Role of Ultrasound in the Assessment of Vocal Cord Function in Infants and Children

The determination of the cause of stridor in the infant and child is an important directive for the otolaryngologist. The limitations of current clinical diagnostic techniques have provided the impetus for pursuing newer, more practical techniques to diagnose vocal cord paralysis in children. The purpose of this paper is to describe a new technique to image the larynx and determine its role in discerning vocal cord paralysis in children. This study began with an animal study (lamb model) demonstrating that computerized ultrasound can accurately delineate laryngeal anatomy and function. The human protocol included 27 patients (age 1 day to 14 years): 15 with normal larynges and 12 with vocal cord paralysis. Recorded ultrasound studies of these subjects were compiled in a randomly ordered videotape and presented twice and viewed in a blinded manner by four expert raters. Statistical analysis of their readings revealed that ultrasound is a highly accurate technique to document vocal cord paralysis, with a high degree of interrater and intrarater reliability. Beyond the accuracy and consistency of computerized ultrasound, there are many other aspects of this technique that make it clinically attractive. Laryngeal ultrasound is noninvasive, painless, and widely accepted. It is relatively safe, with no radiation exposure and no need for sedation or anesthesia. It is well tolerated by patients and their families. The results are easily displayed and recorded and available for hard copy storage. This investigation should not be interpreted as an endorsement for laryngeal ultrasound as a replacement for endoscopy in children. This work does indicate, however, that ultrasound is a technique that can accurately address the special issue of vocal cord mobility in infants and children. At present, this is the primary use for laryngeal ultrasound, although with additional investigation and sophistication it is likely that ultrasound of the larynx may become useful for other purposes.

[1]  K. Grundfast,et al.  Vocal cord paralysis. , 1989, Otolaryngologic clinics of North America.

[2]  Thumfart Wf.  Electrodiagnosis of laryngeal nerve disorders. , 1988 .

[3]  W. Thumfart.  From larynx to vocal ability. New electro-physiological data. , 1988, Acta oto-laryngologica.

[4]  M. Hirano,et al.  Acoustic analysis of pathological voice. Some results of clinical application. , 1988, Acta oto-laryngologica.

[5]  B. Gerratt,et al.  Glottographic measures of vocal fold vibration: An examination of laryngeal paralysis , 1988, The Laryngoscope.

[6]  K. Grundfast,et al.  Vocal cord paralysis in children studied by monopolar electromyography. , 1987, Pediatric neurology.

[7]  G. Berke,et al.  Videostroboscopy of the canine larynx: The effects of asymmetric laryngeal tension , 1987, The Laryngoscope.

[8]  D. Reede,et al.  Sonographic anatomy of the larynx, with particular reference to the vocal cords. , 1987, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[9]  E. Franken,et al.  Chronic airway obstruction in children: evaluation with cine-CT. , 1987, AJR. American journal of roentgenology.

[10]  D. B. Hawkins,et al.  Flexible Laryngoscopy in Neonates, Infants, and Young Children , 1987, The Annals of otology, rhinology, and laryngology.

[11]  G. Woodson,et al.  Vocal Cord Paralysis in Children 1 Year of Age and Younger , 1986, The Annals of otology, rhinology, and laryngology.

[12]  H. Schoening.  Muscles Alive—Their function revealed by electromyography (5th edition): by John V. Basmajian and Carlo J. Deluca. Hardcover. Price $45.00. 561 pages. Williams and Wilkins, PO Box 969, Waverly Press Lane, Easton, MD 21601 , 1986 .

[13]  P Kitzing,et al.  Glottography, the electrophysiological investigation of phonatory biomechanics. , 1986, Acta oto-rhino-laryngologica Belgica.

[14]  S. Satya‐Murti,et al.  Predictive value of laryngeal electromyography in patients with vocal cord paralysis of neurogenic origin , 1985, The Laryngoscope.

[15]  Fourier analysis of infantile stridor: preliminary data. , 1985, International journal of pediatric otorhinolaryngology.

[16]  M. Richardson,et al.  Anatomic abnormalities of the pediatric airway. , 1984, Pediatric clinics of North America.

[17]  D. Rosenfield,et al.  The Role of Electromyography in Clinical Laryngology , 1984, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[18]  T. Mcgill.  Congenital diseases of the larynx. , 1984, Otolaryngologic clinics of North America.

[19]  Donald R. Kirks,et al.  Practical pediatric imaging: Diagnostic radiology of infants and children , 1984 .

[20]  F. Agha.  Recurrent laryngeal nerve paralysis: a laryngographic and computed tomographic study. , 1983, Radiology.

[21]  T. Inouye.  Examination of child larynx by flexible fiberoptic laryngoscope. , 1983, International journal of pediatric otorhinolaryngology.

[22]  W. Grove.  Statistical Methods for Rates and Proportions, 2nd ed , 1981 .

[23]  T. Calcaterra,et al.  Computed tomography of the larynx. , 1978, Radiologic clinics of North America.

[24]  H. Berry,et al.  Laryngeal electromyography: techniques and application. , 1978, Otolaryngologic clinics of North America.

[25]  J. Williams,et al.  Vocal cord paralysis: radiologic observations in 21 infants and young children. , 1977, AJR. American journal of roentgenology.

[26]  I. Farquharson,et al.  Fibreoptic laryngoscopy in the asessment of laryngeal disorders , 1975, The Journal of Laryngology & Otology.

[27]  I. Farquharson,et al.  Fibreoptic laryngoscopy in the assessment of laryngeal disorders. , 1975, The Journal of laryngology and otology.

[28]  M. Hirano,et al.  An Apparatus for Ultra-High-Speed Cinematography of the Vocal Cords , 1974, The Annals of otology, rhinology, and laryngology.

[29]  J. Fleiss,et al.  Statistical methods for rates and proportions , 1973 .

[30]  N. Holmer,et al.  Echo glottography. Ultrasonic recording of vocal fold vibrations in preparations of human larynges. , 1973, Acta oto-laryngologica.

[31]  H. Ma.  The radiologic signs of recurrent laryngeal nerve paralysis. , 1972, Journal of the Canadian Association of Radiologists.

[32]  J M Reid,et al.  Transmission of ultrasound through the larynx as a means of determining vocal-fold activity. , 1972, IEEE transactions on bio-medical engineering.

[33]  R. Light.  Measures of response agreement for qualitative data: Some generalizations and alternatives. , 1971 .

[34]  C. H. Hertz,et al.  Ultrasonic recording of the vibrating vocal folds. A preliminary report. , 1970, Acta oto-laryngologica.

[35]  Jacob Cohen,et al.  Weighted kappa: Nominal scale agreement provision for scaled disagreement or partial credit. , 1968 .

[36]  P. Holinger,et al.  LVI Congenital Webs, Cysts, Laryngoceles and other Anomalies of the Larynx , 1967, The Annals of otology, rhinology, and laryngology.

[37]  D. Brewer.  Perceptual errors in indirect laryngoscopy , 1966, The Laryngoscope.

[38]  W. Saunders.  THE LARYNX. , 1964, Clinical symposia.

[39]  G. Weddell,et al.  THE ELECTRICAL ACTIVITY OF VOLUNTARY MUSCLE IN MAN UNDER NORMAL AND PATHOLOGICAL CONDITIONS , 1944 .