Susanne Voigt-Zimmermann

Proposal for a descriptive guideline of vascular changes in lesions of the vocal folds by the committee on endoscopic laryngeal imaging of the European Laryngological Society

In the last decades new endoscopic tools have been developed to improve the diagnostic work-up of vocal fold lesions in addition to normal laryngoscopy, i.e., contact endoscopy, autofluorescence, narrow band imaging and others. Better contrasted and high definition images offer more details of the epithelial and superficial vascular structure of the vocal folds. Following these developments, particular vascular patterns come into focus during laryngoscopy. The present work aims at a systematic pathogenic description of superficial vascular changes of the vocal folds. Additionally, new nomenclature on vascular lesions of the vocal folds will be presented to harmonize the different terms in the literature. Superficial vascular changes can be divided into longitudinal and perpendicular. Unlike longitudinal vascular lesions, e.g., ectasia, meander and change of direction, perpendicular vascular lesions are characterized by different types of vascular loops. They are primarily observed in recurrent respiratory papillomatosis, and in pre-cancerous and cancerous lesions of the vocal folds. These vascular characteristics play a significant role in the differential diagnosis. Among different parameters, e.g., epithelial changes, increase of volume, stiffness of the vocal fold, vascular lesions play an increasing role in the diagnosis of pre- and cancerous lesions.

Evaluation eines Klassifikationsmodells horizontaler Gefäßveränderungen der Stimmlippen

OBJECTIVE There exists no valid classification of beginning vascular changes of the vocal folds. We tested an own classification model of visible beginning horizontal vascular changes. MATERIAL AND METHODS 168 indirect endoscopic pictures (84 white light=WL and 84 Narrow Band Imaging=NBI) of vocal folds were presented to 3 different consultants for classification (graduation normal, slight, moderately, high-grade belonged to the vascular features ectasia, meander, convolute, frequency of the vessels, ramification, change in direction). The self-confidence was declared by the consultants with a numeric rating scale. RESULTS A classification of beginning vascular changes of the vocal folds is possible, especially of ectasia, meander, convolute, frequency of the vessels, ramification, change in direction (p<0.0001). Significantly more vascular lesions can be detected by NBI than with white light endoscopy alone (p<0.0001). There are no significant differences (p=0.3529) in self-confidence of the classification. But it differs between the consultants highly significant (p<0.0001). The inexperienced classifier shows the highest growth in the learning curve. The intrarater- and interrater-variability differs only slightly between WL and NBI. CONCLUSIONS Beginning horizontal changes of vocal fold vessels can be classified. Endoscopic NBI-pictures of the vocal folds demonstrate the beginning of vascular changes better compared to endoscopic white light pictures alone. The familiarity and expertise with the classification model and the endoscopic imaging technique affect the self-confidence of the evaluation.

Gefäßveränderungen der Stimmlippen – Teil 1: Horizontale Gefäßveränderungen

BACKGROUND In recent decades, the endoscopic methods and technologies for laryngeal examination have improved so much that not only epithelial changes, but also vascular changes are recognizable at earlier stages. When comparing newer and older literature, the associated increasingly differentiated descriptions of such visible vascular changes of the vocal folds lead to terminological blurring and shifts of meaning. This complicates the technical-scientific discourse. The aim of the present work is a theoretical and conceptual clarification of early vascular changes of vocal folds. RESULTS Horizontal changes of benigne vascular diseases, e. g. vessel ectasia, meander, increasing number and branching of vessels, change of direction may develop in to manifest vascular lesions, like varicosis, polyps and in case of ruptures to haemorrhages of vocal folds. These beginning and reversible vascular changes, when early detected and discussed basing on etiological knowledge, may lead to more differentiated prognostic statements and adequate therapeutic decisions, e. g. phonosurgery, functional voice therapy, voice hygiene and voice rest. Vertical vascular changes, like vessel loops, occur primarily in laryngeal papilloma, pre-cancerous and cancerous changes of the vocal folds. Already in small cancerous lesions of the vocal folds the vascular architecture is completely destroyed.

Narrow Band Imaging of the Upper Aerodigestive Tract

Endoscopy of the upper aerodigestive tract (UADT) has been influenced by different innovations over the last two decades. The use of chip-on-the-tip rigid or flexible endoscopes was a change in endoscopic function. The next step was the increase of resolution as well as the introduction of high-definition (HD) imaging especially in flexible endoscopes. 4K resolution is almost ready to take the next step. Additionally, endoscopic imaging techniques, e.g., narrowband imaging, autofluorescence, optical coherence tomography, a.o., have been developed to get more details about the pathological changes besides normal white light endoscopy.

Unilateral Vocal Fold Immobility

Immobility of the vocal folds may have different aetiologies and, consequently, may impact differently on voice function, swallowing and breathing.

Flexible transorale Rhinoskopie (FlexToR)

Nach dem transoralen Einführen des flexiblen Endoskopes und der Inspektion der Mundhöhle, des Oround Hypopharynx durch kaudale Blickrichtung schließt sich ohne Unterbrechung die Endoskopie des Nasopharynx durch das Vorschieben des flexiblen Endoskopes nach kranial und dann ventral zur eigentlichen Rhinoskopie an. Sie beginnt bei den Choanen, führt weiter durch die Nasenhaupthöhle bis hin zum Vestibulum nasi. In Fällen, in denen eine anatomische Obstruktion die anteriore Rhinoskopie behindert, stellt die FlexToR eine sehr gute Alternative dar. Sie kann ergänzend zur anterioren starren oder flexiblen Rhinoskopie und der transoralen endoskopischen Untersuchung mit einem starren Endoskop (bei 70 ° oder 90 °) erfolgen. Die FlexToR ermöglicht eine detaillierte Darstellung der anatomischen Gegebenheiten und der Funktion (mechanisch) von dorsal.