Practical Guidelines on Use of Laryngeal Videostroboscopy

CHICAGO-As evidence accumulates on the benefits and added value of videostroboscopy in the diagnosis of voice problems, many otolaryngologists are turning their attention to whether or not they want to invest in this technology-in terms of both the cost in buying the equipment and the time and skill needed to analyze correctly the many types of lesions one can see using this tool.

Participants at a miniseminar on laryngeal stroboscopy at the recent annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) were given a chance to assess for themselves the benefits of investing in videostroboscopy by listening to a number of presentations by experts in the use of this tool. Along with gathering information on the benefits and limitations, participants were able to get a hands-on feel of the challenges of differentiating lesions seen with this tool by viewing a number of video examples presented.

Benefits of Seeing-But What Is It?

When talking to colleagues who have not yet invested in videostroboscopy, Kenneth W. Altman, MD, PhD, Director of the Grabscheid Voice Center and an otolaryngologist at Mount Sinai School of Medicine in New York, explains that a valuable aspect of a videostroboscopy system is the ability to record and play back exams so that patients can see how their voice problems change over time. It is educational to show people what their vocal folds look like so they can understand, for example, what surgery can do for them, he said. They therefore are more invested in the treatment plan by seeing what the problem is.

Along with showing patients the changes in their vocal folds over time, videostroboscopy has the additional benefit of permitting the vibrational qualities of the vocal folds to be seen. This also helps to distinguish the type of lesion a person may have.

For example, said Dr. Altman, patients with early vocal fold cancer often present with some kind of mass sitting on top of the vocal fold. One could assume that the mass is only on the surface. Using videostroboscopy to look at the vibrational qualities of the vocal fold, however, can provide more information that could reveal that the lesion has infiltrated into the muscle and is therefore a more aggressive cancer than initially thought.

But it is this advantage-of improved visual display of the vocal folds and vibrational qualities-that also creates the main challenge of using this tool.