Eller Robert, Ginsburg Mark, Lurie Deborah, Heman-Ackah Yolanda, Lyons Karen, Sataloff Robert
USAF Aerodigestive and Voice Center, Wilford Hall Medical Center, San Antonio, TX, USA.
J Voice. 2008 Nov;22(6):746-50. doi: 10.1016/j.jvoice.2007.04.003. Epub 2008 Jan 22.
This study was designed to evaluate the usefulness of fiber optic (FO) and distal chip (DC) flexible imaging platforms in the diagnosis of true vocal fold pathology when compared to the gold standard rigid transoral laryngeal telescopic examination. The recorded strobovideolaryngoscopic examinations of 34 consecutive patients were evaluated retrospectively by five raters. All stroboscopy segments were evaluated by two laryngologists, an otolaryngologist, a laryngology fellow, and an otolaryngology resident. Seventeen patients were examined with a high-quality, large-diameter, FO flexible laryngoscope (FO group) and 17 random patients were examined with a DC flexible laryngoscope (DC group). Each patient was also examined using rigid laryngeal videostroboscopy at the same sitting. Examinations of three patients from each group were presented twice to monitor internal consistency. Diagnoses of intrinsic vocal fold pathology made with the flexible laryngoscopes were compared for accuracy to the diagnoses provided using the rigid laryngeal telescope. The ability to make clinical diagnoses via stroboscopy was statistically equivalent with FO technology and DC technology. Rigid examination provided more information than the flexible examination in 27% of the FO examinations and in 32% of the DC examinations. DC technology did not add diagnostic information to the examination when compared to a high-quality, large-diameter, FO endoscope. Rigid endoscopy provides superior images of the true vocal folds and is necessary for precise diagnosis in patients with true vocal fold pathology. Thus, the most cost-effective means of evaluation of voice disorders remains FO flexible endoscopy for dynamic voice assessment and the neurolaryngologic examination followed by rigid stroboscopy for evaluation of the vocal fold edge and mucosal wave. Strobovideolaryngoscopy using high-quality FO or DC flexible equipment should be reserved for patients who cannot tolerate transoral rigid examination, such as children and those with a very strong gag reflex.
本研究旨在评估与金标准刚性经口喉内镜检查相比，纤维光学（FO）和远端芯片（DC）柔性成像平台在诊断真性声带病变中的实用性。由五名评估者对34例连续患者的频闪喉镜检查记录进行回顾性评估。所有频闪喉镜检查片段均由两名喉科医生、一名耳鼻喉科医生、一名喉科住院医师和一名耳鼻喉科住院医生进行评估。17例患者使用高质量、大直径的FO柔性喉镜进行检查（FO组），17例随机患者使用DC柔性喉镜进行检查（DC组）。每位患者在同一次就诊时还使用刚性喉频闪喉镜进行检查。每组三名患者的检查结果被展示两次以监测内部一致性。将柔性喉镜对真性声带病变的诊断准确性与使用刚性喉内镜提供的诊断结果进行比较。通过频闪喉镜进行临床诊断的能力在统计学上，FO技术和DC技术相当。在27%的FO检查和32%的DC检查中，刚性检查比柔性检查提供了更多信息。与高质量、大直径的FO内镜相比，DC技术并未为检查增加诊断信息。刚性内镜能提供更好的真性声带图像，对于真性声带病变患者的精确诊断是必要的。因此，评估嗓音障碍最具成本效益的方法仍然是FO柔性内镜用于动态嗓音评估和神经喉科检查，随后进行刚性频闪喉镜检查以评估声带边缘和黏膜波。使用高质量FO或DC柔性设备的频闪喉镜检查应保留给不能耐受经口刚性检查的患者，如儿童和那些咽反射非常强烈的患者。
