The Evaluation of Benign Glottic Lesions: Rigid Telescopic Stroboscopy Versus Suspension Microlaryngoscopy

  • Seth H. Dailey
    Address correspondence and reprint requests to Seth H. Dailey, MD, University of Wisconsin Hospital and Clinics, K4/720, 600 Highland Avenue, Madison, WI 53792-7375.
    From the Department of Surgery, University of Wisconsin School of Medicine, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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  • Konstantina Spanou
    Otolaryngology Private Practice, Athens, Greece
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  • Steven M. Zeitels
    Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts
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Published:January 30, 2006DOI:


      Rigid telescopic strobo-video-laryngoscopy (RTS) is a primary clinical assessment methodology in the office evaluation of benign glottic lesions. However, diagnostic observations can be made only at the time of suspension microlaryngoscopy (SML). The records of 100 consecutive patients undergoing microlaryngoscopy for benign glottic lesions were retrospectively reviewed. Nine of 100 patients were found to have additional glottic lesions during SML. Sixteen additional lesions were noted in these nine patients. Fifteen of 16 lesions were sulci and/or mucosal bridges. Forty-five percent (4/9) of the patients with additional lesions underwent a management change intraoperatively. Three patients underwent additional surgical dissection, and one underwent less dissection than was planned. The discrepancy in diagnosis between rigid telescopic strobo-video-laryngoscopy and suspension microlaryngoscopy highlights certain key points: (1) During office endoscopy, tangential views of the medial surface of the glottis limit the diagnostic sensitivity. (2) Sulci and mucosal bridges are most subject to this limitation. (3) Informed consent should address the potential need for a change in intraoperative management. It is advisable to discuss the possibility for dissection in both vocal folds, even if a unilateral lesion is observed in the office. (4) Microlaryngoscopy is the final diagnostic step in the evaluation of glottic pathology. Meticulous inspection and palpation of the glottis are recommended during SML.

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        • Garcia M.
        Observations on the human voice.
        Proc Royal Soc Lond. 1855; 7: 397-410
        • Czermak J.
        Ueber den Kehlkopfspiegel.
        Wiener Med Wochenschrift. 1858; VIII: 196-198
        • Turck L.
        On the laryngeal mirror and its mode of employment, with engravings on wood.
        Zeitschrift der Gesellschaft der Aerzte zu Wien. 1858; 26: 401-409
        • French T.
        Trans. Am Laryngol Assoc. 1882; : 32-35
        • French T.
        On photographing the larynx.
        Trans. Am Laryngol Assoc. 1883; : 59-68
        • Oertel M.
        Das laryngo-stroboskop und die Laryngo-Stroboskpische Untersuchung.
        Archiv Laryngologie Rhinologie. 1895; 3: 1-16
        • Zeitels S.M.
        • Franco Jr., R.A.
        • Dailey S.H.
        • Burns J.A.
        • Hillman R.E.
        • Anderson R.R.
        Office-based treatment of glottal dysplasia and papillomatosis with the 585-nm pulsed dye laser and local anesthesia.
        Ann Otol Rhinol Laryngol. 2004; 113: 265-276
      1. Endolaryngeal Micro-diagnosis and Microsurgery. Presented at: 115th Annual Meeting of the American Medical Association, 1966.

        • Kleinsasser O.
        Ein laryngomikroskop zur fruhdiagnose und differentialdiagnose von krebsen im kelkopf. Rachen und mundohohle.
        Z Laryng Rhinol. 1961; 40: 277-279
        • Kleinsasser O.
        Microlaryngoscopy and Endolaryngeal Microsurgery.
        W.B. Saunders, Philadelphia, PA1968
        • Strong M.S.
        Acad Med Bull. 1968; 14: 181-184
        • Strong M.S.
        Microscopic laryngoscopy: a review and appraisal.
        Laryngoscope. 1970; 80: 1540-1552
        • Casiano R.R.
        • Zaveri V.
        • Lundy D.S.
        Efficacy of videostroboscopy in the diagnosis of voice disorders.
        Otolaryngol Head Neck Surg. 1992; 107: 95-100
        • Sataloff R.T.
        • Spiegel J.R.
        • Carroll L.M.
        • Schiebel B.R.
        • Darby K.S.
        • Rulnick R.
        Strobovideolaryngoscopy in professional voice users: results and clinical value.
        J Voice. 1988; 1: 359-364
        • Rosen C.A.
        • Lombard L.E.
        • Murry T.
        Acoustic, aerodynamic, and videostroboscopic features of bilateral vocal fold lesions.
        Ann Otol Rhinol Laryngol. 2000; 109: 823-828
        • Poels P.J.
        • de Jong F.I.
        • Schutte H.K.
        Consistency of the preoperative and intraoperative diagnosis of benign vocal fold lesions.
        J Voice. 2003; 17: 425-433
        • Colden D.
        • Zeitels S.M.
        • Hillman R.E.
        • Jarboe J.
        • Bunting G.
        • Spanou K.
        Stroboscopic assessment of vocal fold keratosis and glottic cancer.
        Ann Otol Rhinol Laryngol. 2001; 110: 293-298
        • Kirstein A.
        Comparison between autoscopy and laryngoscopy: operations.
        Autoscopy of the Larynx and Trachea (Direct Examination Without Mirror). F.A. Davis Co., Philadelphia, PA1897 (47–54)
        • Kirstein A.
        Autoscopy of the Larynx and Trachea (Direct Examination Without Mirror). F.A. Davis Co., Philadelphia, PA1897 (57–58)
        • Zeitels S.M.
        • Franco R.A.
        • Dailey S.H.
        • Burns J.A.
        • Hillman R.E.
        • Anderson R.R.
        Treatment of glottal dysplasia and papilloma with the 585nm pulsed dye laser and local anesthesia.
        Ann Otol Rhinol Laryngol. 2004; 114: 175-180
        • Shohet J.A.
        • Courey M.S.
        • Scott M.A.
        • Ossoff R.H.
        Value of videostroboscopic parameters in differentiating true vocal fold cysts from polyps.
        Laryngoscope. 1996; 106: 19-26
        • Woo P.
        • Casper J.
        • Colton R.
        • Brewer D.
        Diagnosis and treatment of persistent dysphonia after laryngeal surgery: a retrospective analysis of 62 patients.
        Laryngoscope. 1994; 104: 1084-1091
        • Zeitels S.M.
        • Vaughan C.W.
        A submucosal true vocal fold infusion needle.
        Otolaryngol Head Neck Surg. 1991; 105: 478-479
        • Kass E.S.
        • Hillman R.E.
        • Zeitels S.M.
        Vocal fold submucosal infusion technique in phonomicrosurgery.
        Ann Otol Rhinol Laryngol. 1996; 105: 341-347
        • Zeitels S.M.
        Premalignant epithelium and microinvasive cancer of the vocal fold: the evolution of phonomicrosurgical management.
        Laryngoscope. 1995; 105: 1-51
        • Bouchayer M.
        • Cornut G.
        • Witzig E.
        • Loire R.
        • Roch J.B.
        • Bastian R.W.
        Epidermoid cysts, sulci, and mucosal bridges of the true vocal cord: a report of 157 cases.
        Laryngoscope. 1985; 95: 1087-1094
        • Bouchayer M.
        • Cornut G.
        Microsurgical treatment of benign vocal fold lesions: indications, technique, results.
        Folia Phoniatr (Basel). 1992; 44: 155-184
        • Ford C.N.
        • Inagi K.
        • Khidr A.
        • Bless D.M.
        • Gilchrist K.W.
        Sulcus vocalis: a rational analytical approach to diagnosis and management.
        Ann Otol Rhinol Laryngol. 1996; 105: 189-200
      2. Burns J. Imaging the muscosa of the human vocal fold with optical coherence tomography. Ann Otol Rhinol Laryngol. In press.

        • ALA
        In-Vivo Imaging of Human Vocal Folds Using Optical Coherence Tomography.
        American Laryngolocal Association, Boca Raton, FL2005
        • Zeitels S.M.
        • Healy G.B.
        Laryngology and phonosurgery.
        New Engl J Med. 2003; 348: 882-892