and vocal endurance; however, they also exhibited a degree of compromise in voice quality.

Utility of Laryngeal High-speed Videoendoscopy in Clinical Voice Assessment

OBJECTIVE This study aimed to assess the utility of laryngeal high-speed videoendoscopy (HSV) as a clinical tool. DESIGN This is a prospective study of 151 patients. METHODS A total of 151 adult patients (52 male, 99 female) underwent both videoendoscopy with stroboscopy (videostroboscopy) and HSV examination as part of a routine clinical voice assessment. At the time of the examination, ratings for videostroboscopy were reported in the clinical report. Next, the clinicians reviewed the HSV examination and indicated the changes in ratings of HSV relative to videostroboscopy. Finally, the clinical reports were reviewed by a clinician not involved in data collection or clinical care of the patients and noted differences between videostroboscopy and HSV clinical ratings, and resulting diagnoses were identified and grouped. RESULTS Ratings of all vibratory features showed change between videostroboscopy and HSV. Mucosal wave and amplitude of vibration showed the largest percentage change, respectively, in 74% and 53% of the reports. They were followed by the features of glottal closure (36%), phase closure (32%), glottal edge (25%), and phase symmetry (21%). Ratings of supraglottic compression and vocal fold vertical level showed the least change between videostroboscopy and HSV. Changes in initial diagnosis owing to the inclusion of HSV were indicated in 7% of the cases. CONCLUSIONS HSV may be an important laryngeal imaging technique for functional assessment of the pathophysiology of certain voice disorders. HSV could enable important refinements in the diagnosis and management of vocal fold pathology.

Preliminary Assessment of Dynamic Voice CT in Post–Airway Reconstruction Patients

Objectives To compare the ability of the dynamic voice computed tomography (CT) scan to characterize laryngeal function in airway reconstruction patients vs bedside endoscopic nasopharyngolaryngoscopy and videolaryngostroboscopy. Study Design Case series with chart review. Settings Pediatric tertiary care center. Subjects and Methods Retrospective case series of children and young adults with a history of complex airway surgeries with subsequent dysphonia. We analyzed clinical data for all patients who underwent an airway reconstruction procedure between January 1, 2010, and April 30, 2016, and also had a dynamic voice CT and bedside endoscopic exam during the same period. Results Twenty-four patients were analyzed (4 male, 20 female) with a mean age of 15.1 years (95% confidence interval [CI], 12.9-17.22). Patients had a mean of 2.2 airway surgeries (95% CI, 1.8-2.6), with 62.5% of them being open procedures. Laryngotracheoplasty with a cartilage graft was the most common procedure (40.0%). The pattern of laryngeal closure could be detected in all cases with the dynamic CT scan (n = 24/24, 100%) compared to 87.5% (21/24) with the standard endoscopic examination (P = .04). The location of gap closure could be detected in all cases (24/24) with the dynamic voice CT while 20.8% (5/24 patients) could not be rated with standard endoscopy/stroboscopy (P = .02). Dynamic voice CT was able to assess the vertical closure pattern of the glottis 100% (24/24) while it could be detected in 83.3% (20/24) cases with endoscopic study (P = .04). Conclusion Dynamic voice CT shows promise as an additional tool for evaluation of patients with a history of complex airway procedures by providing complementary information.

Influence of preoperative voice assessment on treatment plan prior to airway surgery: Influence of Preoperative Voice Assessment

Voice quality has emerged as an additional long‐term outcome measure for patients with a history of airway surgery. The goal of this study was to evaluate the impact of preoperative voice assessment on the surgical management of patients who required complex airway surgery.

Vertical Phase Difference and Glottal Efficiency in Musical Theater and Opera Singers

OBJECTIVE The objectives of this study were to (1) determine the relationship between vertical phase difference (VPD) and glottal efficiency (GE) in singers and (2) to compare VPD and GE between musical theater and opera singing styles. METHODS Five opera and three musical theater singers (Mean age = 25.3, 100% male) performed a series of vocal tasks at two pitches (low pitch C#3, 133 ± 5 Hz; high pitch C#4, 277 ± 5 Hz) for three levels of loudness (soft, baseline, and loud), while undergoing flexible distal chip videostroboscopy. Aerodynamic and acoustic information for each vocal task was recorded using the Phonatory Aerodynamic System. VPD was qualitatively measured via visual-perceptual judgments of repeated comparison tests, where a blinded rater was asked to select the video in which the subject demonstrated the greatest VPD. Aerodynamic data were analyzed for differences in GE. RESULTS Qualitative visual-perceptual analysis indicated that increased magnitude of VPD was correlated with tasks involving increased loudness or higher pitch. GE was similarly correlated with increased loudness or higher pitch. GE was minimally correlated with subglottal pressure at high pitch. CONCLUSION This prospective study reveals novel human subject evidence that VPD may correlate with GE. Future studies will further explore the implications of VPD with respect to GE, subglottal pressure, and laryngeal mechanics.