About The Book

Stroboscopy and High-Speed Imaging of the Vocal Function, Second Edition presents a complete picture of the art and science of stroboscopy. This unique professional resource includes not only comprehensive coverage of the imaging process, but also the disease process that exists in benign lesions, cancer, and neuropathology. Comparisons of normal images with pathologies are included to enhance readers’ diagnostic skills, and the use of stroboscopic images before and after therapy to determine results enhances their clinical skills. The book also covers the entire range of laryngeal imaging for diagnostics, including rigid endoscopy, videostroboscopy, fiberoptic laryngoscopy, and high-speed imaging.

Written by a physician who works in a multidisciplinary environment, the book outlines the roles of the otolaryngologist, speech-language pathologist, voice scientist, and singing teacher in the clinical examination. Unparalleled full-color illustrations appear throughout.

New to the Second Edition

  • New chapter on High Speed Imaging
  • Updated imaging of vocal fold examination techniques
  • Many added images and illustrations with enhanced figures using video montage.
  • Fully updated to reflect the current research with many new references added from 2010 to 2020
  • References are placed at the end of the relevant chapters.
  • A PluralPlus companion website with high definition video examples of stroboscopy and high-speed imaging

From the Foreword

“Dr. Woo brings new information to the study of the voice through his expertise in stroboscopy, including the techniques to obtain the best video images and to interpret these images. He demonstrates that stroboscopy is one of the clinician’s most relevant working tool. More importantly, he combines the role of stroboscopy with how the tool is used for teaching, patient education, diagnosis, and research. Dr. Woo’s passion for the study of the voice, his unique expertise and talent for sharing his knowledge with others have allowed him to write a textbook that is enjoyable to read and provides a wealth of new visual information about the art and science of the larynx.  Dr. Woo also stresses throughout the book that, thanks to the constant improvement in stroboscopy and the unique collaboration between the otolaryngologist and the speech-language pathologist, we have gained a better understanding of the voice and its disorders. Finally, he challenges us to continue to improve our understanding of the human voice by continually seeking innovative technologies, asking thought-provoking questions, and pursuing collaboration among voice professionals.”
—Thomas Murry, PhD
Professor, Otolaryngology Head and Neck Surgery, Loma Linda University Health

About The Author

Peak Woo, PhD, FACS is in private practice as an otolaryngologist in New York City.  His practice is limited to laryngology and communication and voice disorders.  His primary professional and research interests are in the field of voice production and its disorders.

In 1972, he enrolled in the six-year BA/MD joint degree program offered by the College of Liberal Arts and the School of Medicine at Boston University. After spending 25 years as academic faculty member at Mount Sinai Medical Center, Tufts-New England Medical Center and SUNY-Health Science Center at Upstate, he is now in private practice. He serves as Clinical Professor in Otolaryngology Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai New York.  He continues to participate in the training of residents and laryngology fellows.

Dr. Woo was a past president of the American Laryngological Association, the American Broncho-Esophagological Association, the New York Laryngological Society and the New York Head and Neck Society. He was a past vice president of the Triological Society.   Dr. Woo’s past community activities include Doctor to the New York State Theater and the New York City Opera and he serves as advisor to the New York Singing Teacher Association Professional Development Program.  He has traveled widely and given talks on laryngology and voice disorders

Dr. Woo lives in New Jersey with his wife. He has three grown children Christina, Geoffrey, and Ryan.

Table Of Contents


Chapter 1. History of Stroboscopy and High-Speed Imaging of Laryngeal Vibration

History of Stroboscopy and High-Speed Video
References 5

Chapter 2. Principle of Stroboscopy

Stroboscopy and Talbot’s Law

Chapter 3. Anatomy of the Larynx and Histology of the Vocal Folds

Laryngeal Framework and Skeleton Cartilage
Hyoid Bone
Thyroid Cartilage
Cricoid Cartilage
Arytenoid Cartilages and Epiglottis
Fascia, Ligaments, and Joints of the Larynx
Anatomic Regions of the Larynx
Muscles of the Larynx
Extrinsic Muscles
Cricothyroid Muscle
Thyroarytenoid Muscle
Posterior Cricoarytenoid Muscle
Lateral Cricoarytenoid Muscle
Interarytenoid Muscle
​​​​​Structure of the Vocal Folds
Pathology and the Involvement of the Vocal Fold Layers

Chapter 4. Vocal Fold Vibration and Phonatory Physiology

Criteria for Normal Vocal Fold Vibration
Normal Vibratory Behavior of the Vocal Folds
The Glottal Cycle
Acoustic and Aerodynamic Interactions With Vocal Fold Vibration
The Larynx as DC to AC Airflow Converter
Mass Effects on Vocal Fold Vibration
Effect of Stiffness on Vocal Fold Vibration
Effect of Tension Change on Vocal Fold Vibration

Chapter 5. Videokymography and High-Speed Digital Imaging of the Larynx

Disadvantages of Videostroboscopy
High-Speed Video Imaging of Vocal Vibration
Normal Onset and Offset of Vocal Fold Oscillation
Clinical Application of High-Speed Imaging in Diplophonia

Chapter 6. Normal Phonation and Vocal Fold Vibration

Dynamic Changes in the Glottal Cycle
Gender Differences
Age Differences
Intensity and Amplitude Modulation
Pitch Modulation
Intensity Modulation
Pitch and Amplitude Modulation Interactions

Chapter 7. Abnormal Vocal Fold Vibration

Tension Abnormality
Increase in Tension of the Vocal Fold Ligament
Stiffness Abnormality
Glottal Closure and Level Difference
Unilateral Versus Bilateral Effects of Mass, Tension, and Stiffness

Chapter 8. Instrument and Clinical Operation

Stroboscope Versus High-Speed Imaging of Vocal Fold Vibration
Use of Stroboscopy
Clinical Care in Laryngology and Voice Care
Phonation Research
Image Processing and Automation

Chapter 9. The Clinical Examination Using Videostroboscopy

The Examination Room
Patient’s and Examiner’s Positions
Equipment Considerations
The Stroboscope
Videos and Cameras
Imaging Management
Endoscopes: Rigid, Fiberscope, and Videoendoscopes
Who Is Doing the Examination and What Is the Stroboscopy Data Being Used For?
Otolaryngologist Versus Speech Pathologist
Laryngoscopy Versus Phonoscopic Examination

Chapter 10. Stroboscopy Setup and Recording

Rigid Endoscopic Examination
Performing the Examination
Anesthesia for Rigid and Flexible Laryngoscopy
Tokens Sampled During the Stroboscopy Examination
Avoiding the Pitfalls of Stroboscopy

Chapter 11. Avoiding Errors During Stroboscopy

Recording Artifacts
Closure Problems
Open Phase Predominates and Errors Related to Their Interpretation
Glottic Configuration Abnormalities
Phase Shift Findings During the Production of Falsetto

Chapter 12. Interpretation of Videostroboscopy

Normal Variations
Phase Shifts at Falsetto and Flute Register Are Normal
Interpretation of the Stroboscopy Examination
Fundamental Frequency
Periodicity of the Vocal Fold Oscillation
Phase of Vocal Closure During Modal “ee” Phonation
Phase Symmetry
Configuration of Glottic Closure
Vocal Fold Edge
Mucosal Wave
Nonvibrating Segment
Synthesis of the Clinical Voice Disorder


Chapter 13. Laryngeal Inflammation

Acute Inflammation
Chronic Laryngitis
Radiation Laryngitis
Reflux Laryngitis: Acute and Chronic
Candida Laryngitis

Chapter 14. Granulomatous Diseases of the Larynx

Granulomatous Laryngitis
Rheumatoid Nodules and Autoimmune Deposits of the Larynx

Chapter 15. Granulation and Contact Granuloma

Contact Ulcer, Granulation Tissue, and Intubation Granuloma
Risk Factors and Populations
Physical Examination
Differential Diagnosis
Treatment and Management

Chapter 16. Laryngeal Trauma

Arytenoid Dislocation
Laryngeal Stenosis

Chapter 17. Vocal Fold Scar

Rehabilitation Strategies for Vocal Fold Scar
Prevention of Vocal Fold Scar
Surgical Treatment in the Management of Scar

Chapter 18. Benign Mucosal Lesions

Hemorrhagic Polyps
Polypoid Corditis/Reinke’s Edema
Laryngeal Edema
Pseudocyst and Fibrovascular Lesion
Vascular Ectasia
Acute Vocal Fold Hemorrhage
Sulcus Vocalis
Mucosal Bridge

Chapter 19. Premalignant Lesions and Lesions of Uncertain Behavior


Chapter 20. Malignant Neoplasms of the Larynx


Chapter 21. The Aging Voice


Chapter 22. Benign Tumors and Nonneoplastic Masses of the Larynx

Laryngeal Papillomas
Verrucous Lesions of the Larynx
Other Reactive Lesions
Internal and External Laryngoceles, Saccular Cysts

Chapter 23. Vocal Fold Paralysis and Vocal Fold Paresis

Signs and Symptoms
Voice Quality of Unilateral Vocal Fold Paralysis and Paralysis
Recurrent Laryngeal Nerve Paralysis and Paresis
Paralysis Versus Paresis
Role of Stroboscopy in Treatment Planning for Vocal Fold Paralysis and Paresis
Superior Laryngeal Nerve Paralysis
Combined Laryngeal Nerve Paralysis
Vocal Fold Paresis

Chapter 24. Irritable Larynx Syndrome


Chapter 25. Neurogenic Dysphonia

Spasmodic Dysphonia
Vocal Tremor
Neurogenic Diseases

Chapter 26. Functional Dysphonia and Muscle Tension Dysphonia


Chapter 27. Stroboscopy in the Management of Phonosurgery

Preoperative Analysis of the Lesion Before Surgery
Intraoperative Use of Videostroboscopy
Postoperative Use of Stroboscopy in Analyzing Phonosurgery Results


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