TABLE 3.
Parameters and Scales
| Parameter (Categories) | Parameters (Terms Used) | Scales | |
|---|---|---|---|
| Amplitude of vibration | Amplitude of vibration | Amplitude | ■ 1 = normal; 2 = decreased; 3 = increased ■ Normal; mild; moderate; severe ■ Improved or not improved ■ 0 normal; 1 reduced; 2 absent |
| Amplitude of vibration | ■ Normal if noted at 5, increased if above 5, and decreased below on a 10 cm scale | ||
| Amplitude left or right | ■ 1 = normal; 2 = slightly decreased; 3 = moderately decreased; 4 = severely decreased; 5 = no visible movement ■ VAS-amplitude is considered normal if noted at half the continuum, increased to the right and decreased to the left |
||
| Amplitude of vibration tumor side/nontumor side | ■ 5-point equally appearing interval scale-0 = normal function; 5 = most abnormal finding | ||
| Hyperfunction or ventricular folds | Anteroposterior compression | Anteroposterior hyperfunction | ■ 1 = no shortening of glottal length compared with resting, nonphonating state; 2 = glottal length shortened by 25%; 3 = glottal length shortened by 50%; 4 = glottal length shortened by 75%; 5 = arytenoids touch laryngeal surface of epiglottis, obscuring glottal view. |
| Medial compression | Hyperadduction of false vocal folds False-fold compression hyperfunction |
■ Present or absent ■ 1 = no false fold overclosure, laryngeal ventricles easily seen; 2 = one or both false folds obscure laryngeal ventricles; 3 = one or both false folds obscure ventricles and a portion of the true vocal folds; 4 = one or both false folds obscure the entire true vocal folds but are not touching; 5 = false folds touch and cover the entire glottis. |
|
| Ventricular folds movement | ■ 1 = normal; 4 = fully compressed | ||
| General hyperfunction | Presence of muscle tension dysphonia | ■ No or yes | |
| Degree of compression with phonation | ■ 0 = none; 1 = mild; 2 = moderate | ||
| Supraglottic activity | ■ 1 = normal to 5 = most abnormal | ||
| Hyperfunction | ■ 1 = not present; 2 = sometimes present; 3 = always present | ||
| Supraglottic effort | ■ 0 = none; 1 = mild; 2 = moderate; 3 = severe | ||
| Larynx vestibule involvement | ■ Unchanged; improved or worsened | ||
| Symmetry of ventricular folds | Ventricular folds—symmetry of movement | ■ R > L; L > R; L = R | |
| Arytenoids | Arytenoid movement | Arytenoid movement | ■ 1 = normal; 3 = poor ■ 0 = none; 1 = minimal; 2 = normal |
| Symmetry of arytenoid movement | Arytenoid symmetry | ■ R > L; L > R; L = R | |
| Position symmetry (during voicing) | Decrease of symmetry of the arytenoids and vocal folds | ■ No or yes | |
| Arytenoid position during speech | ■ 2 = normal; 1 = mildly abnormal; 0 = moderately abnormal | ||
| Position symmetry (during respiration) | Arytenoid position during quiet respiration | ■ 2 = normal; 1 = mildly abnormal; 0 = moderately abnormal | |
| Arytenoid position | Arytenoid position | ■ 0 = normal; 1 = mildly tilted forward; 2 = moderately tilted forward; 3 = severely tilted forward | |
| Edema | Vocal fold edema | Asymmetric localized edema on glottic edge | ■ 0 = normal; 1+ = mild; 2+ = moderate; 3+ = severe |
| Edema of vocal folds | ■ 0 = not present to 3 = most severe | ||
| ■ Mild; moderate; severe; polypoid | |||
| ■ Normal; mild; moderate | |||
| ■ Present or absent | |||
| True vocal cord edema | ■ Scored as none to severe; 0 to 4 on Likert scale | ||
| Vocal edema | ■ Present or absent | ||
| Diffuse edema | Diffuse laryngeal edema | ■ Mild; moderate; severe; obstructing | |
| Swelling | ■ 0 = normal; 1+ = mild; 2+ = moderate; 3+ = severe | ||
| Ventricular obliteration | ■ Partial or complete | ||
| Posterior glottic edema | Edema of posterior supraglottis Posterior glottic edema |
■ 0 = not present to 3 = most severe ■ Present or absent |
|
| Subglottic edema | Edema of subglottis | ■ 0 = not present to 3 = most severe | |
| Subglottic edema | ■ Present or absent | ||
| ■ No or yes | |||
| Arytenoid edema | Edema of the arytenoid | ■ Present or absent | |
| ■ Scored as none to severe; 0–4 on Likert scale | |||
| Erythema | Supraglottis erythema | Erythema of posterior supraglottis | ■ 0 = not present to 3 = most severe |
| Subglottis erythema | Erythema of subglottis | ■ 0 = not present to 3 = most severe | |
| Arytenoid erythema | Erythema of the arytenoid | ■ Present or absent | |
| ■ Scored as none to severe; 0–4 on Likert scale | |||
| Vocal fold erythema | Erythema of vocal folds Partial or total vocal fold erythema True vocal cord erythema |
■ 0 = not present to 3 = most severe ■ Present or absent ■ Scored as none to severe; 0–4 on Likert scale |
|
| Diffuse erythema | Erythema or hyperemia | ■ Arytenoids only or diffuse | |
| Reaction or inflammation | ■ Presence or absence | ||
| Glottal closure or gap | Magnitude of glottal gap | Closure | ■ 0 = a wide opening; 1 = intermediate closure; 2 = complete closure ■ Improved or not improved |
| Degree of glottic closure | ■ 0 = no deviance; 1 = slight deviance; 2 = deviance | ||
| Glottal closure | ■ Visual analog scales of 100 mm: a score of 0 meaning “normal, no deviance,” and a score of 100 “extremely deviant” | ||
| ■ 0 = no deviance to 3 = severe deviance | |||
| ■ Complete or incomplete | |||
| ■ 0 = complete; 1 = slightly incomplete; 2 = moderately incomplete; 3 = severely incomplete | |||
| ■ 0 = none; 1 = slight; 2 = one-third gap between both vocal folds; 3 = two-thirds gap; 4 = an open glottis during phonation | |||
| ■ 0 = normal; 1 = mild; 2 = moderate; 3 = severe abnormality Glottic closure ■ Complete at 5 and diminished if noted between 0 and 5, on a 10 cm scale. | |||
| ■ Complete at the right end, absent at the left end, on a VAS | |||
| ■ 1 = complete; 2 = incomplete; 3 = inconsistent | |||
| ■ 0 = complete; 1 = slightly incomplete; 2 = moderately incomplete; 3 = fully incomplete | |||
| ■ Unchanged; improved; worsened | |||
| ■ Present or absent | |||
| Glottal gap | ■ Absent or present | ||
| ■ 0 = severe; 1 = moderate; 2 = mild; 3 = absent | |||
| ■ GR—gap remains or none | |||
| Glottic gap | ■ Presence or absence | ||
| Size of glottal gap | ■ <2 mm or >2 mm | ||
| Degree of glottal incompetence | ■ A 5-point scale was used: 1 = slight, folds just not touching; 3 = moderate, −50% of the length of the folds not touching with 1- to 2-mm gap; 5 = severe, no vocal fold contact throughout the length of the folds and a large (3- to 4-ram) glottal gap | ||
| Vocal gap size | ■ Disappeared; improved or no change | ||
| Presence of slit | ■ Unchanged; improved or worsened | ||
| Glottal incompetence | ■ Present or absent | ||
| Glottal competency | ■ 1 = normal to 5 = most abnormal | ||
| Glottal insufficiency | ■ 1 = complete closure; 2 = mildly incomplete; 3 = moderately incomplete; 4 = severely incomplete | ||
| Glottic closure (insufficiency) | ■ 0 = none; 1 = mild; 3 = moderate; 5 = pronounced | ||
| Glottic occlusion | ■ 1 = sufficient or 2 = insufficient | ||
| Location or shape of glottal gap | Closure at the midmembranous vocal fold Glottic closure of the membranous part of the vocal folds |
■ 100 mm VAS—0 = no gap to 100 = large gap ■ Complete; incomplete (anterior or posterior) or totally missing |
|
| Closure in the respiratory (cartilaginous) glottis | ■ 100 mm VAS—0 = no gap and 100 = large gap | ||
| Closure just anterior to the vocal processes | ■ 100 mm VAS—0 = no gap and 100 = large gap | ||
| Glottic gap at the middle and posterior aspects of the vocal folds | ■ 0 = none; 1 = mild; 2 = moderate | ||
| Degree of glottal closure | ■ None, anterior one-third, anterior two-thirds, and complete | ||
| Glottal closure | ■ 1 = complete closure all along the vocal folds; 2 = indication of incomplete closure of the cartilaginous part; 3 = triangular incomplete closure reaching anterior to the vocal processes; 4 = triangular incomplete closure of the posterior third of the folds; 5 = incomplete closure of the posterior two-thirds of the folds; 6 = incomplete closure all along the folds; A = spindle-shaped incomplete closure, closure at the vocal processes; B = spindle-shaped incomplete closure at the posterior third of the membranous folds, closure at the vocal processes; C = spindle-shaped incomplete closure at the anterior third of the folds, closure at the vocal processes; D = spindle-shaped incomplete closure at the posterior and the anterior thirds of the folds, closure at the vocal processes and at the middle of the membranous portion (“hourglass”) ■ No closure; anterior third; anterior two-thirds; complete ■ 0 = normal; 1 = anterior gap; 2 = posterior gap; 3 = hourglass; 4 = no contact |
||
| Glottic closure | ■ Pictoral | ||
| Glottal gap | ■ 0 = no gap; 1 = small gap between the membranous vocal folds; 2 = glottal gap about one-third of the portion between the membranous v.f.; 3 = glottal gap about two-thirds of the portion between the membranous v.f.; 4 = gap along the whole glottis | ||
| Location of glottal gap | ■ Anteroposterior; posterior; anterior; bowing | ||
| Relative size of glottal gap | ■ 0 = no gap during phonation; 1 = minimal gap; 2 = small gap extending up to one third of the anterior membranous vocal folds; 3 = moderate gap extending up to two-thirds of the posterior membranous vocal folds; 4 = complete glottal incompetence with no observable contact between the vocal folds | ||
| Glottal configuration | ■ Complete; bowing; hourglass; anterior chink; posterior chink; incomplete | ||
| Granuloma | Granuloma formation | Contact granuloma | ■ Present or absent |
| Granuloma formation | ■ Presence or absent | ||
| Granuloma or granulation | ■ Present or absent ■ Noted if present |
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| Regularity/Periodicity | Regularity of vibration | Decrease of regularity | ■ No or yes |
| Regularity | ■ 0 = no deviance to 3 = severe deviance ■ 0 = periodical and symmetrical; 1 = periodical but asymmetrical; 2 = not periodical ■ 0 = no deviance; 1 = slight deviance; 2 = deviance ■ 0 = normal; 1 = mildly irregular; 2 = moderately irregular; 3 = severely irregular |
||
| Regularity of vibration | ■ Visual analog scales of 100 mm: a score of 0 meaning “normal, no deviance,” and a score of 100 “extremely deviant” Periodicity ■ 1 = regular; 2 = irregular successive vibrations | ||
| ■ Normal; mild; moderate; severe | |||
| ■ 1 = regular to 4 = always irregular | |||
| Regularity of vocal fold vibration | ■ 0 = normal; 1 = mildly abnormal; 2 = moderately abnormal | ||
| ■ Absent or visible | |||
| Phase closure | Phase closure ratio | Duration of closure | ■ Predominately closed; half closed and half open; predominately open; always open |
| Phase closure | ■ 1 = open phase predominates to 5 = closed phase predominates | ||
| Closure pattern of vocal folds | ■ 1 = predominantly closed; 2 = closed or open; 3 = predominantly open; 4 = always open | ||
| Phase closure (ratio not specified) | Closure patterns | ■ Normal; mild; moderate; severe | |
| Mucosal wave | Mucosal wave presence or amplitude | Mucosal wave | ■ 1 = absent; 2 = limited to the most medial edge of the vocal folds; 3 = present laterally up to one-fourth of the width of the vocal folds; 4 = present up to but less than one-half the width of the vocal folds; 5 = present at more than one-half the width of the vocal folds (normal) |
| ■ 1 = normal with 30%–50% lateral travel; 2 = increased with lateral travel >50%; 3 = decreased with lateral travel <30% | |||
| ■ Normal if noted at 10 on a 10-cm scale. Every value between 10 and 0 is considered a decreased wave. A wave noted 0 is a completely absent wave. | |||
| ■ Normal or absent or abnormal | |||
| ■ 1 = normal; 2 = small reduction; 3 = moderate reduction; 4 = severely reduced or absent | |||
| ■ 0 = absent; 1 = severely reduced; 2 = mildly reduces; 3 = intact | |||
| ■ Presence or absence | |||
| ■ NNN—normal or near-normal; IBR—improved but reduced | |||
| ■ Present to absent; 0–4 on Likert scale | |||
| ■ Absent or visible | |||
| Glottic wave movement | ■ 0 = no wave; 1 = decreased; 2 = full wave | ||
| Mucosal wave amplitude | ■ Preserved or not | ||
| ■ 0 = normal; 1 = mild; 2 = moderate; 3 = severe abnormality | |||
| ■ 0 = normal; 1 = mild; 2 = moderate; 3 = severe | |||
| Mucosal wave pattern (operated side) | ■ 0 = present, 2 = not present | ||
| Mucosal wave left or right | ■ 1 = normal to 5 = absent | ||
| ■ Scale is unipolar (normal at the right end, completely absent at the left end, VAS) | |||
| Mucosal wave quality | Mucosal wave | ■ 0 = no deviance to 3 = severe deviance | |
| ■ Improved or not improved | |||
| ■ 0 = no deviance; 1 = slight deviance; 2 = deviance | |||
| Mucosal wave characteristics | ■ 1 = normal to 5 = most abnormal | ||
| Quality of mucosal wave | ■ Visual analog scales of 100 mm: a score of 0 meaning “normal, no deviance,” and a score of 100 “extremely deviant” | ||
| Mucosal wave pattern reduction (contralateral side) | ■ 0 = none; 1 = mild; 2 = severe; 3 = complete | ||
| Mucosal wave tumor side or nontumor side | ■ A five-point equally appearing interval scale. Zero represented normal function and five represented the most abnormal finding. | ||
| Mucosal wave amplitude symmetry | Mucosal wave amplitude Amplitude |
■ Symmetric or asymmetric ■ 0 = symmetrical; 1 = smaller than the healthy side; 2 = mucosal traveling wave is not discernible |
|
| Mucosal wave symmetry (not specified) | Mucosal wave symmetry | ■ 0 = normal; 1 = mild; 2 = moderate; 3 = severe abnormality ■ 0 normal; 1 mild irregularity; 2 moderate irregularity; 3 always irregular ■ Severely asymmetrical or normal |
|
| Mucosal wave periodicity | Mucosal wave periodicity | ■ 0 = normal; 1 = mild; 2 = moderate; 3 = severe abnormality ■ 0 = normal; 1 = mild irregularity; 2 = moderate irregularity; 3 = always irregular ■ Severely aperiodic or normal |
|
| Phase symmetry | Phase symmetry | Phase symmetry | ■ 1 = regular to 4 = always irregular ■ 0 = normal; 1 = mildly asymmetrical; 2 = moderately asymmetrical; 3 = severely asymmetrical ■ 1 = symmetrical or 2 = asymmetrical ■ Symmetric or asymmetric ■ 0 = no deviance; 1 = slight deviance; 2 = deviance ■ Improved or not improved |
| Symmetry | ■ 0 = no deviance to 3 = severe deviance ■ Normal; mild; moderate; severe ■ Visual analog scales of 100 mm: a score of 0 meaning “normal, no deviance,” and a score of 100 “extremely deviant” |
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| Phase synchrony | ■ Stays in synchrony during all cycles, in most of the cycles or is out of synchrony | ||
| Mucus | Presence of mucus | Increased mucus on vocal folds | ■ 0 = normal; 1+ = mild; 2+ = moderate; 3+ = severe |
| Laryngeal mucus | ■ No or yes | ||
| Thick endolaryngeal mucus or other | ■ Present or absent | ||
| Vibratory behavior | Presence and extent of vibration | Vibratory patterns | ■ Improved or not improved |
| Vibratory behavior left or right | ■ 1 = always fully present to 5 = complete absence always | ||
| Return of vocal fold function | ■ Yes or no | ||
| Fold vibration | ■ Present or absent | ||
| Vibratory behavior | ■ Improved or not improved | ||
| Presence and extent of nonvibrating portions | Nonvibratory segments Nonvibrating portion of the vocal folds tumor side or nontumor side |
■ 1 = presence or 2 = absence of nonvibratory segment ■ A five-point equally appearing interval scale. Zero represented normal function and five represented the most abnormal finding. |
|
| Inability to sustain waveform | ■ 0 = normal; 1+ = mild; 2+ = moderate; and 3+ = severe | ||
| Location of nonvibrating portions | Location of nonvibratory segments | ■ Anterior; middle; posterior third of the true vocal fold | |
| Level of phonation | Level of phonation | ■ True vocal cord; false vocal cord; supraglottic phonation | |
| Lesions (non-granulomatous) | General lesions (presence and size) | Lesion presence Lesion size |
■ Presence or absence ■ Improvement or nonimprovement ■ 1 = complete resolution of the vocal lesions; 2 = much improvement (>50% of lesion size reduction); 3 = some improvement (<50% of lesion size reduction); 4 = no change |
| Specific lesions (presence and size) | Polyp size Polyps Posterior glottic lesion Ulceration Scarring |
■ Complete remission; shrinkage; no change in size; enlargement ■ Present or absent ■ Present or absent ■ Noted if present ■ Present or absent |
|
| Morphological changes (tissue hyperplasia or cicatrisation) | ■ 0 = none; 1 = mild; 3 = moderate; 5 = severe | ||
| Leukoplakia | ■ Present or absent | ||
| Nodules or prenodules | ■ Present or absent ■ Noted if present |
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| Vascular injection | ■ 0 = normal; 1+ = mild; 2+ = moderate; 3+ = severe | ||
| Pachydermia | Pachydermia | Pachydermia | ■ Scored as none to severe; 0–4 on Likert scale |
| Posterior pachydermia | ■ Present or absent | ||
| Posterior commissure hypertrophy | ■ Mild; moderate; severe; obstructing | ||
| Vertical height | Vertical height difference | Vertical height difference Vertical height difference between the vocal folds |
■ Yes or no ■ 0 = severe and 100 = none (VAS) |
| Vertical level of approximation | ■ Improved or not improved ■ 1 = equal; 2 = right lower; 3 = left lower |
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| Vocal fold edge | Straightness | Vocal fold edge | ■ 0 = straight; 1 = mildly bowed; 2 = moderately bowed; 3 = severely bowed |
| Vocal fold edge of paralyzed side | ■ 0 = straight; 1 = mildly bowing; 2 = moderately bowing; 3 = severely bowing | ||
| Degree of vocal fold bowing | ■ 1 = straight vocal fold edge; 2 = mildly bowed; 3 = moderately bowed; 4 = severely bowed | ||
| Muscle atrophy | ■ Present or absent | ||
| Roughness | Vocal fold edge left or right | ■ 1 = smooth to 5 = rough irregular | |
| Glottic edge irregularity | ■ 0 = normal; 1+ = mild; 2+ = moderate; 3+ = severe | ||
| Not specified | Vocal fold edge | ■ Improved or not improved | |
| Vocal fold edge tumor side/nontumor side | ■ 5-point equally appearing interval scale (0 = normal function; 5 = most abnormal finding) | ||
| Vocal fold (other) | Vocal fold position | Vocal fold position | ■ 0 = midline; 1 = paramedian; 2 = intermediate; 3 = lateral |
| ■ 1 = lateral; 2 = paramedian; 3 = near-midline | |||
| Vocal fold tension | Vocal fold tension | ■ Normal; mild; moderate | |
| Vocal fold size | Muscle bulk asymmetry | ■ Present or absent | |
| Stenosis/web | Presence of stenosis or web | Stenosis Web (may be anterior microweb) |
■ Noted if present ■ Present or absent |
| Recovery | Recovery | Recovery | ■ 1 = complete recovery (normal mucosal wave propagation with symmetric phase and amplitude); 2 = much improvement (normal mucosal wave propagation with minimal asymmetric phase or amplitude); 3 = some improvement (presence of phase asymmetry or decreased amplitude, but the mucosal wave was improved compared with baseline); 4 = no change or worse |
Abbreviations: L, left; R, right; VAS, visual analog scale; v.f., vocal fold.