Videostroboscopy Workshop Ralph Iannuzzi , MD & Ann Walter, PA-C

1. Videostroboscopy Workshop Ralph Iannuzzi, MD & Ann Walter, PA-C

2. LARYNGEAL STROBOSCOPY

3. 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.

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

5. 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

6. 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.

7. 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.

10. 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.

11. 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

12. 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

13. Database

14. 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.

15. -See CD REVIEW OF STROBES RECORDINGS

16. La Valencia B 47x30 10 learners per session 17 chairs, 5 6ft tables, AV cart and screen Videostroboscopy Station 3 Video Tower Screen Station 1 Video Tower Station 2 Video Tower Equipment Table Door Station 4 Equipment Table Equipment Table Projector Speaker Strobes towers draw 10 amps each. Proctors

17. Reminder:complete your workshop cards and turn them in at the end of this session. • Score cards will be used for admission to workshops and attendance. • Credit will only be awarded for completed score cards. • Rotate and complete each station. • Completion of workshop is NOT contingent on pass/fail

18. VideostroboscopySession Evaluation Score cards will be used for admission to workshops and attendance. Credit will only be awarded for completed score cards.

19. VideostroboscopyScore Card Rotate and complete each station. “Go/No Go” for internal use only. Completion of workshop is NOT contingent on pass/fail.