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Objective: Although high-speed imaging (HSI) has been identified as a valuable tool in phonatory biomechanics research, to date, there have only been a selected number of reports investigating the clinical utility of HSI. We aim to elucidate the role of HSI in the diagnosis of the dysphonic patient. Methods: The video files from 28 consecutive dysphonic patients with concurrently acquired videostroboscopy and HSI were retrospectively collected. Stroboscopy video files were edited to include vibratory motion only. Videos were then anonymously and randomly presented to four academic laryngologists. Experts were asked to assign a single best diagnosis for each video file. Assigned diagnoses were then compared with treatment diagnoses conferred based on medical history, phonatory evaluation, laryngeal examination, and response to treatment. Results: Interrater analysis for the four laryngologists demonstrated significant and meaningful correlations for the diagnoses of polyps, cysts, nodules, and normal examination using stroboscopy (kappa > 0.40, P < 0.001). The experts demonstrated significant and meaningful correlations for the diagnoses of polyps, presbyphonia, and normal examination using HSI (kappa > 0.40, P < 0.001). Combined intrarater analysis performed by comparing single rater's diagnosis for single patient across both modalities resulted in poor correlation without statistical significance (kappa = 0.30, P = 0.07). Both stroboscopy- and HSI-assigned diagnoses matched the treatment diagnoses at equal predicted frequencies (32.3%), as demonstrated through multivariate logistic regression analysis (P < 0.001). Conclusion: Overall, HSI did not improve the diagnostic accuracy above stroboscopy alone. Although specific laryngeal states such as presbyphonia may be better diagnosed with HSI, further studies are required to define HSI's precise role in the clinical setting. © 2013 The Voice Foundation.

Summary Objective To investigate the instruments used by general otolaryngologists to visualize the larynx, assess the perception of the instruments’ capabilities, and understand their comfort diagnosing specific etiologies of dysphonia. Study Design Cross-sectional survey. Methods One thousand randomly chosen general otolaryngologists from American Academy of Otolaryngology—Head & Neck Surgery were mailed a survey. Results The response rate was 27.8%. Mean years in practice were 19.5. Mirror and fiberoptic laryngoscopy were most commonly used. Approximately 84.1% used stroboscopy and 33.7% reported laryngoscopy could assess vibration. Respondents were more comfortable diagnosing conditions with obvious laryngeal structural abnormalities compared with those without, such as central neurologic disorders (P ≤ 0.001). Approximately 46.5% were concerned about overdiagnosing laryngopharyngeal reflux (LPR). Conclusions Although 84.1% of general otolaryngologists use stroboscopy, one-third may not appreciate the differences between stroboscopy and laryngoscopy. General otolaryngologists are less comfortable diagnosing voice disorders without obvious laryngeal structural abnormalities, and nearly 50% are concerned that they overdiagnose LPR.

Patients with intracordal lesions complain of an increase in vocal roughness, early vocal fatigue, and a loss of range. The term intracordal may be misleading; the lesions discussed in this article are nonmalignant masses in or just below the epithelial cover of the vocal fold. Laryngeal videostroboscopy (LVS) is the gold standard for the evaluation of patient's intracordal lesions. The timing of surgery depends on the presence of continued dysfunction despite maximal medical and behavioral interventions. The microflap surgical technique is based upon the immunohistochemical characteristics of benign vocal fold lesions, including intracordal cysts. The dissection, within the superficial layer of the lamina propria, spares the overlying mucosal cover and underlying vocal ligament, optimizing vocal outcome.

In adult microlaryngeal surgery appropriate application of the laser can result in improved therapeutic outcomes. Used injudiciously, however, the laser will impart heat energy which can irreversibly alter postoperative laryngeal vibratory characteristics. This article discusses the equipment, safety precautions, and clinical applications of lasers in adult laryngeal surgery because the laser remains a valuable tool for the treatment of specific laryngeal diseases.

Endoscopic evaluation is a crucial component in the assessment of chronic airway obstruction. Acute airway obstruction is a potentially devastating complication of this invasive procedure. This article discusses a systematic approach to endoscopically assessing the airway safely and obtaining the information necessary for longterm management of the chonically obstructed airway.

Chronic airway obstruction usually has an insidious onset. It is often difficult to diagnose unless the patient is examined by a physician familiar with the problem and causes. Potential causes can be divided into infectious, inflammatory, traumatic, and neoplastic. Although the precise incidence of each category is unknown, trauma, secondary to previous prolonged intubation for mechanical ventilation, is currently the most common premorbid factor.

Epidemiological studies of temporomandibular joint (TMJ) dysfunction suggest a significant female predilection for symptomatic disease. Because previous primate research revealed sexual dimorphism in the estrogen receptors (ER) present in the masticatory apparatus, this investigation was undertaken to assess the presence of ER in human TMJ tissues. The negative findings suggest that ER status does not contribute to symptomatic TMJ disease.