Log in | Register

Assessment of vocal cord movement by ultrasound in the ICU

Zhengshang Ruan| Rongrong Ren| Wenwen Dong| Junjie Ma| Zhenyu Xu| Yanfei Mao| Lai Jiang
Original
Volume 44, Issue 12 / December , 2018

Pages 2145 - 2152

Abstract

Purpose

Ultrasound can be used to non-invasively and rapidly examine airway conditions, but vocal cord visualization with the traditional approaches is poor. Our aim was to compare the accuracies of front-side transverse-axis ultrasound (FTU), lateral-side longitudinal-axis ultrasound (LLU), and the combination of both approaches for vocal cord movement disorder diagnoses (e.g., vocal cord paralysis or arytenoid cartilage dislocation).

Methods

We compared FTU, LLU, and the combination of both methods for patients in the intensive care unit (ICU). We used nasal fiber-optic endoscopy to confirm vocal cord injury.

Results

Among the 120 patients examined, 24 (20%) had vocal cord paralysis. The visualization rate of vocal cords for FTU was 71.7% (assessable, 86; non-assessable, 34), that for LLU was 88.3% (assessable, 106; non-assessable, 14), and that for the combined approach was 96.7% (assessable, 116; non-assessable, 4). The sensitivities and specificities were 58.3% (14/24) and 75% (72/96) for FTU, 91.7% (22/24) and 87.5% (84/96) for LLU, and 100% (24/24) and 95.8% (92/96) for the combined approach. Visualization rates for LLU were significantly higher than for FTU (P = 0.002); FTU + LLU rates were higher than those for FTU (P = 0.001). The difference between LLU and FTU + LLU was not statistically significant (P = 0.025).

Conclusion

LLU can be used to evaluate arytenoid cartilage activity in ICUs, and the results are highly correlated with the diagnosis of nasal fiber-optic endoscopy. The combination of FTU and LLU shows promise as a rapid primary screening method for vocal cord injury.

Keywords

References

  1. Tadié JM, Behm E, Lecuyer L et al (2010) Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study. Intensive Care Med 36:991–998
  2. Taenaka H, Shibata SC, Okitsu K et al (2017) Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery: a retrospective review. Eur J Anaesthesiol 34:425
    • View reference on publisher's website
  3. Kundra P, Kumar V, Srinivasan K et al (2010) Laryngoscopic techniques to assess vocal cord mobility following thyroid surgery. ANZ J Surg 80:817–821
    • View reference on publisher's website
  4. Kristensen MS (2011) Ultrasonography in the management of the airway. Acta Anaesthesiol Scand 55:1155–1173
    • View reference on publisher's website
  5. See KC, Ong V, Wong SH et al (2016) Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists. Intensive Care Med 42:63–71
  6. Shepherd W (2011) Endobronchial ultrasound for airway stent selection. J Bronchol Interv Pulmonol 18:207–208
    • View reference on publisher's website
  7. Grmec S, Hajdinjak E, Zadel S (2012) Continuous capnography and ultrasound-based airway management. Resuscitation 83:e15
    • View reference on publisher's website
  8. Oulego-Erroz I, González-Cortes R, García-Soler P et al (2018) Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children. Intensive Care Med 44:61–72
  9. Gupta D, Srirajakalidindi A, Habli N et al (2011) Ultrasound confirmation of laryngeal mask airway placement correlates with fiberoptic laryngoscope findings. Middle East J Anesthesiol 21:283–287
  10. Kandil E, Deniwar A, Noureldine SI et al (2016) Assessment of vocal fold function using transcutaneous laryngeal ultrasonography and flexible laryngoscopy. JAMA Otolaryngol Head Neck Surg 142:74–78
    • View reference on publisher's website
  11. Syamal MN, Benninger MS (2016) Vocal fold paresis: a review of clinical presentation, differential diagnosis, and prognostic indicators. Curr Opin Otolaryngol Head Neck Surg 24:197–202
    • View reference on publisher's website
  12. Holley HS, Gildea JE (1971) Vocal cord paralysis after tracheal intubation. JAMA 215:281–284
    • View reference on publisher's website
  13. Hayes JT, Houston R (1999) Flexible nasolaryngoscopy: a low-risk, high-yield procedure. Postgrad Med 106:107–120
    • View reference on publisher's website
  14. Wong KP, Lang BHH, Ng SH et al (2013) A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery 154:1158–1165
    • View reference on publisher's website
  15. Cheng SP, Lee JJ, Liu TP et al (2012) Preoperative ultrasonography assessment of vocal cord movement during thyroid and parathyroid surgery. World J Surg 36:2509–2515
    • View reference on publisher's website
  16. Wang CP, Chen TC, Yang TL et al (2012) Transcutaneous ultrasound for evaluation of vocal fold movement in patients with thyroid disease. Eur J Radiol 81:e288–e291
    • View reference on publisher's website
  17. Wong KP, Lang BHH, Ng SH et al (2014) Is vocal cord asymmetry seen on transcutaneous laryngeal ultrasonography a significant predictor of voice quality changes after thyroidectomy? World J Surg 38:607–613
    • View reference on publisher's website
  18. Yamamoto N, Yamaguchi Y, Nomura T et al (2017) Successful assessment of vocal cord palsy before tracheal extubation by laryngeal ultrasonography in a patient after esophageal surgery: a case report. A A Case Rep 9:308–310
    • View reference on publisher's website
  19. Wong KP, Lang BHH, Chang YK et al (2015) Assessing the validity of transcutaneous laryngeal ultrasonography (TLUSG) after thyroidectomy: what factors matter? Ann Surg Oncol 22:1774–1780
    • View reference on publisher's website
  20. Schneider R, Sekulla C, Machens A et al (2015) Postoperative vocal fold palsy in patients undergoing thyroid surgery with continuous or intermittent nerve monitoring. Br J Surg 102:1380–1387
    • View reference on publisher's website
  21. Lodewyks CL, White CW, Bay G et al (2015) Vocal cord paralysis after thoracic aortic surgery: incidence and impact on clinical outcomes. Ann Thor Surg 100:54–58
    • View reference on publisher's website
  22. Calo PG, Medas F, Erdas E et al (2014) Role of intraoperative neuromonitoring of recurrent laryngeal nerves in the outcomes of surgery for thyroid cancer. Int J Surg 12:S213–S217
    • View reference on publisher's website
  23. Booka E, Takeuchi H, Nishi T et al (2015) The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine 94:e1369
    • View reference on publisher's website
  24. Sato Y, Kosugi S, Aizawa N et al (2016) Risk factors and clinical outcomes of recurrent laryngeal nerve paralysis after esophagectomy for thoracic esophageal carcinoma. World J Surg 40:129–136
    • View reference on publisher's website
  25. Chen HC, Jen YM, Wang CH et al (2007) Etiology of vocal cord paralysis. ORL 69:167–171
    • View reference on publisher's website
  26. Kurihara N, Imai K, Minamiya Y et al (2014) Hoarseness caused by arytenoid dislocation after surgery for lung cancer. Gen Thorac Cardiovasc Surg 62:730–733
    • View reference on publisher's website
  27. De Jong A, Molinari N, Conseil M et al (2014) Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med 40:629–639
  28. Ellis PDM, Pallister WK (1975) Recurrent laryngeal nerve palsy and endotracheal intubation. J Laryngol Otol 89:823–826
    • View reference on publisher's website
  29. Cavo JW Jr (1985) True vocal cord paralysis following intubation. Laryngoscope 95:1352–1359
    • View reference on publisher's website
  30. Santos PM, Afrassiabi A, Weymuller EA Jr (1994) Risk factors associated with prolonged intubation and laryngeal injury. Otolaryngol Head Neck Surg 111:453–459
    • View reference on publisher's website
  31. Brandwein M, Abramson AL, Shikowitz MJ (1986) Bilateral vocal cord paralysis following endotracheal intubation. Arch Otolaryngol Head Neck Surg 112:877–882
    • View reference on publisher's website
  32. Ahmad S, Muzamil A, Lateef M (2002) A study of incidence and etiopathology of vocal cord paralysis. Indian J Otolaryngol Head Neck Surg 54:294–296

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement