By Clark A. Rosen, C. Blake Simpson
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Extra info for Operative Techniques in Laryngology
Laryngoscope 115:423–428 Roehm PC, Rosen C (2004) Dynamic voice assessment using flexible laryngoscopy—how I do it: a targeted problem and its solution. 1 Fundamental and Related Chapters Please see Chaps. 2 and 3 for further information. 2 Introduction The variety of pathologic conditions that occur within the vocal fold can be separated into categories based on their anatomical location. The chapter is divided among epithelial pathology of the vocal folds, benign midmembranous lesions, and miscellaneous vocal fold pathology.
This lesion typically has a hourglass closure pattern seen on stroboscopy and has minimally reduced or normal mucosal wave vibratory activity on stroboscopy. This lesion responds quite favorably to voice rest and voice therapy and typically will reduce in size with this treatment modality. Surgical excision of the lesion can be done if the contralateral lesion requires surgery. The surgical approach is similar to a vocal fold polyp (see Chaps. 10, “Principles of Phonomicrosurgery” and 15, “Vocal Fold Polyp”).
Indirect (mirror) laryngoscopy and rigid 70 or 90° laryngoscopy are helpful but do not replace flexible laryngoscopy. It is important to obtain an unencumbered, extended viewing period of the vocal folds during a variety of tasks. Flexible laryngoscopy is the only method to view vocal fold mobility in its natural state (refer to Chap. 3, “Videostroboscopy and Dynamic Voice Evaluation with Flexible Laryngoscopy”). When evaluating for suspected UVF paralysis/paresis, a useful task is to ask the patient to perform an “ee-sniff ” maneuver, where the patient alternates between phonating an “e” vowel and sniffing vigorously.