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OBJECTIVES: Digital videokymography based on high-speed videoendoscopy enables the evaluation of therapeutic techniques and voice training, such as the LaxVox technique, on vocal fold vibrations. This study investigated the immediate effects of the LaxVox technique on digital videokymographic parameters obtained through high-speed videolaryngoscopy in adults with voice complaints. STUDY DESIGN: An experimental intrasubject comparative study of adults with voice complaints was conducted. METHODS: Image processing software was used to analyze the videos and obtain digital videokymography parameters. The intraclass correlation coefficient was used to determine the intra-rater reliability of the analyzed parameters. The paired t test and Wilcoxon signed-rank test were used to compare digital videokymography parameters before and after the LaxVox technique, in sex-specific analyses. The significance level was set at 5%. RESULTS: In total, 25 laryngeal images from 15 women and 10 men were analyzed. On digital videokymography analysis, the mean vocal fold opening in the posterior glottal region was decreased immediately after using the LaxVox technique in women. In contrast, no significant changes were found in other parameters compared to pre LaxVox technique values in both men and women with voice complaints. CONCLUSION: Digital videokymography analysis revealed that the LaxVox technique reduces the mean vocal fold opening in the posterior glottal region of women with voice complaints.
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INTRODUCTION: High-speed videolaryngoscopy and quantitative analysis of laryngeal images are relevant in accurately diagnosing vocal fold closure patterns. OBJECTIVE: To analyze the parameters of digital videokymography obtained through high-speed videolaryngoscopy in women and men with complete and incomplete glottal closure, and posterior glottal chink. METHODS: We conducted an observational, analytical, cross-sectional study with data from 65 adults, which we divided into groups according to sex and glottal closure. Digital videokymography parameters were analyzed using an image-processing program. The Anderson-Darling and Mann-Whitney U tests were used to verify sample normality and compare videokymography parameters between groups, respectively. The significance level was set at 5%. RESULTS: Among 65 laryngeal images, 20 each were from women with complete and incomplete glottal closure, and 20 and 5 were from men with complete and incomplete glottal closure, respectively. Considering the clinical relevance of the evaluated data, groups of 11 women and 4 men with posterior glottal chink were compared with sex-similar groups with complete glottal closure. Digital videokymography showed a lower maximum and mean vocal fold opening in women with incomplete glottal closure, and a lower dominant left vocal fold-opening amplitude and higher dominant frequency of bilateral vocal fold opening in men with incomplete glottal closure. It also showed a lower closed phase percentage in the posterior region for women and men, with higher closed phase percentage in the anterior and middle regions in women. Both groups with posterior glottal chink showed similar results. CONCLUSION: Incomplete glottal closure may interfere with the results of the digital videokymography parameters, with higher impact on the posterior vocal fold region in males and the middle and anterior vocal fold regions in females.
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PURPOSE: To compare high-speed videolaryngoscopy (HSV) findings, like open quotient (OQ), vocal fold vibratory onset delay (VFVOD), amplitude symmetry index (ASI) and phase symmetry index (PSI), after 6 months of cordectomy with that after 1 year, and to compare later with the control group. METHODS: Retrospective analysis of HSV recordings of 33 patients of early glottic carcinoma after cordectomy was performed after 6 months and 1 year of cordectomy with the help of videokymogram and digital kymogram. The control group of ten individuals was selected from patients who came to hospital with complaints other than larynx. The comparison was done for different types of cordectomy separately. RESULTS: The mean of OQ, VFVOD, ASI and PSI was found to be significantly higher after 6-month follow-up than after 1-year follow-up, the later was in turn found to be significantly higher than that of the control group, for type II and III cordectomy. The mean of OQ, VFVOD, ASI and PSI for other types of cordectomy also showed similar results, but the significance was not calculated due to less sample size. CONCLUSION: There was significant improvement in OQ, VFVOD, PSI and ASI following CO2 LASER cordectomy after 1 year of follow-up, making it a good management option for early glottic carcinoma. The ability of the HSV to measure variations in the vocal cord vibration, following cordectomy, was well established by this study.
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Carcinoma , Neoplasias Laríngeas , Terapia por Láser , Dióxido de Carbono , Glotis/cirugía , Humanos , Neoplasias Laríngeas/cirugía , Laringoscopía , Estudios Retrospectivos , Resultado del Tratamiento , Pliegues Vocales/cirugíaRESUMEN
OBJECTIVE: Adductor spasmodic dysphonia (AdSD) is a challenging voice disorder to diagnose, often erroneously diagnosed as muscle tension dysphonia (MTD) or vocal tremor, due to its similarity in auditory and perceptual presentation. Assessments using laryngoscopy or strobolaryngoscopy procedures have demonstrated limited utility in the diagnosis of spasmodic dysphonia. High-speed videoendoscopy (HSV) provides visualization of the precise vibratory pattern of phonatory onset and thus, offers an alternative to previous diagnostic strategies for visual diagnosis of AdSD. The purpose of this study was to examine vibratory onset of patients with AdSD and patients with MTD using HSV methodology. METHODS: HSV of six adults with AdSD and five adults with MTD were captured during sustained phonation. Digital kymography was used to obtain precise vibrogram data at the mid-membranous region of the vocal fold prior to and at the onset of phonation. Voice onset delay was examined by (1) quantifying timing of prephonatory delay and steady state delay and (2) describing vocal fold onset movements qualitatively in each diagnosis. RESULTS: HSV adequately captured the phonatory onset of the vocal folds. Voice onset delay was not significantly different between AdSD and MTD. However, there were distinct differences in voice onset gestures. Both AdSD and MTD patients presented with vocal hyperfunction during the onset of phonation. In a subset of AdSD patients, a rapid sustained adduction occurred following the initial vibratory motion. Vocal fold vibration then continued until steady phonation was achieved. This oscillatory break pattern was not observed in patients with MTD. Therefore, there appears to be differences in vocal fold vibratory onset motion between MTD and AdSD. CONCLUSION: HSV captures the precise vibratory onset in patients with MTD and AdSD. Differences were most notable after vibratory onset as opposed to vibratory delay measurements. Examination of voice onset gesture may offer an additional laryngeal parameter to assist in the differential diagnosis of spasmodic dysphonia.
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Disfonía/diagnóstico , Quimografía , Músculos Laríngeos/fisiopatología , Laringismo/diagnóstico , Laringoscopía , Fonación , Grabación en Video , Pliegues Vocales/fisiopatología , Voz , Fenómenos Biomecánicos , Diagnóstico Diferencial , Disfonía/fisiopatología , Humanos , Laringismo/fisiopatología , Valor Predictivo de las Pruebas , Factores de Tiempo , VibraciónRESUMEN
BACKGROUND: A digital kymogram shows real images of vocal fold vibration. However, DKG is difficult to use in clinical practice because the recorded image cannot be seen instantaneously after examination, as considerable encoding time is required to visualize a digital kymogram. In addition, frame-by frame analysis should be implemented to evaluate high-speed videoendoscopy data, but is time- and labor-intensive. PURPOSE: The purpose of the study was to validate the clinical practicability of a real-time multislice digital kymographic system developed by the authors. We analyzed the promptness and accuracy of the examination before and after intracordal injections in patients with unilateral vocal fold paralysis. METHODS: To assess the clinical applicability of this system, six patients with unilateral vocal fold paralysis were selected. Real-time DKG was performed before and immediately after intracordal injection. We observed changes in the digital kymogram after the intracordal injection. RESULTS: Using this system, 10 scanning lines and up to five vertical pixel row could be obtained in real time, and the maximum acquisition time for the DKG image was 10 seconds. A digital kymogram of the patients could be instantaneously acquired, and whether the intracordal injection was appropriate or not. CONCLUSION: This article is the first validation study after the development of the real-time multislice digital kymographic system. Our system may be a promising tool in clinical practice for immediate assessment of the vibratory patterns of the vocal cords. More research is necessary for further clinical validation.
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Electroquimografía/instrumentación , Fonación , Parálisis de los Pliegues Vocales/diagnóstico por imagen , Pliegues Vocales/diagnóstico por imagen , Adulto , Anciano , Estudios de Casos y Controles , Estudios de Factibilidad , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento , Vibración , Parálisis de los Pliegues Vocales/fisiopatología , Parálisis de los Pliegues Vocales/terapia , Pliegues Vocales/fisiopatologíaRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the clinical feasibility and diagnostic accuracy of two-dimensional scanning digital kymography (2D DKG) in patients with vocal cord atrophy before and after treatment. MATERIALS AND METHODS: We analyzed the characteristics of vocal fold vibration in five patients with unilateral vocal fold paralysis and five patients with presbyphonia. In patients with vocal cord paralysis, the status before and after intracordal injection was compared. Furthermore, in patients with presbyphonia, we compared the status before and after voice therapy (Seong-Tae Kim's laryngeal calibration technique). Quantitative parameters such as amplitude and phase symmetry indices, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time and qualitative parameters such as Voice Handicap Index, glottal gap, amplitude, and phase difference were used to evaluate the pre- and post-treatment status. RESULTS: In cases of vocal cord paralysis, vibratory changes of the vocal folds before and after intracordal injection could be identified immediately using 2D DKG. In overcorrection cases, all of the measured parameters were poor except for improvement of the glottal gap. In addition, 2D DKG showed appropriately the changes in vocal cord vibration before and after voice therapy in patients with presbyphonia. CONCLUSION: Two-dimensional DKG may be a useful diagnostic tool in evaluation of the vibratory characteristics of entire vocal cords. In addition, it may also play a role in providing a decision for treatment modalities.
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Disfonía/diagnóstico por imagen , Quimografía/métodos , Enfermedades de la Laringe/diagnóstico por imagen , Fonación , Parálisis de los Pliegues Vocales/diagnóstico por imagen , Pliegues Vocales/diagnóstico por imagen , Adulto , Anciano , Atrofia , Disfonía/patología , Disfonía/fisiopatología , Disfonía/terapia , Estudios de Factibilidad , Femenino , Humanos , Enfermedades de la Laringe/patología , Enfermedades de la Laringe/fisiopatología , Enfermedades de la Laringe/terapia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Resultado del Tratamiento , Vibración , Parálisis de los Pliegues Vocales/patología , Parálisis de los Pliegues Vocales/fisiopatología , Parálisis de los Pliegues Vocales/terapia , Pliegues Vocales/patología , Pliegues Vocales/fisiopatología , Entrenamiento de la VozRESUMEN
OBJECTIVE: High-speed video (HSV) imaging of vocal fold vibration has been possible only through the rigid endoscope. This study reports that a fiberscope-based high-speed imaging system may allow HSV imaging of naturalistic voicing. MATERIALS AND METHODS: Twenty-two subjects were recorded using a commercially available black and white high-speed camera (Photron Motion Tools, 256 × 120 pixel, 2000 frames per second, 8 second acquisition time). The camera gain is set to +6 db. The camera is coupled to a standard fiber-optic laryngoscope (Olympus ENF P-4) with a 300-W Xenon light. Image acquisition was done by asking the subject to perform repeated phonation at modal phonation. Video images were processed using commercial video editing and video noise reduction software (After effects, Magix, and Neat Video 4.1). After video processing, the video images were analyzed using digital kymography (DKG). RESULTS: The HSV black and white video acquired by the camera is gray and lacks contrast. By adjustment of image contrast, brightness, and gamma and using noise reduction software, the flexible laryngoscopy image can be converted to video image files suitable for DKG and waveform analysis. The increased noise still makes edge tracking for objective analysis difficult, but subjective analysis of DKG plot is possible. CONCLUSIONS: This is the first report of HSV acquisition in an unsedated patient using a fiberscope. Image enhancement and noise reduction can enhance the HSV to allow extraction of the digital kymogram. Further image enhancement may allow for objective analysis of the vibratory waveform.
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Tecnología de Fibra Óptica , Laringoscopía/métodos , Fonación , Grabación en Video , Parálisis de los Pliegues Vocales/diagnóstico , Pliegues Vocales/fisiopatología , Trastornos de la Voz/diagnóstico , Calidad de la Voz , Adolescente , Adulto , Anciano , Fenómenos Biomecánicos , Estudios de Casos y Controles , Diseño de Equipo , Femenino , Tecnología de Fibra Óptica/instrumentación , Humanos , Interpretación de Imagen Asistida por Computador , Quimografía , Laringoscopios , Laringoscopía/instrumentación , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Canto , Programas Informáticos , Factores de Tiempo , Vibración , Grabación en Video/instrumentación , Parálisis de los Pliegues Vocales/fisiopatología , Trastornos de la Voz/fisiopatología , Adulto JovenRESUMEN
High-speed videoendoscopy captures the cycle-to-cycle vibratory motion of each individual vocal fold in normal and severely disordered phonation. Therefore, it provides a direct method to examine the specific vibratory changes following vocal fold surgery. The purpose of this study was to examine the vocal fold vibratory pattern changes in the surgically treated pathologic vocal fold and the contralateral vocal fold in three vocal pathologies: vocal polyp (n = 3), paresis or paralysis (n = 3), and scar (n = 3). Digital kymography was used to extract high-speed kymographic vocal fold images at the mid-membranous region of the vocal fold. Spectral analysis was subsequently applied to the digital kymography to quantify the cycle-to-cycle movements of each vocal fold, expressed as a spectrum. Surgical modification resulted in significantly improved spectral power of the treated pathologic vocal fold. Furthermore, the contralateral vocal fold also presented with improved spectral power irrespective of vocal pathology. In comparison with normal vocal fold spectrum, postsurgical vocal fold vibrations continued to demonstrate decreased vibratory amplitude in both vocal folds.
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Cicatriz/cirugía , Enfermedades de la Laringe/cirugía , Fonación , Pólipos/cirugía , Parálisis de los Pliegues Vocales/cirugía , Pliegues Vocales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Estudios de Casos y Controles , Cicatriz/diagnóstico por imagen , Cicatriz/fisiopatología , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Quimografía , Enfermedades de la Laringe/diagnóstico por imagen , Enfermedades de la Laringe/fisiopatología , Laringoscopía , Masculino , Persona de Mediana Edad , Pólipos/diagnóstico por imagen , Pólipos/fisiopatología , Datos Preliminares , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Vibración , Grabación en Video , Parálisis de los Pliegues Vocales/diagnóstico por imagen , Parálisis de los Pliegues Vocales/fisiopatología , Pliegues Vocales/diagnóstico por imagen , Pliegues Vocales/fisiopatologíaRESUMEN
OBJECTIVES: In this paper, a nonlinear least squares fitting method was proposed to quantify subharmonic mucosal waves. STUDY DESIGN AND METHODS: Subharmonic mucosal waves from 10 excised canine larynges were recorded using digital kymography and analyzed using nonlinear least squares and linear least squares methods. Amplitudes of fundamental and subharmonic mucosal wave components of right-upper, right-lower, left-upper, and left-lower vocal fold lips were calculated. Lastly, phase differences of fundamental and subharmonic components of the left and right vocal folds were compared. RESULTS: The results showed that the nonlinear least squares analysis method provides a more effective complement to the linear fitting method for subharmonic mucosal wave extraction. There was a significant difference in amplitudes between the subharmonic and the fundamental components of mucosal waves (P < 0.05). The phase differences of the fundamental and the subharmonic components of the right and left vocal folds were not significantly different. CONCLUSIONS: The application of the nonlinear least squares analysis method in digital kymography is useful for the characterization of subharmonic mucosal waves.
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Quimografía , Mucosa Laríngea/fisiología , Fonación , Procesamiento de Señales Asistido por Computador , Pliegues Vocales/fisiología , Animales , Fenómenos Biomecánicos , Perros , Técnicas In Vitro , Mucosa Laríngea/anatomía & histología , Mucosa Laríngea/cirugía , Análisis de los Mínimos Cuadrados , Modelos Lineales , Dinámicas no Lineales , Vibración , Pliegues Vocales/anatomía & histología , Pliegues Vocales/cirugía , Vocalización AnimalRESUMEN
BACKGROUND AND OBJECTIVES: High-speed videolaryngoscopy (HSV) is the only technique that captures the true intra-cycle vibratory behavior of the vocal folds by capturing full images of the vocal folds. However, it has problems of no immediate feedback during examination, considerable waiting time for digital kymography (DKG), recording duration limited to a few seconds, and extreme demands for storage space. Herein, we demonstrate a new post-processing method that converts HSV images to two-dimensional digital kymography (2D-DKG) images, which adopts the algorithm of 2D videokymography (2D VKG). MATERIALS AND METHODS: HSV system was used to capture images of vocal folds. HSV images were post-processed in Kay image-process software (KIPS), and conventional DKG images were retrieved. Custom-made post-processing system was used to convert HSV images to 2D-DKG images. The quantitative parameters of the post-processed 2D-DKG images was validated by comparing these parameters with those of the DKG images. RESULTS: Serial HSV images for all phases of vocal fold vibratory movement are included. The images were converted by the scanning method using U-medical image-process software. Similar to conventional DKG, post-processed 2D DKG image from the HSV image can provide quantitative information on vocal fold mucosa vibration, including the various vibratory phases. Differences in amplitude symmetry index, phase symmetry index, open quotient, and close quotient between 2D-DKG and DKG were analyzed. There were no statistical differences between the quantitative parameters of vocal fold vibratory movement in 2D-DKG and DKG. CONCLUSION: The post-processing method of converting HSV images to 2D DKG images could provide clinical information and storage economy.
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Quimografía , Métodos , Membrana Mucosa , Vibración , Pliegues Vocales , VozRESUMEN
Technique of high-speed digital imaging (HSDI) is unique technique, allowing for assessment of real vocal fold vibrations. AIM: The aim of the study is to present the usefulness of HSDI in the diagnosis of clinical type of dysphonia. MATERIALS AND METHODS: The study group was diagnosed at the Department of Clinical Phonoaudiology and Logopedics at the Medical University of Bialystok and treated at the Phoniatric Clinic in years 2012-2015. HSDI technique with a digital camera was used for visualization of the larynx. The rigid endoscope with 90° optics was used for visualizing the vocal folds vibrations during phonation of "e" vowel, at the rate of 4000 frames per second. Playback of recorded sequence set at 15 frames per second, what allowed to assess vocal folds vibrations in slow motion mode during over 8 minutes. Mucosal wave (MW), glottal closure, symmetry, regularity and synchrony of vocal fold vibration were analyzed. Digital kymography (DKG) of the larynx was made for analyzing the value of the Open Quotient (OQ) in the assessment of degree of glottal insufficiency. RESULTS: In the analyzed group of patients, the functional dysphonia was diagnosed in 71%, organic dysphonia in 29% patients. In 68%, glottal insufficiency was registered in the rear part at the glottis. The oedematous-hypertrophic changes were diagnosed in 21% of the cases, hypertrophic changes of larynx - in 6%, vocal fold polyps - in 3% and vocal fold nodules - in 2% of patients. CONCLUSIONS: Examination of the larynx by using HSDI technique is quick, non-invasive to patient. HSDI allows to objective assessment of the degree of severity of insufficiency of glottal closure, what is confirmed by the objective values of the OQ. Evaluation of MW allows for the differentiation of clinical type and severity of organic dysphonia.
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Diagnóstico por Imagen , Disfonía/diagnóstico por imagen , Pliegues Vocales/diagnóstico por imagen , Adulto , Disfonía/patología , Femenino , Humanos , Quimografía , Masculino , Persona de Mediana Edad , Vibración , Pliegues Vocales/patologíaRESUMEN
PURPOSE: The aim of the study was to investigate the voice quality parameters in 72 rheumatoid arthritis (RA) patients and their relationships with the clinical manifestations and disease activity. The control group consisted of 30 healthy subjects. MATERIAL AND METHODS: All RA patients were evaluated by extensive clinical, laboratory and radiographic studies. The phoniatric assessment included the analysis of vocal folds vibrations by digital stroboscopy (DS) of the larynx using HRES ENDOCAM 5562 system, digital kymography (DKG) and High-Speed Digital Imaging (HSDI) technique. The acoustic voice analysis was conducted using DiagnoScope Specialist program. RESULTS: Voice quality disorders were registered in 32 (44.44%) RA patients and observed more frequently in patients with moderate and severe activity (DAS28≥3.2) than in mild RA. In digital stroboscopy, confirmed by digital kymography, the hypofunctional dysphonia was observed especially in patients with DAS28≥3.2. Outcomes of the subjective assessment of voice quality were in accordance with the objective parameters and acoustic voice examination. CONCLUSIONS: In RA patients the most frequent voice quality disorders with hypofunctional dysphonia were registered. The relationships between voice quality disorders, clinical activity and radiographic progression of RA patients were observed. Digital stroboscopy, digital kymography, High-Speed Digital Imaging and acoustic voice analysis used in the complex diagnosis of RA confirmed the presence of pathological changes in the larynx. There is a need of cooperation between rheumatologists and phoniatricians in the diagnosis and treatment of dysphonia in RA patients.
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Artritis Reumatoide/fisiopatología , Calidad de la Voz/fisiología , Adulto , Anciano , Artritis Reumatoide/patología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The purpose of this study was to examine the spectrum of normal adult vocal fold vibration obtained through direct visualization technique using digital kymography (DKG). DKG extracts high-speed kymographic images of each vocal fold sampled at a single or multiple points along the vocal folds. Thus, direct and objective quantification of the cycle-to-cycle movements of the left and right vocal folds were obtained. In this study, DKG spectrum configuration in males and females were examined. Samples were obtained from seven subjects (three males and four females) with no history of voice disorders. Subjects were asked to produce tokens obtained from a standard clinical laryngeal evaluation producing tokens at modal, low, and high frequency and at modal frequency with increased loudness. Results demonstrated that the spectrum of normal adult phonation consisted of a large and robust H1 (fundamental frequency) and significant attenuation of power in the higher harmonics (H2, H3). The spectral peaks were quasiperiodic with no spectral smearing. Analysis of the spectral data revealed variations in the spectrum that were influenced by the frequency of phonation and gender. Subjects demonstrated a range of left-right asymmetry of the spectral peaks (2-26%). This study presents a preliminary database of direct spectral characteristics of normal adult vocal fold vibration over a range of frequencies and intensities. Furthermore, these measures provide data from which similar measures obtained from dysphonic pathologies can be compared.