Stroboscopy and High-Speed Imaging of the Vocal Function

Second Edition

Peak Woo

Details: 437 pages, Full Color, Hardcover, 8.5" x 11"

ISBN13: 978-1-63550-236-7

© 2022 | Available


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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

Peak Woo Discusses Stroboscopy and High-Speed Imaging of the Vocal Function, Second Edition



“The number and quality of the endoscopic images is quite remarkable and do reflect the size of practice of the author.  […]
As before, the second edition is divided into Basic Sciences (the Anatomy, Physiology and the physics of stroboscopic imaging) and then Disorders of the Larynx. In the former there is now extensive coverage of digital high-speed video endoscopy, or videokymography.
Throughout the book the illustrations of videostroboscopy are really well reproduced, but, even better, they are accompanied by a series of on-line examples. By definition, this is an exercise in dynamic movement and the videos are invaluable. Advances in chip-tip video (avoiding the need for fibres) and contact endoscopy and narrow band imaging also reflect recent advances.
In coverage of laryngeal pathology there are at least as many still endoscopic images as those of stroboscopy, making this a great atlas of disease and, so , of relevance to those with a  general otolaryngology interest. Chapters cover such topics as Inflammatory, Autoimmune, Granulomatous, Neoplastic, Traumatic and Neurologic abnormalities.
I particularly appreciated a section entitled ‘Who is doing the Examination and what is the Stroboscopy Data Being Used for?’ (p137). This explains the different approaches to voice problems for the otolaryngologist and the Speech/Language Pathologist and the differing value of Stroboscopy for each of them.”

—Liam M Flood, FRCS, FRCSI, in Journal of Laryngology & Otology (November 2021)

“This is another noteworthy release by Plural Publishing. In this comprehensive textbook, Peak Woo, MD focuses on stroboscopy and high-speed imaging of voice production regarding basic science and laryngeal disorders. Its predecessor, Stroboscopy, by the same author in 2010, can now be replaced with this second edition that introduces a chapter dedicated to high-speed imaging of the larynx that is becoming prevalent in the research of voice production. The volume also contains elaborate details quoting cur-rent research on imaging techniques, enhanced images, and a spectacular array of video files via a companion website hosted by the publisher. The foreword is penned by the author’s professional friend and collaborator, Thomas Murry, MD, who is an equally accomplished voice scientist, researcher, and clinician.
The textbook consists of two parts, “Basic Science” and “Laryngeal Disorders.” The first section deals with the history and principles of stroboscopy and high-speed video imaging. The chapters related to anatomy and physiology of the larynx, histological properties of vocal fold layers, and the effects of disorders on these layers help build the foundation for readers, especially phonosurgeons, to understand the importance of vocal fold imaging in successful diagnostics and intervention… The chapters related to normal and abnormal vocal fold vibration amplify the importance of understanding basic science in clinical intervention of voice.
One of the most valuable resources in this textbook are the chapters that acclimate new clinicians and laryngologists to the set-up, recording, and interpretation of videostroboscopy. Visual analysis, a subjective study, requires extensive training; one can-not be oversaturated with information or experience. The video examples of every parameter involved in stroboscopic evaluation will indeed help to not only increase visual accuracy of findings but also enhance interpretation. These chapters are written for both neophyte and expert. The author also specifies how findings and interpretation can differ between speech language pathologists and laryngologists. This is crucial for students and early stage clinicians in both these professions.
The second section of this textbook, “Laryngeal Disorders,” covers almost all disorders from muscle tension dysphonia to malignancy of the larynx. In addition to giving an overview of these functional, organic, and neurogenic disorders, these chapters also include histopathology as and when needed, stroboscopic findings and its relevance to diagnosis and treatment, including phonosurgery.
Overall, this is a definitive source for clinicians, voice teachers, and re-searchers in the field of speech science, vocal arts, and medicine.”

–Nandhu Radhakrishnan, PhD, Kansas State University, in the Journal of Singing (May/June 2022)

“When I was asked to review this book, I was really looking forward to receiving it…Needless to say, it did not disappoint. The author, Peak Woo, is well known in laryngology circles and this is the second edition of this very informative book. This 437-page book is organized into two roughly equal parts. The first part consists of 12 chapters and is a detailed account of basic sciences, anatomy, mechanics and introduction to stroboscopy. The latter part is specifically on laryngeal disorders. There are associated web pages that house the 4k videos accompanying the text – these really help to add context.
This book will appeal to ENT surgeons with an interest in laryngology, as well as speech and language therapists. It has incredibly clear descriptors and possibly the best explanation of stroboscopy that I have ever read. It even goes so far as giving a historical narrative to stroboscopy from its 19th century evolution, from slits in wheels and laryngeal mirrors to modern-day high-quality digital image capture.
The anatomy and physiology within the first part is detailed enough for the majority of ENT surgeons and those in training for their final exam. The images and diagrams are of very high quality and will further aid one’s understanding. I particularly enjoyed the chapter on videokymography, mainly because it is something new and not used in my everyday practice; although after reading this chapter, I wish it was. Part one concludes with some good practical information on how to set up stroboscopy, as well as interpreting the images.
Part two is more focused on laryngeal disorders and, whilst this text is not an atlas of laryngology, there are some very high-quality images. It focuses on more common laryngeal pathology that anyone with an interest in laryngology will encounter on a frequemt basis. There are lots of high-quality montages explaining the effect of this pathology on the cords. Where surgery is the management of choice for these conditions, there is a small operative note explaining the steps involved.
The section on vocal fold paralysis paresis is particularly useful and often debated at meetings; here, it is summed up in a few pages.
Overall, it is clear why Peak Woo is regarded as an expert laryngologist, and this book highlights Peaks’ passion to pass on the information for one generation to the next. I would give this book 5/5/ and would encourage anybody undertaking and laryngeal work/voice clinic to read it just to further aid their own understanding.”

–Omar Mulla, ENT Consultant, Doncaster Royal infirmary, UK in ENT & Audiology News (September/October 2022)

Foreword by Thomas Murry, PhD



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 


Peak Woo

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.

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Purchase of Stroboscopy and High Speed Imaging of the Vocal Function, Second Edition comes with access to supplementary materials on a PluralPlus companion website.

To access the materials, you must register the access code printed on the inside front cover of your book on the companion website.

*Note: If you have purchased this book used or have rented it, your access code will not work if it was already redeemed by the original buyer of the book. Plural Publishing does not offer replacement access codes for used or rented books.

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