Q+A CENTER

With the new HSV system implemented at Massachusetts General it is expected that the higher temporal resolution and registration of true intracycle glottal dynamics by HSV will provide more accurate descriptions of the underlying pathophysiology of disordered voice production than is possible with stroboscopy. Such increases in accuracy will lead to important refinements in the assessment and diagnosis of vocal pathology.

Quantitative and qualitative approaches are being used primarily focusing on comparisons of HSV measures with intraoperative characterization of vocal fold pathology, both in terms of preoperative assessments and with respect to relative changes in measures postoperatively (i.e., comparisons of presurgery and postsurgery assessments). If this study shows positive results, it is hoped that the HSV methods will be widely adopted in clinical practice to improve the assessment of voice disorders, and will become a particularly valuable and necessary tool for the development, evaluation, and continued improvement of advanced phonomicrosurgical procedures.

There are, of course, challenges remaining. From the science end, Deliyski says, "we need to understand more of the vocal-fold physiology. We need to be able to relate the acoustics or other signals, like oral pressure and airflow, to the vocal-fold vibrations. We're trying to use high-speed videos to understand the relationships from what we see in the image to what we hear or measure outside of the body.

"The second challenge is to link this to identifying disorders. With stroboscopy, it was pretty much a different image. Now, when we realize the actual vibrations, we have different sensitivity and specificity. We need to generate new norms from vocally normal people and voice patients to conclude what is causing the disorder. It's all work that's remaining."