Usefulness of laryngeal ultrasonography for screening of postoperative vocal cord paralysis in children

Objective: Laryngeal ultrasonography has gradually been gaining popularity as a screening tool for vocal cord paralysis in children. The aim of this study is to evaluate the diagnostic accuracy of pediatric laryngeal ultrasonography by pediatric intensivists in identifying postoperative vocal cord paralysis in PICU. Methods: Thirty patients who had hoarseness or inspiratory stridor after postoperative tracheal extubation in PICU at Kobe Children ’ s Hospital from October 2017 to July 2019 were enrolled in this retrospective study. They underwent bedside laryngeal ultrasonography by two pediatric intensivists for the assessment of vocal cord movement. Subsequently, flexible nasolaryngoscopy was performed to confirm the ultrasonographic findings. Results: The median age of the study group was 2.5 [interquartile range (IQR) 1-6] months, and the median body weight was 5.1 [IQR 3.4-6.5] kg. Hoarseness was observed in 23 of 30 patients (77%) after postoperative tracheal extubation, and inspiratory stridor in 15 of 30 patients (50%). The median duration between extubation and laryngeal ultrasonography was 2 [IQR 1-3] days, and between extubation and nasolaryngoscopy was 4 [IQR 3-6] days. Vocal cord movement was visualized by ultrasonography in all patients. It revealed vocal cord paralysis in 19 patients and normal vocal cords in 11 patients. In 26 out of 30 patients, the ultrasonographic findings corresponded with the results of flexible nasolaryngoscopy. The sensitivity and specificity of laryngeal ultrasonography was 86% and 89%, respectively. Conclusions: Laryngeal ultrasonography by pediatric intensivists is a reliable method of screening of postoperative vocal cord paralysis in children. It can be used as an initial assessment tool for pediatric vocal cord paralysis in PICU.

[1]  S. Bratton,et al.  Current Epidemiology of Vocal Cord Dysfunction After Congenital Heart Surgery in Young Infants. , 2019, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[2]  Michael P. Anderson,et al.  Neonatal vocal fold motion impairment after complex aortic arch reconstruction: What should parents expect after diagnosis? , 2019, International journal of pediatric otorhinolaryngology.

[3]  S. Anne,et al.  Analysis of Vocal Fold Motion Impairment in Neonates Undergoing Congenital Heart Surgery , 2018, JAMA otolaryngology-- head & neck surgery.

[4]  C. Brizard,et al.  Laryngeal ultrasound detects a high incidence of vocal cord paresis after aortic arch repair in neonates and young children , 2018, The Journal of thoracic and cardiovascular surgery.

[5]  W. DeCampli,et al.  Recurrent Laryngeal Nerve Injury and Swallowing Dysfunction in Neonatal Aortic Arch Repair. , 2017, The Annals of thoracic surgery.

[6]  M. Kabbani,et al.  Bedside Ultrasound in the Diagnosis and Treatment of Children with Respiratory Difficulty Following Cardiac Surgery , 2017, Journal of clinical imaging science.

[7]  J. Ongkasuwan,et al.  Laryngeal ultrasound and vocal fold movement in the pediatric cardiovascular intensive care unit , 2017, The Laryngoscope.

[8]  Monish S Raut,et al.  Vocal Cord Paralysis After Cardiac Surgery and Interventions: A Review of Possible Etiologies. , 2016, Journal of cardiothoracic and vascular anesthesia.

[9]  B. Lang,et al.  Determining the Learning Curve of Transcutaneous Laryngeal Ultrasound in Vocal Cord Assessment by CUSUM Analysis of Eight Surgical Residents: When to Abandon Laryngoscopy , 2016, World Journal of Surgery.

[10]  D. Zurakowski,et al.  Outcomes of recurrent laryngeal nerve injury following congenital heart surgery: A contemporary experience , 2015, Journal of the Saudi Heart Association.

[11]  Y. Kanda,et al.  Investigation of the freely available easy-to-use software ‘EZR' for medical statistics , 2012, Bone Marrow Transplantation.

[12]  P. Manning,et al.  Postoperative assessment of laryngopharyngeal dysfunction in neonates after Norwood operation. , 2012, The Annals of thoracic surgery.

[13]  T. Hsiao,et al.  Transcutaneous ultrasound for evaluation of vocal fold movement in patients with thyroid disease. , 2012, European journal of radiology.

[14]  X. Rong,et al.  Value of ultrasonography in diagnosis of pediatric vocal fold paralysis. , 2011, International journal of pediatric otorhinolaryngology.

[15]  G. Wiet,et al.  Correlation of Glottal Closure Using Concurrent Ultrasonography and Nasolaryngoscopy in Children: A Novel Approach to Evaluate Glottal Status , 2006, Dysphagia.

[16]  C. Garel,et al.  Laryngeal ultrasonography in infants and children: a new way of investigating. Normal and pathological findings. , 1992, International journal of pediatric otorhinolaryngology.