Motivated laryngeal examination

A “Motivated” laryngeal examination is an examination in which the clinician “pushes” the larynx to reveal its secrets. If topical anesthesia is used, this can be done without undue discomfort to the patient, and laryngeal images can be close and clear rather than far and fuzzy.


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Siren

An uninterrupted sound that begins very low in a person’s vocal range and ascends to a very high pitch, sometimes the highest possible pitch that person can produce. A single siren could also go from low to high and back to low one or more times without interruption. A clinician might ask a patient to perform a siren during the vocal capability battery in order to assess pitch range capability or even vocal skill.

Projected voice

A voice that is perceptibly “thrown” or “called out,” as when talking to a group of 20 or more people. A clinician might ask a patient to project the voice during the vocal capability battery in order, for example, to reveal weakness not evident or only slightly apparent at normal speaking voice volume, to detect vocal inhibition, or to unmask a nonorganic voice disorder.

Vocal commitments

Events or circumstances that permit, invite, or demand much voice use. A person’s vocal commitments could include his or her occupation, childcare, rehearsals and performances, hobbies or even volunteer activities to which a person is highly committed, sports, and so forth. Heavy vocal commitments and innative talkativeness are the two potential sources of vocal overuse and, unsurprisingly, are often seen together.

Vocal loudness scale

A scale from 1 to 7 that we use to describe the loudness of a person’s typical speaking voice as compared with one’s experience of the rest of the human race. For example, someone whose vocal loudness seems to be unexceptional and does not draw any attention to itself—average, in other words—might be considered a “4.” The person who speaks so softly that everyone who encounters him or her has to strain to understand might be a “1.” The person whose voice is (often unconsciously) so loud that one needs to step back or hold the telephone away from the ear might be considered a “7.” See also: disorder of vocal loudness perception.

Narrow-band illumination

The use of only two narrow wave bands of light (blue and green) during an endoscopic examination, so as to make blood vessels and other tissues in the mucosa more visible. Blood vessels become more visible under narrow-band illumination because both of the wave bands are easily absorbed by hemoglobin in the blood. In addition, the blue and green wave bands in narrow-band illumination each penetrate the tissue to differing degrees, so that blood vessels near the mucosal surface appear as a different color from blood vessels deeper in the tissue.

In the field of laryngology, narrow-band illumination can help an examining clinician to identify the vascular changes that characterize a range of disorders, including recurrent respiratory papillomatosis, capillary ectasia, glottic sulcus, ulcerative laryngitis, and others. It can also help to identify subtle, hazy leukoplakia. The technology, developed by Olympus, is officially called Narrow Band Imaging™. KayPentax offers a different, software-based method for highlighting vascularity and other tissue characteristics, which is called iScan™.


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Videoendoscopic swallowing study (VESS)

A method of evaluating a person’s swallowing ability by means of a video-documented physical examination, looking from inside the throat. Also called the fiberoptic endoscopic evaluation of swallowing (FEES). The videoendoscopic swallowing study (VESS) is to be distinguished from the videofluoroscopic swallowing study (VFSS), which is an x-ray-based assessment.

How it works:

To perform a VESS, a clinician uses a fiberoptic or distal-chip nasolaryngoscope. The clinician begins by examining the structure and function of the patient’s palate, tongue, pharynx, and larynx, including sensation, if desired. Next, to assess the patient’s swallowing capabilities and limitations, the clinician positions the tip of the nasolaryngoscope just below the nasopharynx and, looking downward into the throat, asks the patient to swallow a series of colored substances with a range of consistencies (e.g., blue-stained water, blue-stained applesauce, and orange-colored crackers).

As the patient swallows these substances, the clinician watches to see if any significant traces remain in or reappear in the space above, around, or within the larynx, rather than disappearing into the entrance to the esophagus. If significant traces remain in view, or if any material spills into the opening of the larynx or down the trachea, the patient may have presbyphagia. If significant traces initially disappear but then re-emerge upward from the esophageal entrance, the patient may have cricopharyngeal dysfunction, with or without a Zenker’s diverticulum.

Benefits of the videoendoscopic swallowing study:

This method has particular value for patients who are bedfast and cannot travel to the radiology suite, or for patients whose swallowing function is rapidly evolving (improving, usually), such as those recovering from a mild stroke. For clinicians experienced with this technique, VESS can also often be used with new patients complaining of dysphagia during the initial consultation as a robust and—depending on patient history—potentially stand-alone method of diagnosis and management. Sometimes, the VESS findings, along with a patient history of solid food lodgment at the level of the cricoid cartilage or cricopharyngeus muscle, will indicate when VFSS should also be obtained to assess for possible cricopharyngeal dysfunction. Even in this latter circumstance, when VFSS is called upon to confirm a suspected diagnosis, VESS will have already oriented the examiner to the nature and severity of the problem. In most follow-up circumstances other than after cricopharyngeal myotomy, VESS is generally more efficient and inexpensive than VFSS.


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Videoendoscopic Swallowing Study (VESS)
This video features an example of a 100-year-old patient undergoing VESS.

Videofluoroscopic swallowing study (VFSS)

An x-ray-based method of evaluating a person’s swallowing ability. The videofluoroscopic swallowing study (VFSS) is also sometimes called the modified barium swallow, or the “cookie swallow.”

In a radiology suite under fluoroscopy (which creates moving rather than still x-ray images), the patient is asked to swallow barium in thin liquid and paste consistencies, and then in paste on a cookie or cracker. The barium bolus is followed radiographically through the mouth, throat, and into the esophagus. Both lateral and anteriorposterior views are recorded and, depending on the facility, a simple screening sequence of the subsequent movement down the esophagus is also recorded.


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Videos:

Barium Swallow (Barium Esophagram)
This video presents a clear visual example of a barium swallow, a test that involves having the patient swallow a barium solution while using x-rays to observe the flow of the barium, which can reveal swallowing deficiencies.
Cricopharyngeal Dysfunction: Before and After Cricopharyngeal Myotomy
This video shows x-rays of barium passing through the throat, first with a narrowed area caused by a non-relaxing upper esophageal sphincter (cricopharyngeus muscle), and then after laser division of this muscle. Preoperatively, food and pills were getting stuck at the level of the mid-neck, and the person was eating mostly soft foods. After the myotomy (division of the muscle), the patient could again swallow meat, pizza, pills, etc. without difficulty.