Anatomic factors affecting the use of ultrasound to predict vocal fold motion: A pilot study

Παπαθανάκος

Innovative Surgical Sciences

et al. 2022

In December 2019, the new coronavirus infection (COVID-19) was declared a pandemic by the World Health Organization after rapidly spreading over the world in just a few months. All elective operations and nonemergency treatments have been postponed worldwide. However, some patients require surgical therapy as well, and the time spent waiting should not have a negative impact on the surgical outcome or disease course. Following the initial onset of the COVID-19 epidemic, instructions for proper and safe surgery for healthcare staff and patients should develop. Thyroid surgeries have decreased during the COVID-19 pandemic. Most of them can be postponed for a long time. Assessment of thyroid nodules recommends clinical examination, imaging studies, fine needle aspiration (FNA) and vocal cord examination. All these procedures are necessary, and sometimes they cannot be postponed. To determine the best timing, a thorough preoperative assessment should be undertaken, taking into account both oncological and anatomical features. Furthermore, COVID-19 status must be negative prior to any intervention, and hospital infrastructure must be ready to deal with the demanding situation.

Section: How To Improve?mentioning

confidence: 79%

Thyroid surgery during the COVID-19 pandemic: difficulties – how to improve

Παπαθανάκος

Innovative Surgical Sciences

et al. 2022

J of Ultrasound Medicine

“…The majority of studies defined partial movement of the vocal cords as evidence of hypomobility, six studies graded degrees of hypomobility, 6,9,10,22,26,34 and classification of reduced movement was not expressly defined in six 20,[27][28][29]31,32 (Table 2). US was performed by anesthesiologists, intensivists, and surgeons in 21 studies.…”

Section: Resultsmentioning

confidence: 99%

“…Studies reported between 0 and 29.63% of patients could not be visualized, with the median being 4.67% (interquartile range 0–12.73%) and these cases were frequently attributed to calcification of the thyroid cartilage predominantly in men. The majority of studies defined partial movement of the vocal cords as evidence of hypomobility, six studies graded degrees of hypomobility, 6,9,10,22,26,34 and classification of reduced movement was not expressly defined in six 20,27–29,31,32 (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Laryngeal Ultrasound Detects Vocal Fold Immobility in Adults

Hamilton

Tawfik

et al. 2021

Laryngeal ultrasound (US) is becoming widely accepted for assessing true vocal fold immobility (TVFI), a potential complication of laryngeal and thyroid surgery. The objective of this project is to perform a systematic review and meta‐analysis of pooled evidence surrounding laryngeal US as a modality for diagnosing TVFI in adults at risk for the condition in comparison to laryngoscopy as a gold standard. Medical subject heading terms were used to search MEDLINE, Embase, Google Scholar, Web of Science, and the Cochrane Library for relevant citations from January 1, 2000, to June 30, 2020. Studies were included if they involved patients 16 years and older, where laryngeal US was compared to laryngoscopy for TVFI. Studies were excluded if there were insufficient data to compute a sensitivity/specificity table after attempting to contact the authors. Case reports, and case series were also excluded. The initial search returned 1357 citations. Of these, 109 were selected for review utilizing the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Thirty citations describing 6033 patients were included in the final meta‐analysis. A bivariate random effects meta‐analysis was performed, revealing a pooled sensitivity for laryngeal US of 0.95 (95% confidence interval [CI] 0.88–0.98), a specificity of 0.99 (95% CI 0.97–0.99), and a diagnostic odds ratio of 1328.2 (95% CI 294.0–5996.5). The area under the curve of the hierarchical summary receiver operating characteristic curve was 0.99 (95% CI 0.98–1.00). Laryngeal US demonstrates high sensitivity and specificity for detecting VFI in the hands of clinicians directly providing care to patients.

“…Identification of VF motion coincided with the anterior thyroid angle, which is more obtuse in females. The study demonstrated that the accuracy and resolution of the image may be distorted by the patient’s anatomy [ 24 ].…”

Section: Review Of the Literaturementioning

confidence: 99%

Transcutaneous laryngeal ultrasonography in vocal fold assessment before and after thyroid surgery in light of recent studies

Galazka¹,

Wolff²,

Dedecjus³

2022

Pol J Radiol

Transcutaneous laryngeal ultrasonography (TLUS) has become a cheap, convenient, and novel method in vocal fold (VF) assessment. The gold standard method of VF examination is laryngoscopy. It requires ear, nose, and throat specialist consultation and additional equipment. Moreover, laryngoscopy causes distress to patients, and during the COVID-19 pandemic it is a high-risk, aerosol-producing procedure. The aim of the paper was to review publications on the role of TLUS in VF evaluation. Considered aspects included VF visibility, factors affecting them, and different variables measured during TLUS examination. The visibility of VFs in TLUS ranged from 72.8 to 100%. Among men it was significantly lower (17-100%) in comparison to women (83-100%). All but 2 authors concluded that TLUS is a viable tool that can be an alternative to laryngoscopy in diagnosing VFs. Obesity, age, male gender, height, calcified thyroid, and incision close to the thyroid cartilage were independent factors for inaccessible vocal folds. VF displacement velocity (VFDV) is the most objective parameter measured by Doppler, and it is proportional to the velocity of the wave causing the vibrations of the VFs. After VF paralysis, this parameter is reduced. Valsalva manoeuvre, low-frequency transducer, and different transducer positions can improve images obtained on USG. TLUS in a majority of cases can adequately assess whether the function of the VFs is intact or paresis/paralysis has occurred. It is noninvasive and rapid, it adds no extra cost, and it can be a part of the preoperative examination of the thyroid gland. TLUS can usually be a convenient alternative to laryngoscopy.