Horizontal vocal cords
When viewing the larynx with a rigid endoscope, my tendency has always been to place the camera on the endoscope such that the vocal cords are viewed in a vertical position. However, what matters for resolution is the number of pixels that the pathology fills up on the camera. Since voice disorders are always related to the vibrating edge of the vocal cords, the high definition format, 1080i uses up 1920 x 1080 pixels and placing the edge of the vocal cords along the axis of the 1080 pixels wastes much of the viewing frame. While this is perhaps a pretty picture and while it is easy to run the camera - since moving the endoscope left also moves the image left; advancing the endoscope into the mouth or tilting the endoscope upward shows more of the posterior larynx - most of the lateral pixels in the image offer nothing more than cosmesis. Recently, I have been placing the camera onto the rigid endoscope at a 90° angle. This places the vocal cords horizontally on the monitor. This makes moving the camera a bit less intuitive, but learnable. I have zoomed the lens in such that the vibrating margin of the vocal cords tends to almost fill the 1920 horizontal pixels on the high definition screen. There is a bit less light available at the higher zoom, but it seems adequate for the exposure of the white vocal cords. These photos were taken during stroboscopy with the KayPentax 9400 laryngeal strobe which uses a xenon light. The example photos are from 3 different patients.