Office-based narrow band imaging-guided flexible laryngoscopy tissue sampling: A cost-effectiveness analysis evaluating its impact on Taiwanese health insurance program

Narrow band imaging (NBI)-guided flexible laryngoscopy tissue sampling for laryngopharyngeal lesions is a novel technique. Patients underwent the procedure in an office-based setting without being sedated, which is different from the conventional technique performed using direct laryngoscopy. Although the feasibility and effects of this procedure were established, its financial impact on the institution and Taiwanese National Health Insurance program was not determined. Methods: This is a retrospective case–control study. From May 2010 to April 2011, 20 consecutive patients who underwent NBI flexible laryngoscopy tissue sampling were recruited. During the same period, another 20 age-, sex-, and lesion-matched cases were enrolled in the control group. The courses for procedures and financial status were analyzed and compared between groups. Results: Office-based NBI flexible laryngoscopy tissue sampling procedure took 27 minutes to be completed, while 191 minutes were required for the conventional technique. Average reimbursement for each case was New Taiwan Dollar (NT$)1264 for patients undergoing office-based NBI flexible laryngoscopy tissue sampling, while NT$10,913 for those undergoing conventional direct laryngoscopy in the operation room (p < 0.001). The institution suffered a loss of at least NT$690 when performing NBI flexible laryngoscopy tissue sampling. Conclusion: Office-based NBI flexible laryngoscopy tissue sampling is a cost-saving procedure for patients and the Taiwanese National Health Insurance program. It also saves the procedure time. However, the net financial loss for the institution and physician would limit its popularization unless reimbursement patterns are changed

Cricothyroid Dysfunction in Unilateral Vocal Fold Paralysis Females Impairs Lexical Tone Production

In this cross-sectional study, we compared voice tone and activities relating to the laryngeal muscle between unilateral vocal fold paralysis (UVFP) patients with and without cricothyroid (CT) muscle dysfunction to define how CT dysfunction affects language tone. Eighty-eight female surgery-related UVFP patients were recruited and received acoustic voice analysis and laryngeal electromyography (LEMG) when the patient was producing the four Mandarin tones. The statistical analysis was compared between UVFP patients with (CT+ group, 17 patients) and without CT muscle (CT− group, 71 patients) involvement. When producing Mandarin Tone 2, the voice tone in the CT+ group had smaller rise range (p = 0.007), lower rise rate (p = 0.002), and lower fundamental frequency (F0) at the offset point of the voice (p = 0.023). When producing Mandarin Tone 4, the voice tone in the CT+ group had smaller drop range (p = 0.019), lower drop rate (p = 0.005), and lower F0 at voice onset (p = 0.025). The CT+ group had significantly lower CT muscle activity when producing the four Mandarin tones. In conclusion, CT dysfunction causes a limitation of high-rising tone in Tone 2 and high-falling tone in Tone 4, a property that dramatically limits the tonal characteristics in Mandarin, a tonal language. This limitation could further impair the patient’s communication ability