Virtual versus Conventional Laryngeal Endoscopy

Abstract

We have evaluated the capacity of virtual laryngoscopy and conventional laryngoscopy conducted with a rigid or flexible instrument to visualize laryngeal structures in 64 patients with normal endoluminal anatomy. Virtual laryngoscopy allowed total visualization of laryngeal structures, including those that could not be reached by a flexible instrument. There was good correlation between virtual laryngoscopy and "real" images, indicating satisfactory diagnostic accuracy (p < .05). Although virtual laryngoscopy does not provide histologic data, it is a fast and noninvasive technique that can be added to and integrated with conventional laryngoscopy, and it can be an alternative in cases in which conventional laryngoscopy is difficult, contraindicated, or impossible. It is particularly useful for the study of laryngeal narrow spaces and in the visualization of subglottic regions and of other more restricted areas (inferior tonsil region, posterior surface of the epiglottis, glossoepiglottic vallecula, Morgagni's ventricle, anterior commissure).

Comparison of diagnostic accuracy of computed tomography virtual endoscopy and flexible fibre-optic laryngoscopy in the evaluation of neck anatomic structures and neoplasms

“…This finding highlights the importance of CT-VE in the endoscopic representation of the anatomical structures and the utility of this modality as a complement to other techniques. 9 This correlation has already been estimated by Businco 12 who described satisfactory diagnostic accuracy. Furthermore, Byrne et al.…”

“…In addition, Magnano 10 described other factors such as swallowing, phonation and breathing that decrease the image quality and limit the assessment of these structures. In disagreement to these reports, some studies 12 , 13 have reported high accuracy of VE in lesions localised in the vocal cords. However, Walshe 14 described that it is important to have an air mucosa interface and mucosal distortion in order to be able to identify lesions.…”

“…8 , 14 On the other hand, VE has multiple limitations described by several studies, including radiation exposure and the inability to identify mucosal irregularities or flat lesions. 7 , 8 , 16 , 19 Moreover, this technique cannot give real-time imaging, 16 whereas in endoscopy, the visualisation of the airway mucosa allows the evaluation of the intraluminal anatomy, the morphology, vascularisation and colour of the mucosa, 12 giving the opportunity to recognise abnormalities and take tissue samples. 8 , 10 Additionally, the quality of the images depends on the collaboration of the patient, 10 and it requires specialised software and time to do the reconstructions, thereby increasing the costs, 11 although with technology improvement, the reconstructions are quicker and with better detail.…”