HSC Section 6 Nov2016 Green Book

Rosow DE, Sulica L. Laryngoscopy of vocal fold paralysis: evaluation of consistency of clinical findings. Laryngoscope . 2010; 120(7):1376-1382. EBM level 2.................44-50

Summary: This study sent videostroboscopy examination results from patients with unilateral vocal fold paralysis (VFP) to 22 blinded laryngologists and asked them to rate the results on twelve different criteria. The interrater reliability for each criterion was then calculated. The criteria with the best interrater agreement were glottic insufficiency, vocal fold bowing, and salivary pooling, which showed moderate agreement. All other criteria showed fair or poor agreement. The authors concluded that while it would be ideal to have a standardized rating scale for evaluation of VFP, the lack of interrater agreement across a wide range of laryngologists with different training and different backgrounds suggests that this may be very difficult to achieve. Simpson CB, May LS, Green JK, et al. Vibratory asymmetry in mobile vocal folds: is it predictive of vocal fold paresis? Ann Otol Rhinol Laryngol . 2011; 120(4):239-242. EBM level 4..................................................................................................................51-54 Summary: This study is a retrospective review of 23 patients with symptoms suggestive of glottic insufficiency and stroboscopy examinations showing normal vocal fold mobility and vibratory asymmetry. All patients underwent laryngeal electromyography (LEMG) to determine presence of paresis. A total of 19 patients (83%) had evidence of paresis on LEMG. Blinded reviewers evaluated stroboscopy examinations for presence of paresis, but their ability to predict the distribution (sidedness) of the paresis was 37% or worse. The authors note that their findings suggest that all clinical and stroboscopic diagnoses of vocal fold paresis should be followed up with LEMG as the gold standard for diagnosis. C. Office-Based Procedures Croake DJ, Stemple JC, Uhl T, et al. Reliability of clinical office-based laryngeal electromyography in vocally healthy adults. Ann Otol Rhinol Laryngol . 2014; 123(4):271-278. EBM level 3......................................................................................55-62 Summary: Using a quantitative analysis protocol to inform an essentially qualitative technique, the study results indicated that there was generally poor to fair reliability in the laryngeal electromyography (LEMG) signal over testing sessions. Vocal intensity was an important variable that affected LEMG signal reliability. Standardization of LEMG protocols using vocal control parameters and quantitative analyses may help improve LEMG reliability in clinical settings. Koszewski IJ, Hoffman MR, Young WG, et al. Office-based photoangiolytic laser treatment of Reinke’s edema: safety and voice outcomes. Otolaryngol Head Neck Surg . 2015; 152(6):1075-1081. EBM level 4........................................................................63-69 Summary: This study provides a retrospective analysis of patients undergoing office-based laser treatment of endoscopically proven Reinke’s edema. Nineteen patients met criteria for the study inclusion. Five procedures were truncated due to patient intolerance. Phonatory frequency range increased (N = 12, p = 0.003), while percent jitter decreased (N = 12, p = 0.004). Phonation threshold pressure decreased after treatment (N = 4, p = 0.049). The Voice Handicap Index also decreased (N = 14, p = 0.001).