To understand vocal fold biomechanics video on slide 7

1. PRESENTER: DR. ARJUN SURESH

2.  Videostroboscopy - practical and useful technique - clinical
evaluation - visco-elastic properties of phonatory mucosa.
 Painless, OPD-based procedure
 Essential evaluation of laryngeal mucosa, vocal fold motion
biomechanics, and mucosal vibration.
 Helps detect pathology - determine impact on voice and airway
function.

3.  Method used to visualize vocal fold vibration.
 Uses synchronized, flashing light passed via flexible or rigid
telescope
 Flashes of light are synchronized to vocal fold vibration at
slightly slower speed, allowing examiner to observe it during
sound production in slow motion

4.  Essential for planning effective phonomicrosurgery.
 Real-time information - nature of vibration, image to detect vocal
pathology, and permanent video record of examination.
 Improves sensitivity of subtle laryngeal diagnoses.
 Helps evaluate:
1. Vocal fold biomechanics
2. Laryngeal mucosa
3. Mucosal Vibration

5. • Cause of voice dysfunction or hoarseness - vocal cord swelling,
irritations, misuse, growths, polyps or acid reflux.
• To visualize your vocal cords
• To evaluate or detect vocal cord lesions and other irregularities
like inflammation, scar tissue or muscle tension conditions
• To assess swallowing issues, which could be caused by muscle
abnormalities

6. You may be a candidate for videostroboscopy if you're
experiencing chronic or intermittent voice problems like:
 Breathiness, hoarseness, decreased or loss of vocal range or
vocal fatigue
 Tightness, discomfort or pain or burning in your throat while
talking
 The feeling of "something in your throat“ (foreign body
sensation)
 Symptoms and hoarseness caused by acid reflux

8.  A strobe - visualize the mucosal waves across the vocal folds.
 Synchronized to the frequency of the voice.
 The mucosal waves are too fast for the human eye to appreciate.
 The strobe slows this process by visualizing the mucosal wave across
several cycles of vocalization.
 Mucosal waves originate upon contact or closure of the vocal folds
and move from a medial to lateral direction
 Mucosal folds are at the same position on both vocal folds at any
particular time

9.  No absolute CI – patient should have adequate mouth opening
and patent nasal airway.

10. A videostroboscopic unit:
 A stroboscopic light source and microphone,
 Video camera
 Endoscope
 Video recorder.
Stroboscopy can be performed by using either rigid or flexible
Endoscopes.

11. Standard 70-degree rigid
strobolaryngoscope.
Camera attachment with mounted
microphone
Laryngeal microphone
flexible laryngostroboscope

12.  Videostrobolaryngoscopy begins by seating the patient in the
examination chair at a height comfortable for the examiner.
 The patient leans forward with the neck flexed and the head
extended at the atlo-occipital joint (Kirstein position).

13.  Once the patient is in appropriate position,
 Spray topical anesthesia – posterior part of tongue and
oropharynx.
 Calibrate microphone and hold against thyroid lamina.
 To avoid condensation – dip scope in hot water.
 Open mouth, protrude tongue- scope is inserted.
 Proper focus – visualise subepithelial vasculature of vocal
fold.

14.  With Vocal folds in focus – ask patient to produce ‘ee’ sound.
 Should be done at low, mid and high frequency pitches and
different volumes.
 Examiner - comment on arytenoid and vocal fold mobility,
glottic closure pattern, mucosal wave, and pliability.
 Ulcerative lesions or masses can also be observed.

15. 1. VOCAL CYST
- Encapsulated, spheroid lesions - mucus or keratin
- Located - lamina propria of the vocal fold.
- Keratin cysts - likely congenital & mucous cysts - likely acquired.
- Generally unilateral, though several may be present at the time of
diagnosis.
- On stroboscopy, region of the cyst - diminished pliability - mucosal wave
does not propagate normally through the region of the cyst.
- Mucosal-wave deficit - size and location of the cyst.
- Illustrated by the fact - small superior-surface cysts minimally affect vocal
function.

17.  Unilateral or bilateral.
 Represent phonotraumatic pathology - collision forces, shearing
stresses - lamina propria.
 Consistency - gelatinous to fibrotic.
 Glottic closure – compromised - gaps anterior and posterior to the
lesion in maximal closure.
 The vibratory patterns of VC – asymmetric - diminution of vibration
near the lesion.
 Medial surface polyp - disturbs the vibratory pattern - contralateral
vocal fold during closure.

19.  Bilateral fibrovascular lesions - symmetric sessile masses.
 Occur in the center of the musculomembranous region -
basement-membrane - between the overlying epithelium and
the underlying superficial lamina propria.
 Glottic closure is compromised - high pitch frequencies.
 Mucosal wave - usually preserved bilaterally - pliability and
amplitude - decreased in the region of the nodule.