频闪喉镜检查和高速视频内镜检查在声带肿物患者围手术期评分中获得功能结果的疗效
Efficacy of Videostroboscopy and High-Speed Videoendoscopy to Obtain Functional Outcomes From Perioperative Ratings in Patients With Vocal Fold Mass Lesions.
作者信息
Powell Maria E, Deliyski Dimitar D, Zeitels Steven M, Burns James A, Hillman Robert E, Gerlach Terri Treman, Mehta Daryush D
机构信息
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee; Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio.
Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio; Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan.
出版信息
J Voice. 2020 Sep;34(5):769-782. doi: 10.1016/j.jvoice.2019.03.012. Epub 2019 Apr 17.
OBJECTIVES
A major limitation of comparing the efficacy of videostroboscopy (VS) and high-speed videoendoscopy (HSV) is the lack of an objective reference by which to compare the functional assessment ratings of the two techniques. For patients with vocal fold mass lesions, intraoperative measures of lesion size and depth may serve as this objective reference. This study compared the relationships between the pre- to postoperative change in VS and HSV visual-perceptual ratings to intraoperative measures of lesion size and depth.
DESIGN
Prospective visual-perceptual study with intraoperative measures of lesion size and depth.
METHODS
VS and HSV samples were obtained preoperatively and postoperatively from 28 patients with vocal fold lesions and from 17 vocally healthy controls. Two experienced clinicians rated amplitude, mucosal wave, vertical phase difference, left-right phase asymmetry, and vocal fold edge on a visual-analog scale using both imaging techniques. The change in perioperative ratings from VS and HSV was compared between groups and correlated to intraoperative measures of lesion size and depth.
RESULTS
HSV was as reliable as VS for ratings of amplitude and edge, and substantially more reliable for ratings of mucosal wave and left-right phase asymmetry. Both VS and HSV had mild-moderate correlations between change in perioperative ratings and intraoperative measures of lesion area. Change in function could be obtained in more patients and for more parameters using HSV than VS. Group differences were noted for postoperative ratings of amplitude and edge; however, these differences were within one level of the visual-perceptual rating scale. The presence of asynchronicity in VS recordings renders vibratory features either uninterpretable or potentially distorted and thus should not be rated.
CONCLUSIONS
Amplitude and edge are robust vibratory measures for perioperative functional assessment, regardless of imaging modality. HSV is indicated for evaluation of subepithelial lesions or if asynchronicity is present in the VS image sequence.
目的
比较频闪喉镜检查（VS）和高速视频内镜检查（HSV）疗效的一个主要局限在于缺乏客观参照标准来比较这两种技术的功能评估分级。对于声带肿物病变患者，术中病变大小和深度的测量结果可作为这一客观参照标准。本研究比较了VS和HSV视觉感知分级术前至术后的变化与病变大小和深度的术中测量结果之间的关系。
设计
一项采用病变大小和深度术中测量的前瞻性视觉感知研究。
方法
术前和术后从28例声带病变患者及17例嗓音健康对照者获取VS和HSV样本。两名经验丰富的临床医生使用这两种成像技术，通过视觉模拟量表对振幅、黏膜波、垂直相位差、左右相位不对称性及声带边缘进行评分。比较两组VS和HSV围手术期评分的变化，并将其与病变大小和深度的术中测量结果进行相关性分析。
结果
HSV在振幅和边缘评分方面与VS同样可靠，而在黏膜波和左右相位不对称性评分方面明显更可靠。VS和HSV围手术期评分变化与病变面积的术中测量结果之间均存在轻度至中度相关性。与VS相比，使用HSV能在更多患者中获得更多参数的功能变化情况。术后振幅和边缘评分存在组间差异；然而，这些差异在视觉感知评分量表的一个等级范围内。VS记录中存在的不同步性使振动特征难以解读或可能失真，因此不应进行评分。
结论
无论成像方式如何，振幅和边缘都是围手术期功能评估可靠的振动指标。对于上皮下病变的评估或VS图像序列中存在不同步性的情况，建议使用HSV。
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