Differences in Glottal Closure and Visibility of the Anterior Commissure during Rigid-90°, Rigid-70°, and Flexible Laryngostroboscopy.
Roland Paulus, Matthias Leonhard, Guan-Yuh Ho and 2 others
PMID 37004509WHAT IT FOUND
Flexible endoscopy showed better vocal fold closure and anterior commissure visibility than rigid scopes in healthy adults.
Rigid 70-degree scopes offered slightly better anterior visibility than 90-degree scopes but similar closure findings. Technique choice directly affects diagnostic interpretation.
Key findings
01Flexible endoscopy demonstrated higher frequencies of complete vocal fold closure during loud phonation compared to both rigid endoscopic techniques.
02The anterior commissure was visible in 90.5% of flexible endoscopy examinations during low-soft phonation, compared to 33.3% for rigid-90° and 42.9% for rigid-70° endoscopy.
03Agreement between the three endoscopic techniques for assessing vocal fold closure type was only moderate, indicating that the choice of scope significantly influences the observed closure configuration.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study included only young to middle-aged adults (mean age 34.6) with normal voices, so findings may not apply to older adults, children, or patients with voice disorders. It was not determined whether differences in closure and visibility were caused by the endoscope itself, patient posture, tongue position, or the mechanical pressure of the instrument. The sample size was small (21 participants), which limits the generalizability of the agreement statistics.
Declared interests
The authors declared no conflicts of interest, and the study received no funding.
The easy way to misread this
Do not assume that a lack of complete glottal closure or poor anterior commissure visibility seen during rigid laryngostroboscopy represents a pathologic voice disorder. These findings may be artifacts of the examination technique, particularly the tongue protrusion required for rigid scopes. Flexible endoscopy showed significantly better closure and visibility in the same healthy participants, suggesting that rigid-scope findings require careful clinical correlation before being labeled as abnormal.