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

Abstract

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.