Clinical Implementation of Laryngeal High-Speed Videoendoscopy: Challenges and Evolution

TLDR

High‑speed videoendoscopy captures true intracycle vocal fold vibration, surpassing videostroboscopy, yet its clinical adoption remains limited by technical, methodological, and validity concerns. This article reviews the practical, technological, and methodological challenges encountered, outlines the advances achieved, and proposes the necessary steps to establish HSV as a robust clinical tool. We describe the integration of color high‑resolution HSV, facilitative playback and dynamic segmentation methods, and ongoing efforts to implement HSV in phonomicrosurgery, while analyzing implementation challenges and prospects. The resulting tool offers deeper insight into laryngeal biomechanics, enables more accurate functional assessment of voice‑disorder pathophysiology, and promises refinements in diagnosis and management of vocal‑fold pathology.

Abstract

High-speed videoendoscopy (HSV) captures the true intracycle vibratory behavior of the vocal folds, which allows for overcoming the limitations of videostroboscopy for more accurate objective quantification methods. However, the commercial HSV systems have not gained widespread clinical adoption because of remaining technical and methodological limitations and an associated lack of information regarding the validity, practicality, and clinical relevance of HSV. The purpose of this article is to summarize the practical, technological and methodological challenges we have faced, to delineate the advances we have made, and to share our current vision of the necessary steps towards developing HSV into a robust tool. This tool will provide further insights into the biomechanics of laryngeal sound production, as well as enable more accurate functional assessment of the pathophysiology of voice disorders leading to refinements in the diagnosis and management of vocal fold pathology. The original contributions of this paper are the descriptions of our color high-resolution HSV integration, the methods for facilitative playback and HSV dynamic segmentation, and the ongoing efforts for implementing HSV in phonomicrosurgery, as well as the analysis of the challenges and prospects for the clinical implementation of HSV, additionally supported by references to previously reported data.