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The Role of the SLP and Assistive Technology in Life Care Planning
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
Videostroboscopy has continued to be the mainstay of clinical laryngeal imaging since the 1980s and basic stroboscopy technology is now being coupled with high definition video sensors to significantly improve image quality and, through increased spatial resolution, potentially enhance assessment of vocal fold tissue health and function. Videostroboscopy has limitations that other developing technologies are addressing. New high-speed/high-resolution digital video cameras with unprecedented increases in light sensitivity and frame rates are capturing vocal cord actions that cannot be seen with videostroboscopy alone. These actions include true cycle to cycle details of vocal fold vibration, as well as nonperiodic phenomena associated with more severe types of dysphonia, voice breaks, and the beginning and end of voiced sounds. Researchers also are working to develop better tools to parse the huge amount of data collected during high-speed imaging.
Structural Disorders of the Vocal Cords
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Yakubu Gadzama Karagama, Julian A. McGlashan
The simplest method of examining the larynx and vocal folds is with a mirror.7 Although excellent views can be obtained by an experienced examiner, the images are relatively small, of brief duration and frequently the anterior glottic region is not well visualized. In addition, the mucosal wave cannot be seen due to the relative speed of vibration of the vocal folds (usually over 100 cycles per second) compared with the ability of the retina to process individual images (five images per second).8 Superior views of the larynx can generally be obtained using flexible fibre-optic and videoscopic transnasal endoscopes or rigid telescopes inserted through the mouth. Either approach has its own advantages and drawbacks. The transnasal flexible videolaryngostroboscope is associated with less gag reflex compared to the transoral rigid videostroboscopy. However, the rigid telescope may give a slightly better picture quality, although the distal tip high definition flexible videolaryngostroboscope provides images almost as good as those obtained on rigid videostroboscopy.15 Occasionally both modalities may be helpful.16 The examination should be recorded for further review if necessary.
Swallowing disorders
Published in Declan Costello, Guri Sandhu, Practical Laryngology, 2015
Jacqui Allen, Peter C. Belafsky
When an otorhinolaryngology surgeon assesses the patient, a history and examination will be performed and should be followed by an endoscopic examination of the larynx and pharynx. Laryngeal motor and sensory function is assessed, particularly vocal fold mobility and glottal closure. Where possible, videostroboscopy should be used if vocal abnormalities are identified and a functional endoscopic evaluation of swallowing (FEES) should be performed (by the otorhinolaryngology surgeon or a trained SLT). FEES is a dynamic real-time assessment of the swallow from a luminal perspective. The mucosa may be assessed along with the mobility and health of the vocal folds. Safety of deglutition, particularly penetration, aspiration and residue, may be evaluated. FEES is performed at the bedside or in the clinic, and requires only a nasopharyngoscope and food to administer. Advantages include: lack of exposure to ionising radiation; ability to assess patients who are unfit for transport to other departments at bedside; direct visualisation of glottic function; ability to test strategies or compensatory manoeuvres; and speed of the study. FEES guides dietary recommendations and may be repeated frequently as the patient’s condition changes. The main disadvantage of FEES is the period of obscuration of view, termed the ‘whiteout’, that occurs with constriction of the luminal space as swallowing occurs. For a brief moment the endoscope tip is enveloped in mucosa and no view of the bolus or glottis is possible. Airway violation occurring at this point cannot be seen. Technical proficiency in passing the endoscope is required and difficult nasal anatomy may make this uncomfortable for the patient or impossible to achieve. There is also a need for appropriate sterilisation of the endoscope and equipment used.
Update on the diagnosis and management of pediatric laryngotracheal stenosis
Published in Expert Review of Respiratory Medicine, 2022
Matthew M Smith, Lauren S Buck
Unfortunately for patients who have undergone posterior grafting in the past, future dysphonia is a potential consequence. In these patients, it is important to identify if there is the present of posterior glottic diastasis [22]. If posterior glottic diastasis is present, endoscopic posterior cricoid reduction (EPCR) can be an option to reduce posterior glottic diastasis. After appropriate work up (generally including videostroboscopy, acoustic analysis, dynamic voice CT and MLB) the patient is placed into suspension with an appropriate laryngoscope to view the posterior cricoid. The CO2 laser is then used to ablate a central portion of this area, with the amount based on measurements from the patient’s dynamic voice CT and intraoperative findings (typically a large spot diameter of 1.8 mm). Once reduced, the cricoid is then sutured to close the surgical defect. De Alarcon et al found that patients who underwent EPCR had improvements in vocal efficiency, loudness and perceived voice handicapping [22].
Voice therapy in paediatric dysphonia
Published in Hearing, Balance and Communication, 2020
Mattia Gambalonga, Davide Brotto, Niccolò Favaretto
The second step consists of the clinical examination of the child, which should be performed by a qualified specialist in order to obtain the patient’s collaboration. The neck should be manually inspected in order to identify possible abnormalities in the cartilages or suspicious tumefactions. A videoscopic visualization of the larynx should be obtained, and this often is the most difficult part of the examination, especially in very young children. In these patients, small flexible nasopharyngoscopes are preferable because they are well-tolerated and require less participation in the examination. Some authors even proposed to perform the endoscopic evaluation in conscious sedation [19]. However, videostroboscopy can be efficiently performed only with rigid endoscopes or with high-resolution flexible endoscopes: the first requires substantial collaboration during the exam and adequate expertise by the operator, the second consists of an expensive instrument, not available in all clinical institutions. The aim of the exam is to obtain a reasonably good visualization of the larynx and the subglottis, in order to exclude severe conditions and to guide the diagnostic and therapeutic process.
Extracranial internal carotid artery tortuosity may cause vocal cord palsy
Published in Acta Oto-Laryngologica, 2019
Jens Maier, Luka Abdulhady, Henrik Glad
This retrospective study was conducted at a university hospital covering a population of 800,000. The Danish patient safety authority (Journal no. 3-3013-1713/1) and the Danish data protection agency (Journal no. 2016-41-4761) approved the protocol. We reviewed the records of all patients presenting at the ENT outpatients clinic with VCP in the year 2015. The data collection included age, sex, medical history, CT results, laryngological and general medical follow-up, laryngological treatment, and determination of the etiology of the VCP. For inclusion, the VCP, defined as partial or complete vocal cord palsy [10], had to be confirmed by videostroboscopy or flexible laryngoscopy. Furthermore, a contrast-enhanced CT study investigating the cause of VCP, performed within three months before or after the laryngoscopy/videostroboscopy, needed to be accessible.