According to Dr. Dee Parker, clinical director of the Center for Voice, Western Medical Center, Santa Ana, CA, the use of stroboscopy in the operating room has become a routine part of medialization laryngoplasty performed at the medical center. She attributes this, in large measure, to the mobility of the Kay stroboscopy unit, and to the Martin arm which was designed to hold the scope in place. The surgical procedure is performed on patients suffering from vocal fold paralysis.

Initial attempts at using stroboscopy in the OR were hampered by the bulkiness of the equipment and by the time required to set it all up and dismantle it, Parker explained. Although the surgeon loved the visualization afforded by the technology, the down time in the OR was simply cost-prohibitive.

"All of that changed when Kay’s strobe and cart became available, because the Kay system is so mobile," Parker said. "We’ve now streamlined the procedure to the point where it’s just a natural part of getting a patient ready for surgery."

In fact, stroboscopy may now reduce the actual time spent in surgery. First, explains Dr. Stanley Lowenberg, MD, an otolaryngologist specializing in laryngology and voice disorders at the medical center, "We can obtain a pre-operative video showing us the glottal chink that needs to be closed. This tells us how far we have to move the vocal cord medially and where to position the Silastic block." Second, during the surgery itself, the surgeon can directly view the interior of the larynx and make the necessary adjustments very quickly.

"To see inside the larynx while we’re on the outside and the patient is awake and able to phonate is really terrific," Lowenberg adds.

Accessibility is no longer an issue either, because the Martin arm simply attaches to the table. As a result, the surgeon has direct access to the patient at all times.

Says Lowenberg, "The Martin arm is a lot less cumbersome than an IV pole. It not only holds the scope in place, it is really the key to the whole procedure."

Parker concurs. "With the scope placed and balanced on that arm, we can do whatever focusing or adjustments we have to make, because it is completely out of the way of the physician and the operating field," she said.

Improved patient compliance is another important benefit derived from the use of stroboscopy in the OR. "Patients like this level of technology," suggests Parker. "They are quite impressed with the picture, and having seen what the problem is that they’ve struggled with, they understand it better." Some have even called her the day before their surgery for assurance that the strobe will be in the room the next day.

Blomgren, Michael and Yang Chen, et al. "Acoustic, aerodynamic, physiologic, and perceptual properties of modal and vocal fry registers." The Journal of the Acoustical Society of America, Vol. 103, No. 5, 1998.

Twenty normal subjects produced multiple sustained vowels and syllable strings of /pi/ in both modal and vocal fry registers. Acoustic (fundamental frequency, jitter, shimmer, and signal-to-noise ratio), aerodynamic (airflow and air pressure), and electroglottographic data were obtained on each sample of data. The disparate types of data were acquired simultaneously. Results demonstrated considerable differences across voice parameters for the modal and vocal fry registers. The data emphasize that the aeromechanical mechanisms of vocal fold vibratory behavior are substantially different between modal and vocal fry registers. The paper presents a model of vocal fry phonation to account for the results obtained. The Computerized Speech Lab (CSL) was among the tools used in the multi-channel data acquisition and analysis for this study.

Orlikoff, Robert F. "Scrambled EGG: The Uses and Abuses of Electroglottography" Phonoscope, Volume 1, Number 1, 1998.

This article provides an extensive overview of electroglottography (EGG) and describes the strengths and limitations of this technique as a clinical tool. Electroglotto- graphy has gained widespread usage, particularly among voice clinicians and researchers, during the last 15-20 years. The technique is appealing because it provides a simple, non-invasive means of displaying certain important aspects of vocal fold dynamics during phonation. The EGG signal has traditionally been interpreted qualitatively though, more recently, articles have been published describing quantitative techniques. With appropriate data acquisition systems, the EGG signal can be correlated with acoustic data, stroboscopy, and other types of physiologic data.

Leonard, Rebecca and Katherine Kendall. Dysphagia Assessment and Treatment Planning: A Team Approach, Singular Publishing Group, San Diego, 1997.

This book is a comprehensive and practical manual for professionals wishing to establish or further develop a team approach to dysphagia assessment and treatment. It is written by a group of practicing professionals including the disciplines of speech pathology, radiology, nutrition, otolaryngology, nursing, and physical/rehabilitative medicine. An inside look at a dysphagia team’s protocol and procedures, along with step-by-step guidelines for measuring dysphagia deficits, is provided. A CD-ROM, which demonstrates a series of dynamic swallowing studies with quantification of different aspects of the swallow, is included with the book.

Karnell, Michael P. Videoendoscopy: From Velopharynx to Larynx, Singular Publishing Group, San Diego, 1994.

Are there any special considerations for running any of Kay’s DOS-based products (CSL,Visi-Pitch II) under Windows ’98?

Fortunately, Microsoft’s newly released operating system, Windows ’98, runs DOS-based programs the same as Windows ’95. Many recall that the upgrade from Windows 3.1x to Windows ’95, required a different installation process and operation of DOS-based programs. Users can refer to Kay’s Web site for specific information on running Kay’s DOS-based products under Windows.

New users should note that under Windows ’98 (and even under Windows ’95, versions 4.01 and higher) the Channel Bar used for accessing the internet must be turned off before using any of Kay’s DOS-based applications. To do this, click on Start, Settings, Active Desktop, and Customize my Desktop. Then disable the Channel Bar, and click Apply. Please contact Kay’s service department (ext. 160) or e-mail us at service@kayelemetrics.com with any questions or problems.

Can the voice-activation threshold for masking be modified in the Facilitator?

Yes. The Facilitator has both continuous and voice-activated masking. In the voice-activated mode, the masking ideally should not be triggered unless the person wearing the Facilitator speaks. In some environments, the ambient noise level may be so loud that the masking will be inappropriately triggered. To accommodate different ambient acoustic environments, turn on the Facilitator and switch to Masking (voiced) mode. While pressing the Volume "down" button, press the Mode button (the two buttons must be held down simultaneously). The LCD display will show Adjust Threshold. Use the Adjust buttons (up or down) to change the threshold. For example, to adjust to a loud environment, increase the threshold so that ambient noise does not activate the masking. Press Mode or Power to store the new threshold setting.

How do I go about returning an instrument for repair?

Before you return an instrument for repair, you should first call Kay’s service department. In many cases, our technicians are able to troubleshoot and fix a problem over the phone with a little assistance. If it is determined that an instrument needs to be returned, Kay will provide you with a Return Material Authorization (RMA) number which should be placed on your shipping label.

Obtaining quality video images with flexible endoscopes can be demanding and is inherently more difficult than with most rigid endoscopes. Assuming your scope is in reasonable condition and you are using recommended system components, you can optimize image quality using the tips below.

Since a flexible scope produces, by design, a "pixelated" image, a lens with less magnification is sometimes preferable. The standard lens purchased for rigid endoscopes is 35mm. A 28mm lens (Model 9115) may produce a more pleasing image because it decreases image "graininess".

Camera adjustments will vary between flexible and rigid scopes, so you need to be comfortable adjusting various settings. If you are using Kay’s computer-integrated system, the endoscope/camera file used (e.g., OlymP3.cam) should have settings optimized for each scope. If the image is too dim, adjust the Gain setting higher; or you may need to have your light source bulb adjusted or replaced. When white balancing the flexible scope, it is helpful to turn off/lower the room lights so that ambient light does not affect white balance adjustments. This will provide "truer" color.

The moiré effect (colored lines/bars) is a common struggle with flexible scopes coupled to CCD cameras. This effect is caused by an interference pattern between the pixels of the scope and those of the CCD camera element. This effect can be minimized by slightly defocusing the lens which softens the image. Rotating the scope slightly in the lens adaptor can also minimize the effect. Reduce the camera’s AP Gain setting (accessed under the "special menu") to the minimum value. If you are getting loss of color, adjust the Chroma Gain (also a special menu item) higher.

What happens when the featured performer at a benefit concert to raise funds for a voice clinic is stricken with laryngitis the day of the performance? Well, not only does the show still go on, it serves as a poignant demonstration that voice disorders can occur at any time and that they have the potential to be devastating.

For years, the Speech-Language Pathology and Audiology Clinic at the Saint John Regional Hospital, in Saint John, New Brunswick, Canada, has longed to purchase a videostroboscopy unit. However, the relatively low profile of the department kept it from being on the priority list for capital equipment funding.

According to Charlotte Polley, a speech-language pathologist on the staff, "Ever since Dr. Andrea Garland, one of our ENTs, visited Vanderbilt in Nashville, she’s been in awe of their setup and the wonderful support that they receive from the performing community."

Not long after, Polley happened to complain to one of her patients about having to send her to Toronto for a stroboscopy exam. That patient, Phyllis Knox, suggested a benefit concert to raise the funds needed to purchase the equipment. Knox, a singer herself, agreed to chair the event and to rally the support of a number of friends in the performing arts community.

One such friend, Wendy Nielsen, was performing at the Metropolitan Opera in New York when she agreed to star in this benefit performance. Over time, 11 other performers, including Michael McMahon from Montreal, a nationally renowned pianist and accompanist for Nielsen and others, agreed to donate their time to this special event.

Knox’s committee, named Voices with Vision, was comprised of an ENT specialist, a speech pathologist, singers, performers, and media people from both newspaper and radio.

"It was a real community effort getting it going," Polley said. "And despite all of the work, it was worth the effort. In fact, the Saint John Regional Hospital Foundation, the official fundraising arm for the entire hospital, took us under their wing this year, supporting us in this concert and in the purchase of the equipment."

Saint John will now have the only stroboscopy equipment in the province. "As a regional hospital that sees patients for tertiary care for cancer, cardiology, and the like, it will be a real boon for the hospital to be a center for this exam," Polley observed. "Not only will we get referrals because of this equipment, it will be nice not to have to send our patients to Toronto."

The site of the concert was the Imperial Theatre, which opened in 1913. In its day, it was one of the major theatres in Canada. The Imperial went from being an active theatre to a movie theatre, before it was finally purchased by a church. In the early 1980s, a major community fundraising project raised the necessary money to buy the theatre back. Another fundraiser was later held to refurbish it to its original condition. Having reopened in 1994, the historic old theatre was deemed the perfect setting for this gala benefit concert, A Flight of Song.

Although Wendy Nielsen was unable to sing, she did attend and emcee the event. A post-concert reception provided the audience an opportunity to meet and greet the performers and to view a large display of the equipment.

Spasmodic dysphonia (SD), also known as laryngeal dystonia, is a neurological voice disorder that involves involuntary "spasms" of the vocal cords causing interruptions of speech and affecting voice quality. SD causes the voice to break up or to have a tight, strained, or strangled quality. Often a great deal of effort is needed to speak, and occasionally no sound is produced. SD can affect almost anyone. The first signs of the disorder are often found in those between 30 and 50 years of age.

Kay’s CSL, Visi-Pitch II, and RLS Stroboscopy System are widely used by practitioners to evaluate SD and other such voice disorders.

SD affects an estimated 50,000 individuals in the United States. Because many physicians have never seen a case of the disorder, it is often misdiagnosed as laryngitis, cancer, or stress. Left undiagnosed and untreated, individuals needlessly suffer years of severe pain and embarrassment.

Founded in 1989 as a non-profit, charitable organization, the National Spasmodic Dysphonia Association (NSDA) has a three-fold mission of advancing medical research into the causes of and treatments for spasmodic dysphonia, promoting physician and public awareness of the disorder, and sponsoring support groups for patients and their families.

In 1997, the NSDA produced a 15-minute educational video, What is Spasmodic Dysphonia?, which was awarded first place in the American Medical Association’s Crystal Medallion Awards. The video is designed for primary care physicians, ENTs, speech pathologists, and medical schools, but is also appropriate for patients and the general public. It explains what SD is and how it is diagnosed and treated. It focuses particularly on the problem of misdiagnosis and on the use of botulinum toxin injections, currently the most successful treatment for SD.