title: The effect of endoscopic sheaths on visualization in distal chip and fiberoptic laryngoscopy.
abstract: Endoscopic sheaths covering the laryngoscope are advised to prevent cross contamination, but might hamper visualization as the most important tool in the diagnostic approach of laryngeal disease. We evaluated whether endoscopic sheaths change image quality and diagnostic accuracy of flexible distal chip laryngoscopy (DCL) and flexible fiberoptic laryngoscopy (FOL). Twelve healthy volunteers underwent a flexible laryngoscopy using a distal chip and a fiberoptic laryngoscope with and without endoscopic sheaths, and in this way 48 images were collected. To determine diagnostic accuracy, the 48 images were mixed with images of 40 patients. All images were randomly shown to four experts in the field of laryngology and head and neck oncology. Observers were asked to validate image quality, choose a diagnosis, and express their confidence level of that diagnosis. Image quality was validated better in DCL as compared to FOL (p < 0.05) both with or without endoscopic sheaths. Endoscopic sheaths worsened image quality in DCL (p < 0.05) but not in FOL. No differences were observed between DCL and FOL with or without endoscopic sheaths in diagnostic accuracy (79-89%). Confidence levels (7.7-8.1) were comparable in DCL and FOL and not influenced by endoscopic sheaths. Image quality in DCL is superior to FOL, but significantly hampered by the use of endoscopic sheaths. In FOL the image quality is already low and not further diminished by endoscopic sheaths.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands, b.e.ch.plaat@umcg.nl.
authors.forename: Boudewijn E C
authors.initials: BE
authors.lastname: Plaat
authors.forename: Bernard F A M
authors.initials: BF
authors.lastname: van der Laan
authors.forename: Jan
authors.initials: J
authors.lastname: Wedman
authors.forename: György B
authors.initials: GB
authors.lastname: Halmos
authors.forename: Frederik G
authors.initials: FG
authors.lastname: Dikkers
mesh_terms: D000328:Adult; D019723:Endoscopes; D004724:Endoscopy / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000175:diagnosis*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation*; D008297:Male; D055100:Optical Fibers; D015203:Reproducibility of Results
references.citation: Am J Infect Control. 2007 Oct;35(8):536-44
references.pmid: 17936146
references.citation: Laryngoscope. 2002 Mar;112(3):559-64
references.pmid: 12148871
references.citation: J Voice. 2012 Nov;26(6):772-8
references.pmid: 22285452
references.citation: Laryngoscope. 2010 Oct;120(10):1950-3
references.pmid: 20824777
references.citation: Laryngoscope. 2012 Jun;122(6):1331-4
references.pmid: 22499435
references.citation: Laryngoscope. 2013 Jan;123(1):215-9
references.pmid: 23070976
references.citation: Laryngoscope. 2012 Aug;122(8):1826-30
references.pmid: 22566012
references.citation: J Laryngol Otol. 1975 Mar;89(3):299-316
references.pmid: 1127325
references.citation: Laryngoscope. 2010 Dec;120(12):2410-6
references.pmid: 21046544
references.citation: Eur Arch Otorhinolaryngol. 2010 Sep;267(9):1423-8
references.pmid: 20352239
references.citation: Ann Otol Rhinol Laryngol. 2001 Apr;110(4):385-7
references.pmid: 11307918
references.citation: Eur Arch Otorhinolaryngol. 2014 Aug;271(8):2227-32
references.pmid: 24515919
references.citation: Otolaryngol Head Neck Surg. 2009 Sep;141(3):307-10
references.pmid: 19716004
references.citation: Cochrane Database Syst Rev. 2011 Mar 16;(3):CD005606
references.pmid: 21412890
references.citation: Ann Otol Rhinol Laryngol. 2012 Nov;121(11):708-13
references.pmid: 23193902