ORIGINAL RESEARCH • Point of Care, Clinician-Performed Laryngeal Ultrasound and Pediatric Vocal Fold Movement Impairment
Cervical and thoracic surgeries may lead to vocal fold movement impairment (VFMI). Unilateral VFMI can result in dysphagia and/or a weak and breathy voice, and stridor in some infants. In pediatric cardiac surgery, the incidence of VFMI following these surgeries varies from 1.1% to 67%.
The standard for diagnosis of VFMI is ﬂexible nasolaryngoscopy (FNL). However, FNL can be challenging and inaccurate in children due to poor cooperation, secretions, and obstructing supraglottic structures. In addition, it can cause signiﬁcant physiologic changes in blood pressure, heart rate and oxygen saturation, which can be a particular concern in vulnerable groups such as congenital heart disease and pulmonary hypertension.
An alternate way of assessing vocal fold mobility can be achieved with transcervical laryngeal ultrasound (LUS), which causes fewer changes in physiologic parameters. The goal in this study was to evaluate the use of LUS as a point of care, otolaryngologist-performed assessment of vocal fold movement in the pediatric population.
MATERIAL AND METHODS
LUS and FNL were performed and recorded on 30 consecutive patients (11 with a clinical diagnosis of VFMI and 19 with clinically normal mobility at the time of FNL and LUS) in a pediatric voice clinic. All LUS was performed by a single clinician on the same day as the FNL with a 12 MHZ linear probe. Ultrasound was performed with probe placed over the cricothyroid membrane angled slightly superiorly. The probe was orientated such that the right vocal fold was on the left side of the screen.
Patients’ ages ranged from 3 months to 17 years with a median age of 4 years and 6 months and thirteen of the patients were female. Interrater agreement regarding interpretation of LUS was κ = 0.7 and for interpretation of FNL was κ = 0.7802. Each reviewer had near perfect to substantial agreement between their own interpretation of the LUS and FNL.
The authors concluded that despite being a small study, LUS is well tolerated by patients and provides additional information that may aid in diagnosis of VFMI in patients who cannot undergo FNL.