How are the vocal cords examined?
- Mirror Laryngoscopy: Indirect laryngoscopy is done in a doctor's office using a small hand mirror held in the mouth at the back of the throat, a head mirror worn by the doctor, and a light source. The mirror worn by the doctor reflects light into the mouth. Some doctors now use headgear equipped with a bright light. This mirror provides only a limited view of the larynx, and is now considered to be a less preferred method of accurate examination. Indirect laryngoscopy has been largely replaced by newer direct fiber-optic laryngoscopic techniques that provide better views and greater comfort during the examination. What does this exam typically cost? Since this requires no specialized electronic equipment, this type of observation is ordinarily included with your regular examination fee for seeing the otolaryngologist, which is usually around $75.00.
- Flexible Laryngoscopy: A flexible fiber-optic scope (picture)
the doctor uses to look at your throat. The scope can be inserted through
the nose or mouth, since it is only a little larger in diameter than a spaghetti
noodle. A local anesthetic may be sprayed into your nose or throat to numb it.
Using this tool, your doctor can obtain close-up images of your voice box and
vocal folds. This type of scope has advantages and disadvantages.
The advantages are that this tube can be passed through the nose, which allows
the patient to speak, sing, and/or otherwise use the voice during the procedure,
allowing the doctor to view your vocal cords in action. Another advantage is the
fact that this scope can be maneuvered around by the doctor, so as to get a
magnified view of any part of the larynx. The disadvantage of the flexible laryngoscopy is that the clarity of the image is not as good as that of the
rigid laryngoscopy.
During this exam, many people feel a strong sensation to gag, even if a local anesthetic is used. But it usually only takes a couple of minutes to complete this exam. What does this procedure typically cost? In my experience, this type of scope usually costs $275.00 to $325.00. So if your insurance pays 80%, then you will owe a little more than $55.00. - Rigid Laryngoscopy: This examination provides the clearest
magnified view of the voice box. A rigid telescope-tube (picture)
is passed through the patient's mouth. This tube is about 8-10 inches long
and is about the same diameter as a tube of chap stick. The examiner then
holds the patient's tongue while viewing the voice box. Images are usually
recorded on video. As with the flexible laryngoscopy, this tool has pros
and cons. The advantages of using the rigid scope is that the lighting is
extremely bright, thus giving optimal clarity to the images. The downside
of this method is that it is done through the mouth with the tongue protruded
and held by the examiner, thus examination of the voice box is somewhat limited.
The patient is not able to speak or sing. Action is usually limited to a
few sounds such as "eeee".
What is the cost of the rigid laryngoscopy? Usually, this cost will be the same as above for the flexible laryngoscopy.
This procedure is also called telescopic laryngoscopy and/or transoral laryngoscopy.
- Videostroboscopy: Videostroboscopy is one of the most state-of-the-art and practical techniques currently available for observing and recording the motion of the vocal cords. This procedure is
generally performed by an otolaryngologist and a speech language pathologist. Although the naked eye can see the vocal cords, it cannot see the actual cord vibrations, which are much too rapid to be visible with the unaided eye.
Watching the vocal cords vibrate in normal speed is somewhat like watching a
hummingbird flap its wings. You can see that they are moving, but it is
impossible to see the movement clearly. Videostroboscopy uses
controlled high-speed flashes of light timed to the frequency of the patient's
voice. Images acquired during these flashes provide a slow motion-like
view of vocal fold vibration during sound production. These images can then lead to an accurate diagnosis and recommendations for treatment.
(Not all stroboscopy equipment uses a flashing light source. Some
equipment uses the shutter-like action similar to that of a camera.)
While a laryngoscopy helps identify problems of a general nature, a videostroboscopy provides a more detailed view and can reveal problems with the vocal cords such as lesions or vibratory irregularities. Vocal fold vibration is the core of sound production for speaking and singing. Documenting the state of vocal fold vibration is critical in the investigation of voice disorders, as well as in the evaluation of effectiveness of treatment plans. It also provides photo documentation of the larynx for later review and comparison. Stroboscopy provides key information needed in the investigation of voice disorders. It allows the examiner to evaluate two key components of sound production: vocal fold vibration and vocal fold closure.
Videostroboscopy can be be performed through the nose or mouth. When performed through the mouth, the rigid scope is usually used. Many doctors prefer this scope, as it offers a much brighter and clearer image of the vocal cords. However, the scope that is performed through the nose (nasolaryngoscopy with videostroboscopy) can offer some distinct advantages in some cases. When performed through the mouth, the examiner holds the patient's tongue. Therefore, the patient can only make sounds, such as "aahhh" and "eee". But when performed through the nose, the patient is still able to speak, sing, auctioneer, cough, laugh, whisper and so forth. The examiner can then observe the vocal cords as they are being exercised in a specific application, such as the singing voice. It usually takes 30 minutes to an hour to complete the procedure and discuss the findings. The actual scope part of the procedure usually only takes a couple of minutes to complete.
Videostroboscopy can be performed with a flexible laryngoscope or a rigid laryngoscope. Usually a monitor is positioned near your head, and as you say various sounds, a video of the vocal cord vibrations is recorded and displayed on the monitor. A small monitoring device is strapped around the neck to measure voice pitch and intensity during the scope. The otolaryngologist and speech pathologist are able to view the images in real time during the exam, adjusting the speed of the vibration images as necessary. The recording can be played back instantly to help you understand what appears on the screen, or at a later time to allow the otolaryngologist and speech pathologist to analyze the images in detail.
Historically, stroboscopy is not new. It was first used in 1878 to examine the larynx, only 24 years after the introduction of the laryngeal mirror. Throughout the years, the stroboscopic light received a mixed reception from practicing clinicians. As recently as 1984, it was estimated that less than two dozen laryngeal stroboscopes were being used in the United States. A number of factors no doubt contributed to the reluctance of clinicians to use stroboscopy in evaluations. The great expense of the equipment, the absence of standards regarding observations, and the inability of make a permanent record of the recordings all seemed to have fuel hesitancy regarding using stroboscopy. Also it appears that in years past many laryngologists, speech pathologists, and speech scientists failed to understand the importance of the vibratory characteristics of the vocal folds. However, in recent years stroboscopy has become the most state of the art, advanced practice of examing the vibration of the vocal folds.
** Special note: It is very interesting to watch the playback of the videostroboscopy. Your doctor can show you the vocal cords moving in normal motion which is difficult to see clearly because of the fast movement. But when he turns the strobe light on, it's really neat to instantly see them appear in slow motion.
How much does a videostroboscopy cost? I have presently had four of these performed in the past, and the cost was $810.00 for this procedure. Hopefully, your insurance will pay a large amount of this fee.
This procedure is also called fiber optic laryngoscopy, nasopharyngoscopy, or transnasal laryngoscopy.
This procedure is also called laryngeal stroboscopy, laryngostroboscopy, stroboscopic laryngoscopy, strobolaryngoscopy.
Important Tip: If you have a strong tendency to gag during any of the scopes mentioned above, try the following suggestions: (1) Ask the doctor to spray the local anesthetic heavily on your tongue and all the way to the front tip of it. (2) During the scope, concentrate on breathing normally. If you try to swallow, it only makes the sensation worse. (3) If the scope is inserted through the nose, try very hard not to swallow. In my experience, this creates a painful sensation that will make your throat feel irritated for several hours.
Also, some examiners will try to insert the rigid scope into the mouth without
touching any part of your throat. But usually the scope will bump
different parts of the throat or tonsils. What helped me is when the
doctor lays the scope on my tongue and slides it all the way back and keeps it
touching the entire time.
Additional Tip: If you have a videostroboscopy performed, you usually have the option to carry home a souvenir. Most videostroboscopy equipment has the ability to freeze any of the video frames just recorded and print you a picture. Just ask your doctor, and he will no doubt happily do this for you.