Feasibility and accuracy of laryngeal ultrasound for the assessment of vocal cord mobility in children

Tzyynong L Friesen; Gabrielle L Cahill; Matthew T Brigger; John Naheedy; Xinlian Zhang; Wen Jiang

doi:10.1016/j.ijporl.2022.111193

Feasibility and accuracy of laryngeal ultrasound for the assessment of vocal cord mobility in children

Int J Pediatr Otorhinolaryngol. 2022 Aug:159:111193. doi: 10.1016/j.ijporl.2022.111193. Epub 2022 Jun 2.

Authors

Tzyynong L Friesen¹, Gabrielle L Cahill², Matthew T Brigger³, John Naheedy⁴, Xinlian Zhang⁵, Wen Jiang³

Affiliations

¹ Department of Otolaryngology, University of California San Diego, San Diego, CA, USA; Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, CA, USA. Electronic address: tfriesen@health.ucsd.edu.
² Department of Otolaryngology, University of California San Diego, San Diego, CA, USA.
³ Department of Otolaryngology, University of California San Diego, San Diego, CA, USA; Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, CA, USA.
⁴ Department of Radiology, University of California San Diego, San Diego, CA, USA.
⁵ Division of Biostatistics and Bioinformatics, University of California San Diego, San Diego, CA, USA.

PMID: 35724492
DOI: 10.1016/j.ijporl.2022.111193

Abstract

Objective: Transcutaneous laryngeal ultrasonography has been utilized to document vocal cord mobility in the adult perioperative thyroidectomy setting with variable success. The aims of this study were to assess the feasibility of using transcutaneous ultrasound in vocal cord visualization in children, to determine the accuracy in detecting vocal cord immobility compare to flexible laryngoscopy, and to identify any barriers that may affect its utility.

Methods: This is a prospective blinded-assessor study. Transcutaneous laryngeal ultrasound and flexible laryngoscopy were performed in two pediatric settings: perioperative thyroid surgery and inpatient consultation for airway, voice, or swallowing concerns. The video recordings of ultrasound and laryngoscopy were assessed by two fellowship-trained pediatric otolaryngologists independently.

Results: A total of 83 paired laryngoscopy and ultrasound assessments were performed, 39 for perioperative thyroidectomy and 44 for inpatient consultation. The majority had normal vocal cord mobility (65/83, 78%), while 16 had unilateral cord palsy and 2 had bilateral palsy. The vocal cords were successfully visualized on ultrasound in 82/83 (99%) evaluations. Compared to gold standard laryngoscopy, the sensitivity for diagnosing vocal cord palsy on ultrasound was 53-83%, and the specificity was 97-98%. The sensitivity for detecting asymmetric vocal cord movement was 56-88%, and the specificity was 99%. The agreement between ultrasound and laryngoscopy diagnoses were 87-94% (κ = 0.58-0.83, moderate to near perfect agreement). The intra-rater agreement was 95-100% (κ = 0.64-1.0), and inter-rater agreement was 90% (κ = 0.66). Both subjects with bilateral vocal cord palsy had incorrect ultrasound diagnoses by both observers.

Conclusion: We were able to utilize transcutaneous laryngeal ultrasound to successfully visualize vocal cord mobility in almost all pediatric patients with a high degree of specificity. The modality has limitations in the assessment of bilateral vocal cord palsy, and its sensitivity was observer-dependent.

Keywords: Laryngeal ultrasound; Pediatric otolaryngology; Thyroidectomy; Vocal cord mobility; Vocal cord paralysis.

Published by Elsevier B.V.

MeSH terms

Adult
Child
Feasibility Studies
Humans
Laryngoscopy
Prospective Studies
Thyroidectomy
Ultrasonography
Vocal Cord Paralysis* / diagnostic imaging
Vocal Cords* / diagnostic imaging