Videofluoroscopy
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Videofluoroscopy is a clinical evaluation method that is used in most clinics on a regular basis for diagnosis of problems with voice production or swallowing after total laryngectomy. Van As et al (2001) describe a standardized protocol for the assessment of these recordings. This protocol not only consists of visual assessments but also contains objective quantitative measures of the neoglottis. Their study also investigated the relation between the evaluation of the videofluoroscopy recordings in relations to perceptual evaluation, acoustic analyses, and maximum phonation time, in order to reveal which aspects are important to judge in relation to voice quality. As a result of these studies, a set of parameters has been selected that are relevant to assess in videofluoroscopy recordings. These parameters are: visual assessment of the presence of a neoglottic bar (yes/no), regurgitation of barium during phonation (yes/no), tonicity of the neoglottis during phonation (hypotonic, normotonic, hypertonic, spasm, stricture) and quantitative measures in mm (in digitalized images of rest and phonation) of the minimal neoglottic distance at rest and during phonation, the surface area of the neoglottic bar at rest and during phonation, the prominence of the neoglottic bar at rest and during phonation, and the increase of the maximal sub-neoglottal distance from rest to phonation. To the right are two examples of videofluorscopic images (a case of hypertrophy at the top and a case of hypotrophy below; by clicking on the links below the images the accompanying /aa/ sound can be heard). Each image shows the situation at rest on the left side and the situation during voicing on the right. Note that during voicing in the hypertrophic case the subneoglottic area is widely extended, whereas in the hypotonic case no contact can be seen between the neoglottic bar and the anterior pharyngeal wall. |
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