Aetna considers videostroboscopy medically necessary as a diagnostic procedure for detection of vocal cord pathology (e.g., polyps, invasive carcinoma, and vocal cord paralysis) in members who have received both a mirror-image and an endoscopic examination, and in whom no abnormal function or clinical pathology has been found with these tests, despite persistent symptoms.

Aetna considers videostroboscopy experimental and investigational for all other indications because its effectiveness for indications other than the one listed above has not been established.

The cover and body of the vocal cord have different densities and therefore different mechanical properties.  The stiff underlying body is comprised of the vocalis muscle of the vocal cord and the deep lamina propria, and is responsible for the transverse movement of the cord.  The loose cover consists of the overlying mucosa and the superficial lamina propria, and vibrates primarily in the vertical direction and forms the traveling mucosal wave.  Ordinarily, the vibrating movements of the vocal cords are too rapid to be seen by the unaided eye.  One method of getting a clear view is by means of videostroboscopy.

Evaluation of the larynx by videostroboscopy is usually performed using a stroboscopic unit coupled with a Wolf rigid laryngoscope and a video recorder.  If patients exhibit extreme gagging, the transoral approach is replaced by the transnasal approach using a flexible fiberoptic laryngoscope.  For the latter procedure, local anesthesia is topically applied to the nasal, pharyngeal, and laryngeal mucosa of the patient before the fiberscope is inserted transnasally into the larynx.  The procedure requires the patient to cause the vocal cords to vibrate by speaking or singing during the evaluation: therefore, the procedure can not be performed on aphonic patients, patients who are unable to hold steady phonation for at least 2 to 3 seconds, and persons with a high degree of breathy voice and incomplete glottic closure.

Videostroboscopy provides detection of vibratory asymmetries, structural abnormalities, small masses, submucosal scars and other conditions that might not be visible under continuous light.  It produces not only valuable information concerning the motion of the normal vocal cord movements.  In contrast, stroboscopic examination revealed that half of the same patients had reduced mobility.  Studies have suggested that stroboscopic examinations might be the most useful technique in the early detection of invasive cancers of the vocal cords.  A careful videostroboscopic examination can differentiate, to a certain extent, epithelial hyperplasia and dysplasia from invasive carcinoma of the vocal cords.  Videostroboscopy is also useful for evaluating patients with vocal cord paralysis.