Excerpt from Dynamic Voice Evaluation Using Flexible Endoscopy
Synonyms, Key Words, and Related Terms: dynamic voice evaluation using flexible endoscopy, dysphonia, voice analysis, voice evaluation, DVE, voice disorder, speaking disorder, larynx lesions, mass lesions of the larynx, mucosal wave abnormality, functional larynx disorder, movement disorders of the larynx, flexible fiberoptic laryngoscope, flexible laryngoscopy, flexible laryngoscope, adenoid hypertrophy, larynx mass, velopharyngeal insufficiency, VPI, velopharyngeal incompetence, nasopharyngeal examination, nasopharyngeal exam, larynx examination, larynx exam, oropharynx neoplasm, oropharynx retention cysts, lingual tonsillitis, oropharynx examination, nasopharynx examination, hypopharynx examination, oropharynx exam, nasopharynx exam, hypopharynx exam, paradoxical vocal fold movement disorder, vocal fold mobility, and vocal fold atrophy, hyperfunctional voice disorder, muscle tension dysphonia, MTD, spasmodic dysphonia, atrophic vocal cords
Indirect mirror laryngoscopy is the traditional modality used to perform laryngeal examinations on dysphonic patients. It may be inadequate for the diagnosis of mass lesions when patient gagging does not permit adequate visualization. Because of the gagging and the unnatural position of the larynx during the examination, mirror laryngoscopy is not practical for the diagnosis of voice disorders that relate to physiologic and functional pathology. The rod lens telescope, introduced by Hopkins, has several advantages over the traditional indirect laryngoscope. It produces a magnified, recordable image of the larynx that is superior for the diagnosis of mass lesions and mucosal wave abnormalities, especially when performing stroboscopy.
However, its use requires one to grasp the tongue and advance it forward, which can lead to a variable degree of gagging in susceptible patients and has the potential for altering the normal laryngeal anatomy due to the tethering effect of the tongue on the larynx. These factors decrease its use for the diagnosis of functional and movement disorders of the larynx because findings can be subtle and require a physiologic laryngeal position for examination.1 The flexible fiberoptic laryngoscope, introduced by Sawashima and Hirose in 1968, allows visualization of the larynx with the patient in a comfortable, natural position.2 Therefore, indirect laryngoscopy and the rod lens telescope for dynamic voice evaluation is preferable. This article describes an appropriate method of performing a comprehensive dynamic voice evaluation using flexible laryngoscopy.
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