Voice Diagnostix
Voice Diagnostix

Research and Evidence Based Practice

Laryngeal Videostroboscopy 

ASHA is behind using laryngeal videostroboscopy in its position statement:

American Speech-Language-Hearing Association. (1998). The Roles of Otolaryngologists and Speech-Language Pathologists in the Performance and Interpretation of Strobovideolaryngoscopy. Available HERE

American Speech-Language-Hearing Association's stance on Vocal Tract Visualization and Imaging. Available HERE.



Videostroboscopy and its benefits

In this recent article in the Laryngoscope, Seth Cohen, Nelson Roy, Mark Courey and others take a look at how important Videolaryngostroboscopy (VLS) is as an evaluation tool. They did this retrospectively for patients from 2004-2008, who had been evaluated by an otolaryngologist and then had a specialty voice evaluation with a VLS component within 90 days. Findings? Half of the patients had a change in diagnosis following a VLS. HALF! That means this examination can correctly identify disorders that would have been misdiagnosed otherwise.

Think about the otolaryngologist. Seeing 20-30 patients per day, voice complaints usually result in a brief look with a flexible endoscope through the nose. This is to determine the depth of evaluation necessity. The ENT will then usually refer the patient to a voice specialist for a videostroboscopic examination, or do it himself if he has the training, technology and time. He makes the best call he can for the technology and time he has, and when he knows the patient will benefit from further analysis, he refers. This is efficient.

What makes a videostroboscopy so much more comprehensive?

  1. It can be recorded and reviewed multiple times to educate the patient and to share with other care providers.
  2. It is magnified greater than a flexible endoscope, so you see the laryngeal vestibule in greater detail.
  3. The strobe light allows the vocal folds to be seen in motion. This helps us evaluate the vocal folds in five ways, as well as for color and structure.

This saves us money, it saves the patient money, and it saves insurance companies money. In this study, 83% of 125 individuals who had the diagnosis of acute laryngitis had their diagnosis changed to something different. This was not the only initial diagnosis, but it showed the biggest change. Difference in diagnosis means that there were differences in treatment patterns as well. 

The article also states that ENT's are less comfortable with diagnosing specific voice disorders unless they are very visual in presentation, so even more reason for you to let Voice Diagnostix help you!

Source: Exerpts taken from blog originally published on www.atempovoicecenter.com. Reference: Change in diagnosis and treatment following specialty voice evaluation: A national database analysis. Cohen, Seth; Kim, Jaewhan; Roy, Nelson; Wilk, Amber; Thomas, Steven, & Courey, Mark. Laryngoscope, 13 Feb 2015, doi: 10.1002/lary.25192


fiberoptic endoscopic evaluation of swallow

American Speech-Language-Hearing Association's stance on speech-language pathologists performing endoscopic assessment of swallowing functions. Available HERE.

American Speech-Language-Hearing Association's stance on speech-language pathologists in the performance and interpretation of endoscopic evaluation of swallowing. Available HERE.

American Speech-Language-Hearing Association's stance on Use of Endoscopy by Speech-Language Pathologists: Position Statement. Available HERE.



Bastian R. Video endoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. Otolaryngol-Head & Neck Surg 1991; 104(3):339-50.

Crary, M.A., Baron, J. (1997) Endoscopic and Fluoroscopic Evaluations of Swallowing: Comparison of Observed and Inferred Findings. Dysphagia, 12(2).

Kelly, A. M., Drinnan, M. J., & Leslie, P. (2007). Assessing penetration and aspiration: How do Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing compare? The Laryngoscope, 117(10), 1723-1727.

Langmore, S.E., Schatz, K., & Olsen, N. (1991). Endoscopic and video fluoroscopic evaluations of swallowing and aspiration. Annals of Otalgia, Rhinology & Laryngology. 100(8), 678-681.

Leder, S. B., Sasaki, C. T., & Burrell, M. I. (1998). Fiberoptic Endoscopic Evaluation of Dysphagia to Identify Silent Aspiration. Dysphagia, 13(1), 19-21.

Madden, C., Fenton, J., Hughes, J., & Timon, C. (2000). Comparison between videofluoroscopy and milk-swallow endoscopy in the assessment of swallowing function. Clinical Otolaryngology, 25(6), 504-506.

Rao N., Brady, S. L., Chaudhuri, G., Donselli J. J., & Wesling, M. W. (2003). Gold-standard? Analysis of the videofluoroscopic and fiberoptic endoscopic swallow examinations. Journal of Applied Research, 3(1), 89-96.

Mu, C.H., Hsiao, T.Y., Chen, J.C., Chang, Y.C., &Lee, S.Y. (1997). Evaluation of swallowing safety with fiberoptic endoscope: Comparison with video fluoroscopic technique. Laryngoscope, 107, 396-401.


FEES is Safe.

"When (Fiberoptic Endoscopic Evaluation of Swallow with Sensory Testing) FEESST is performed…by properly trained clinicians, the incidence of complications is practically nonexistent." –Aviv

Aviv, J.E., Murray, T., Zschommler, A., Cohen, M., Gartner, C. Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1340 consecutive examinations. Annals of Otology, Rhinology & Laryngology. 2005;114:173-176.

Aviv, J.E., Kaplan, S.T., Thompson, J.E., Spitzer, J., Diamond, B., Close, L.G. The safety of flexible endoscopic evaluation of swallowing with sensory testing: an analysis of 500 consecutive evaluations. Dysphagia. 2000;15:39-44.

Cohen, M.A., Setzen, M., Perlman, P.W., Ditkoff, M., Mattucci, K.F., Guss, J. The safety of flexible endoscopic evaluation of swallowing with sensory testing in an outpatient otolaryngology setting. Laryngoscope. 2003;113:21-24.


FEES is comfortable

Singh, V., Brockbank, M.J., Todd, G.B. Flexible transnasal endoscopy: is local anesthetic necessary? Journal of Laryngology and Otology. July 1997;111:616-618.

Leder, S.B., Ross, D.A., Briskin, K.B., Sasaki, C.T. A prospective, double-blind, randomized study on the use of a topical anesthetic, vasoconstrictor, and placebo during transnasal flexible fiberoptic endoscopy. Journal of Speech, Language and Hearing Research. 1997;40:1352-1357.


FEES helps reduce the amount of hospital re-admissions.

Donelan-McCall, N., T. Eilertsen, R. Fish, and A. Kramer. 2006. Small Patient Pop- ulation and Low Frequency Event Effects on the Stability of SNF Quality Measures. Washington, DC: MedPAC.

Mor, V., Intrator, O., Feng, Z., & Grabowski, D. C. (2010). The Revolving Door of Rehospitalization From Skilled Nursing Facilities. Health Affairs (Project Hope), 29(1), 57–64. doi:10.1377/hlthaff.2009.0629

Coleman EA, Min S, Chomiak A, Kramer AM. "Post-Hospital Care Transitions: Patterns, Complications, and Risk Identification." Health Services Research 2004:37(5):1423-1440.






American Speech-Hearing and Language Association

Ampcare Effective Swallow Protocol



Informational Article on MBS and FEES