Indigo Carmine Chromoendoscopy for the Diagnosis of Minor Structural Alterations of the Vocal Fold Cover. A New Application for the Technique

INTRODUCTION

Minor structural alterations (MSA) of the laryngeal mucosa are entities involving epithelial vocal cord covering modifications. Among differentiated structural alterations of the vocal cords are sulcus vocalis, epidermoid cysts, micro diaphragms, mucosal bridges, and vasculodysgenesis. While many of these MSA are evident and can be easily visible using conventional endoscopic methods, diagnosis can be difficult even with the help of stroboscopy. MSA can often go unnoticed and may be associated with polyps, cysts or vascular alterations. Its impact on the voice could be significant. In many cases, direct suspension laryngoscopy under general anesthesia is necessary to obtain a definitive diagnosis.

OBJECTIVES

The purpose of this article is to describe a new diagnostic endoscopic method that uses contrast dyes, such as indigo carmine, for the detection of MSA of the vocal fold mucosal covering.

MATERIAL AND METHODS

This research work uses the contrast dye Indigo Carmine as an endoscopic tissue stain, which is applied to the mucosal surface of the vocal cords under local anesthesia in the office or under general anesthesia in the operating room. The dye fills the interstices, highlighting irregularities such as depressions and elevations in architecture.

RESULTS

Our study involved performing indigo carmine chromoendoscopy procedures on patients suspected of having vocal fold MSA-type sulcus vocalis, mucosal bridge, or bag-type sulcus. We identified cases where this technique is useful for diagnosing previously undetected alterations, shedding light on dysphonia "without an apparent cause."

CONCLUSIONS

Indigo carmine chromoendoscopy is a useful technique for detecting MSA of the mucosal surface of the vocal folds. It has the potential to diagnose MSA in patients where current in-office endoscopic techniques are insufficient.

Visible Vessels of Vocal Folds: Can they have a Diagnostic Role?

BACKGROUND

Challenges in visual identification of laryngeal disorders lead researchers to investigate new opportunities to help clinical examination. This paper presents an efficient and simple method which extracts and assesses blood vessels on vocal fold tissue in order to serve medical diagnosis.

METHODS

The proposed vessel segmentation approach has been designed in order to overcome difficulties raised by design specifications of videolaryngostroboscopy and anatomic structure of vocal fold vasculature. The limited number of medical studies on vocal fold vasculature point out that the direction of blood vessels and amount of vasculature are discriminative features for vocal fold disorders. Therefore, we extracted the features of vessels on the basis of these studies. We represent vessels as vascular vectors and suggest a vector field based measurement that quantifies the orientation pattern of blood vessels towards vocal fold pathologies.

RESULTS

In order to demonstrate the relationship between vessel structure and vocal fold disorders, we performed classification of vocal fold disorders by using only vessel features. A binary tree of Support Vector Machine (SVM) has been exploited for classification. Average recall of proposed vessel extraction method was calculated as 0.82 while healthy, sulcus vocalis, laryngitis classification accuracy of 0.75 was achieved.

CONCLUSION

Obtained success rates showed the efficiency of vocal fold vessels in serving as an indicator of laryngeal diseases.

Consecuencias laringoscópicas, electroglotográficas, acústicas y sintomatológicas producidas por la sobrecarga vocal en mujeres con voces sanas y no entrenadas

La sobrecarga es una de las etapas del continuo de carga vocal. Actualmente, se considera que su investigación permite una mejor comprensión de la patología y sintomatología funcional de la voz. El objetivo de este trabajo fue analizar las consecuencias laringoscópicas, electroglotográficas, acústicas y sintomatológicas producidas por la sobrecarga vocal en mujeres con voces sanas y no entrenadas. Se examinó el comportamiento acústico, laringoscópico, electroglotográfico y sintomatológico de 30 mujeres que se sometieron a una tarea de sobrecarga vocal caracterizada por la lectura ininterrumpida de un texto durante 60 minutos, cuya intensidad fluctuó entre los 75 y 85 dB. A nivel laringoscópico, se observó mayor vascularización, aumento de la compresión supraglótica y cambios en la amplitud, simetría y onda mucosa. Acústicamente, se evidenció incremento significativo en la frecuencia fundamental e intensidad vocal. En la electroglotografía, el cociente de cierre y la fase abierta y cerrada disminuyeron significativamente, mientras que a nivel sintomatológico, la totalidad de la muestra expresó al menos un síntoma de fatiga vocal. En conclusión, los hallazgos observados son expresiones de la fatiga del mecanismo tiroaritenoideo y de la inflamación aguda de la cubierta cordal. 

Assessment of videolaryngostroboscopy images based on visible vessels of vocal folds

Extraction of vessel structures and the vessel features automatically forms an essential step for computer-aided diagnosis. Visible vessels of vocal folds become a diagnostic aid for vocal fold pathologies by publication of limited number of researches which analyze the effects of vocal fold pathologies on visual characteristics of blood vessels. In this paper we present a novel system that extracts blood vessels centerlines on vocal folds images and detects pathologically altered vocal folds exploiting visual characteristics of vessels.

Sulcus mucosal slicing technique

PURPOSE OF REVIEW

To present the accurate surgical indication for the slicing mucosal technique, the case selection, surgical aspects, rehabilitation concerns, and the characteristics of immediate and long-term outcomes.

RECENT FINDINGS

The literature is still scarce; few cases are submitted to the slicing mucosa technique due to its specific indication; an alternative procedure was designed for cases where mucosal movement is strongly reduced, the inner section of the vocal ligament or submucosal scar tissue, which can eventually be associated with fat inclusion. Some selected cases may require thyroplasty type III to optimize functional results.

SUMMARY

Slicing technique is an aggressive powerful resource for the surgical treatment of severe cases of sulcus striae major, in which mucosal wave is absent and glottic chink is moderate to severe; voice is intensely deviated immediately postoperation; vocal rehabilitation is mandatory and an intensive regimen is usually required for the first 2 months; final results can mostly be achieved up to 6 months.