The Role of Laryngoscopy and Videostroboscopy in Diagnosing Dysphonia

Yet the best available data shows that videostroboscopy often changes diagnosis and treatment. “The research shows that roughly 10 to 47 percent of diagnoses change or are modified after you go from laryngoscopy to stroboscopy in tertiary care voice clinics,” Dr. Cohen said.

“Is a stroboscopy absolutely necessary? Under certain circumstances, I think it is,” Dr. Courey said. You wouldn’t perform a middle ear operation to replace the ossicles without doing an audiogram, right? You may know that the patient has a conductive hearing loss test because of a tuning fork test, but what otologist is going to operate without specifically defining what the conductive hearing loss is? For laryngologists, the laryngoscopy is like our tuning fork. Stroboscopy is our audiogram.”

Of course, videostroboscopy is not appropriate or necessary for all patients with voice complaints. “If a patient presents with a very large polyp that’s creating dysphonia and just wants to know that it’s not cancer, you document that in the chart and ask the patient, ‘Do you want to look at this further?’ If the patient specifically says no, then delaying the stroboscopy is appropriate. However, I think you should document that discussion,” Dr. Courey said.

“You wouldn’t perform a middle ear operation to replace the ossicles without doing an audiogram, right? You may know that the patient has a conductive hearing loss test because of a tuning fork test, but what otologist is going to operate without specifically defining what the conductive hearing loss is? For laryngologists, the laryngoscopy is like our tuning fork. Stroboscopy is our audiogram.”

—Mark Courey, MD

Working with Speech-Language Pathologists

Videostroboscopy is performed either by otolaryngologists or speech-language pathologists (SLPs). “Speech pathologists look at things from a physiologic perspective,” said Dr. Branski. “We try to determine if the patient is stimulable for voice therapy. Physicians tend to look at it from a straightforward anatomical perspective.” Because both health care specialties have a slightly different focus, it’s in patients’ best interests for otolaryngologists and SLPs to collaborate—and absolutely necessary for both to view the video of the exam (not just the still photos), no matter who performed the videostroboscopy.

“No otolaryngologist would operate on sinus disease without having the CT scan in the OR and having looked at all of the images available on that CT. In the same way, you should not operate on the larynx unless you have looked at and interpreted the entire videostroboscopy,” Dr. Courey said. “There are no official guidelines on this, but why would you apply a different standard?”