Videostroboscopy Workshop Jeffrey Lehman, MD Updated 2/21/2017 April 21, 2017 Chicago Videostroboscopy Workshop Jeffrey Lehman, MD Updated 2/21/2017

LARYNGEAL STROBOSCOPY Attribution and thanks to Author RALPH IANNUZZI, MD

Learning Objectives Recognize the usage and care of videostroboscopy equipment. Discuss indications for videostroboscopy examination of the adult. Identify normal anatomy, normal variants and abnormal findings visible via videostroboscopy Practice performing and recording a videostroboscopy exam on a simulated adult patient.

Intro to Stroboscopy Identify System Components Understanding How a Strobe Works System Operations Introduction to the Clinical Exam

Identifying System Components Monitor Strobe Light Source ( foot pedals) Camera and Lens Endoscope (flexible or Rigid) Microphones Recording System (computer, DVD or VCR) Printer Uninterrupted Power Supply (UPS) OPTIONAL ITEMS EPK Processor Electroglottograph Cart

Understanding How A Strobe Works Strobe box has two types of light, a flashing Xenon and a constant Halogen for constant viewing. A microphone is used to detect the Fundamental Frequency of the vocal folds. The flash is synchronized (video rate 30 times a second) or Pitch rate.

Understanding How A Strobe Works The flashing Strobe light creates an illusion that the cords are moving in slow motion, but it is actually a composite image, sampled from a variety of glottal cycles.

Muscle Vibratory layer Any change that affects this layer – stiffness of vocal fold layers, weakness or failure of closure, imbalance between R and L vocal folds from a lesion on one vocal fold – causes voice problems.

Diagnostic Value of Stroboscopic Examination in Hoarse Patients “Videostroboscopy contributed significant diagnostic information in 27.2% of the cases” (versus non-stroboscopic means). “It was instrumental in changing the diagnosis in 10% of the cases.” Case no. 4: original diagnosis was “recurrent laryngeal cancer”; changed to “excessive mucous” Conclusion: “Stroboscopy should be performed in selected patients suspected of vocal fold pathology. It is especially useful in serial examinations to help assess treatment progress.” “Diagnostic Value of Stroboscopic Examination in Hoarse Patients”, Woo, Peak, et.al.; 1991: Journal of Voice, Vol. 5; No. 3

More Pronounced Results In Study Done By Sataloff, et.al Diagnoses were noted before and after employing use of videostroboscopy in 377 patients Results: 29% of original diagnoses had additional diagnosis added 18% of original diagnoses were incorrect 47% of original diagnoses were modified Sataloff, et.al.; “Strobovideolaryngoscopy: Results and Clinical Value; Annals of Oto, Rhino, Laryngo, September 1991

Database

Assessment form and selections based on Bless and Hirano Template. Data and still images from database are imported into a Microsoft Word template customized to your institution. Later changes reflect emphasis on report writing, network integration, and database features.

REVIEW OF STROBES RECORDINGS -See CD REVIEW OF STROBES RECORDINGS

Videostroboscopy Workshop: Evaluation Score cards will be used for admission to workshops and attendance. Credit will only be awarded for completed score cards. Name Session 1 2 On scale of 1through 5 with 5 being most likely Scale 1-5 1. Were learning objectives met? 2. Was instruction free of commercial bias? 3. Was there adequate instruction before practice? 4. Was there adequate supervision during practice? 5. Were training aids useful/realistic in learning skill? 6. How likely are you to perform these skills in future 7. Did this training improve your skills? Comments:

Videostroboscopy Workshop: Score Card Rotate and complete each station. “Go/No Go” for internal use only. Completion of workshop is NOT contingent on pass/fail. Task Go No Go Understand indications & contraindications to exam. Properly explain procedure. Apply topical anesthetic & decongestant. Perform supervised videostroboscopy on simulated patient. Identify normal anatomy. Demonstrate proper equipment handling technique. Comments Proctor Name Proctor Signature

Videostroboscopy: Room Set Up Proctors Screen Projector Speaker Station 2 Video Tower Station 1 Video Tower Station 4 Projector Speaker Equipment Table Equipment Table Proctors