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High Speed Laryngeal Imaging Update

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I was asked to give a brief update at the Saunder's Symposium for the Department of Otolaryngology at The Ohio State University in 2012. This was a great honor. The videos have been removed due to size of the file.

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High Speed Laryngeal Imaging Update

  1. 1. High Speed Laryngeal Imaging Saunders Symposium – 2012 Ryan M. Hendricker, M.D. Laryngology and General Otolaryngology Medical Director,Voice and Swallowing Disorders Center Midwest Ear, Nose &Throat S.C. 8600 State Route 91 Peoria, IL 61615 Phone: 309-691-6616 Email: ryan.m.hendricker@osfhealthcare.org Website: mw-ent.com
  2. 2. Disclosures  None
  3. 3. Greetings from Peoria, IL
  4. 4. Objectives  Briefly review the history of laryngeal imaging  Compare the parameters of stroboscopy to high speed video  Discuss the advantages and disadvantages of high speed video imaging
  5. 5. Objectives  Briefly review the history of laryngeal imaging  Compare the parameters of stroboscopy to high speed video  Discuss the advantages and disadvantages of high speed video imaging
  6. 6. History of Laryngeal Imaging  Mirror 1780s-early 19th century  Glottoscope 1829  Direct laryngoscopy 1850’s  First stroboscopic descriptions 1895-1932  Fiberoptics 1950’s  Transnasal fiberoptic laryngoscopy 1970’s  High speed video 1970’s  Electrical stroboscope 1970  Distal chip technology late 1990’s Woo, P. Stroboscopy. Plural Publishing 2010.
  7. 7. Gold Standard: Stroboscopy  Most widely available/used modality  Collection of still images from subsequent glottal cycles  Stroboscopic light desynchronized to create perception of glottal cycle Woo, P. Stroboscopy. Plural Publishing 2010.
  8. 8. Gold Standard: Stroboscopy
  9. 9. Gold Standard: Stroboscopy  Features typically analyzed  Fundamental frequency  Symmetry of motion  Periodicity  Mucosal wave  Presence/absence  Amplitude  Glottic Closure Woo, P. Stroboscopy. Plural Publishing 2010.
  10. 10. The Problem with Stroboscopy  Cannot examine intra-cycle changes or cycle to cycle variability  Patient must be able to have some degree of sustained phonation (pitch tracking)  Difficult to examine onset/offset  So…what about all our patients with…  Aperiodic vibration/scar  Muscle tension dysphonia  Spasmodic dysphonia  Voice breaks  Diplophonia Deliyski, D., and Robert Hillman. “State of the Art Laryngeal Imaging: Research and Clinical Implications.” Curr Opin Otolaryngol Head Neck Surg. 2010 June:147-152.
  11. 11. Other options?  High speed videoendoscopy (HSV)  Videokymography (VKG) Deliyski, D., and Robert Hillman. “State of the Art Laryngeal Imaging: Research and Clinical Implications.” Curr Opin Otolaryngol Head Neck Surg. 2010 June:147-152. Jiang, J. et al. “Mucosal Wave Measurement andVisualization Techniques.” JVoiceVol. 25, No 4, 395-405.
  12. 12. Videokymography  Videokymography (VKG) is a high-speed imaging modality that is often used to supplement stroboscopy for irregular vibratory patterns Deliyski, D., and Robert Hillman. “State of the Art Laryngeal Imaging: Research and Clinical Implications.” Curr Opin Otolaryngol Head Neck Surg. 2010 June:147-152. Jiang, J. et al. “Mucosal Wave Measurement andVisualization Techniques.” JVoiceVol. 25, No 4, 395-405.
  13. 13. High Speed Videoendoscopy (HSV)  Advantages  Overcomes limitations of stroboscopy  Full visualization and objective measurement of periodic/aperiodic vibration  Can visualize unstable phonatory characteristics  Can visualize transient behaviors  Phonatory breaks  Laryngeal spasms  Cough  Pitch onset/offset  Throat-clearing  Laughing Deliyski, et. al. In Press. Presented atTheVoice Foundation May 2012. Philadelphia, PA
  14. 14. What about High Speed?
  15. 15. Problems with High Speed Video  Insufficient frame rates  Lack of meaningful practice guidelines  Lack of “normals” for comparison  Physical limitations  Structures become invisible at higher velocities due to temporal averaging (blurring)  Different phonatory behaviors produce drastically different glottal configurations (pressed, breathy, normal, etc.)  Gender differences  3D world, 2D images; scope limitations Deliyski, et. al. In Press. Presented atTheVoice Foundation May 2012. Philadelphia, PA
  16. 16. Mucosal Wave  What is it?  Superficial tissue displacement/propagation of the epithelium and SLP from inferior to superior surface  2d/3d  What amount of lateral excursion is normal?  What degree of asymmetry is expected?  Different for HSV and stroboscopy? Deliyski, et. al. In Press. Presented atTheVoice Foundation May 2012. Philadelphia, PA
  17. 17. Mucosal Wave: Normophonic Patients  What is it?  Superficial tissue displacement  2d/3d  What amount of lateral excursion is normal?  What degree of asymmetry is expected?  Different for HSV and stroboscopy?  Gender** Deliyski, et. al. In Press. Presented atTheVoice Foundation May 2012. Philadelphia, PA *Shaw et al. Mucosal Wave: A Normophonic Study AcrossVisualization Techniques. JVoice 22, No. 1, 23-33.
  18. 18. The Required Speed of High-Speed Videoendoscopy for Specific Clinical Voice Assessment Protocols  Compared frame rates from 16,000 fps to 2,000 fps  1st noticeable difference  When did it change clinical diagnosis (e.g., presence/absence of mucosal wave) Deliyski, et. al. In Press. Presented atTheVoice Foundation May 2012. Philadelphia, PA
  19. 19. The Required Speed of High-Speed Videoendoscopy for Specific Clinical Voice Assessment Protocols  Features examined  Mucosal wave magnitude  Mucosal wave extent  Amplitude asymmetry  Phase asymmetry  Aperiodicity  Glottal edge*  Loss of glottal contact  Mucous bridge breaking Deliyski, et. al. In Press. Presented atTheVoice Foundation May 2012. Philadelphia, PA
  20. 20. The Required Speed of High-Speed Videoendoscopy for Specific Clinical Voice Assessment Protocols  1st noticeable difference  Minimum of 8,000 fps required  Clinical change  Minimum of 4,000 fps  A rate of 8,000 fps is free from visually perceivable feature degradation  Rates greater than 5,333 fps have minimal degradation  Rates less than 2,667 fps should be clinically interpreted with caution Deliyski, et. al. In Press. Presented atTheVoice Foundation May 2012. Philadelphia, PA
  21. 21. Summary  High speed digital imaging is not new…but technology is changing  Practice parameters and flexible endoscopy application are needed for widespread high- speed utility  Stroboscopy is still the work-horse, but there are significant limitations in pathologic voices

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