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Utilization of laryngeal ultrasound and laryngoscopy for the diagnosis and management of bilateral vocal fold paralysis

En

Abstract

Objective

Management of a severely compromised airway because of bilateral paralysis of the vocal cords represents a significant challenge. The aim of this study is to establish the validity and accuracy of ultrasonography in the evaluation of CO 2 laser surgery using optical endoscopy as the gold-standard technique.

Participants and methods

A thorough ultrasonographic examination of the vocal cords during different phases of respiration and phonation, both pre-CO 2 and post-CO 2 laser surgery, was performed. Endoscopic partial transverse cordectomy, using a CO 2 laser, was the operation of choice in the management of bilateral vocal cord paralysis. Thirty-six patients were included in this study; a control group of 125 normal volunteers was also included for standardization of the ultrasonographic technique.

Results

Patients with bilateral immobility of the vocal cords (36) in the adduction position were subjected to a CO 2 laser. Endoscopic partial transverse cordectomy was performed. Twenty patients required unilateral laser surgery because the anterior angle was 12° or greater by ultrasound measurement. Postoperative follow-up of the anterior angle increased from 14° to 26°, whereas 16 patients (45%) required bilateral laser surgery as the anterior angle was less than 12° on ultrasound. Postoperatively, the anterior angle increased from 16° to 26°.

Conclusion

Ultrasonography is the modality of choice in the evaluation of patients with bilateral vocal cord paralysis quantitatively and dynamically. These might improve the functional results of one-step CO 2 laser surgery.

Level of evidence

4.

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Correspondence to Mohamed R. Ahmed MD.

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El Henawi, D.M., Ahmed, M.R., Farid, A.M. et al. Utilization of laryngeal ultrasound and laryngoscopy for the diagnosis and management of bilateral vocal fold paralysis. Egypt J Otolaryngol 31, 231–236 (2015). https://doi.org/10.4103/1012-5574.168322

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Keywords

  • larynx
  • paralysis
  • ultrasound vocal fold