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

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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.

References

  1. Shao J, Stern J, Wang ZM, Hanson D, Jiang J. Clinical evaluation of 70 degrees and 90 degrees laryngeal telescopes. Arch Otolaryngol Head Neck Surg 2002; 128: 941–944.

    Article  Google Scholar 

  2. Remacle M. The contribution of videostroboscopy in daily ENT practice. Acta Otorhinolaryngol Belg 1996; 50: 265–281.

    CAS  PubMed  Google Scholar 

  3. Hartnick CJ, Zeitels SM. Pediatric video laryngo-stroboscopy. Int J Pediatr Otorhinolaryngol 2005; 69: 215–219.

    Article  Google Scholar 

  4. Wolf M, Primov-Fever A, Amir O, Jedwab D. The feasibility of rigid stroboscopy in children. Int J Pediatr Otorhinolaryngol 2005; 69: 1077–1079.

    Article  Google Scholar 

  5. Ossof RH, Sisson GA, Duncavage JA, et al. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis. Laryngoscope 1984; 94: 1293–1297.

    Google Scholar 

  6. Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1989; 98(Pt 1):930–934.

    Article  CAS  Google Scholar 

  7. Kashima HK. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol 1991; 100(Pt 1):717–721.

    Article  CAS  Google Scholar 

  8. Laccourreye O, Escovar M, Gerhardt J, et al. CO2 laser endoscopic posterior partial transverse cordectomy for bilateral paralysis of the vocal fold. Laryngoscope 1999; 109:415–418.

    Article  CAS  Google Scholar 

  9. Arens C, Eistert B, Glanz H, Waas W. Endolaryngeal high-frequency ultrasound. Eur Arch Otorhinolaryngol 1998; 255: 250–255.

    Article  CAS  Google Scholar 

  10. Friedman EM. Role of ultrasound in the assessment of vocal cord function in infants and children. Ann Otol Rhinol Laryngol 1997; 106: 199–209.

    Article  CAS  Google Scholar 

  11. Ooi LL, Chan HS, Soo KC. Color Doppler imaging for vocal cord palsy. Head Neck 1995; 17: 20–23.

    Article  CAS  Google Scholar 

  12. Bisetti MS, Segala F, Zappia F, Albera R, Ottaviani F, Schindler A. Non-invasive assessment of benign vocal folds lesions in children by means of ultrasonography. Int J Pediatr Otorhinolaryngol 2009; 73: 1160–1162.

    Article  Google Scholar 

  13. Huang CC, Sun L, Dailey SH, Wang SH, Shung KK. High frequency ultrasonic characterization of human vocal fold tissue. J Acoust Soc Am 2007; 122: 1827.

    Article  Google Scholar 

  14. Vats A, Worley GA, de Bruyn R, Porter H, Albert DM, Bailey CM. Laryngeal ultrasound to assess vocal fold paralysis in children. J Laryngol Otol 2004; 118: 429–431.

    Article  CAS  Google Scholar 

  15. Sirikci A, Karatas E, Durucu C, Baglam T, Bayazit Y, Ozkur A, et al. Noninvasive assessment of benign lesions of vocal folds by means of ultrasonography. Ann Otol Rhinol Laryngol 2007; 116: 827–831.

    Article  Google Scholar 

  16. Garel C, Legrand I, Elmaleh M, Contencin P, Hassan M. Laryngeal ultrasonography in infants and children: anatomical correlation with fetal preparations. Pediatr Radiol 1990; 20: 241–244.

    Article  CAS  Google Scholar 

  17. Youssefzadeh S, Steiner E, Turetschek K, Gritzmann N, Kürsten R, Franz P. The sonography of laryngeal cysts. Rofo 1993; 159: 38–42.

    Article  CAS  Google Scholar 

  18. Garel C, Elmaleh M, Hassan M, et al. Laryngeal ultrasonography in infants and children, pathological finding. Pediat Radiol 1999; 21: 164–167.

    Article  Google Scholar 

  19. Shugar JM, Som PM, Biller HF. An evaluation of the carbon dioxide laser in the treatment of traumatic laryngeal stenosis. Laryngoscope 1982; 92: 23–26.

    CAS  PubMed  Google Scholar 

  20. Lawson G, Remacle M, Hamoir M, Jamart J. Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: functional results. J Voice 1996; 10: 314–319.

    Article  CAS  Google Scholar 

Download references

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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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