Transcutaneous laryngeal ultrasonography: a reliable, non-invasive and inexpensive preoperative method in the evaluation of vocal cords motility—a prospective multicentric analysis on a large series and a literature review

Background: Ultrasound (US) is not widely used as part of the speech and language therapy (SLT) clinical toolkit. The COVID-19 pandemic has intensified interest in US as an alternative to SLT instrumental tools such as the videofluoroscopic swallowing study (VFSS), fibreoptic endoscopic evaluation of swallowing (FEES) and endoscopic evaluation of the larynx (EEL) as a non-invasive, non-aerosol-generating procedure that can be delivered at the bedside to assess swallowing and/or laryngeal function. To establish the appropriacy of routine US use, and in response to a national professional body request for a position statement, a group of expert SLTs conducted a rapid review of the literature. Aim: To explore critically the clinical utility of US as an assessment tool for swallowing and laryngeal function in adults. Methods & Procedures: A rapid review of four databases was completed to identify articles using US to assess swallowing and/or laryngeal function in adults compared with reference tests (VFSS/FEES/EEL/validated outcome measure). Screening was completed according to predefined inclusion/exclusion criteria and 10% of abstracts were rescreened to assess reliability. Data were extracted from full texts using a predeveloped form. The QUADAS-2 tool was used for quality ratings. Information from included studies was summarized using narrative synthesis and visual illustration. Outcomes & Results: Ten papers used US to assess swallowing, and 13 to assess laryngeal function. All were peerreviewed primary studies across a range of clinical populations and with a wide geographical spread. Four papers had an overall low risk of bias, but the remaining 19 had at least one domain where risk of bias was judged as high or unclear. Applicability concerns were identified in all papers. The papers that used US to assess swallowing varied widely in terms of the anatomical structures assessed and methodology employed. The papers assessing laryngeal function were more homogenous in their methodology. Sensitivity and specificity data were provided for 12 of the laryngeal function papers with ranges of 64.3-100% and 48.5-100%, respectively. Conclusions & Implications: There is burgeoning evidence to support the use of US as an adjunct to SLT clinical assessment of swallowing and laryngeal function. However, the current literature does not support its use as a

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“…2019, Gambardella et al . 2020), while PPV was higher than NPV in one study (de Miguel et al . 2017).…”

Section: Resultsmentioning

confidence: 90%

“…2016, Gambardella et al . 2020, Wong et al . 2014), thyroid surgery plus other endocrine‐related neck procedures ( n = 1) (Wong et al .…”

Section: Resultsmentioning

confidence: 99%

Utility of ultrasound in the assessment of swallowing and laryngeal function: A rapid review and critical appraisal of the literature

Allen

Clunie

Slinger

et al. 2020

Intl J Lang & Comm Disor

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“…Transcutaneous Laryngeal Ultrasonography has been described extensively in the literature, as a non-invasive and painless indirect examination of vocal cords function [ 5 ]. It permits a good analysis of the dynamic aspect of the larynx while being inexpensive, rapid, repeatable and well tolerated by the patient.…”

Section: Discussionmentioning

confidence: 99%

“…If the patient is asked to temporarily stop breathing, the operator can appreciate the adduction of the vocal folds on the midline. Vocal fold mobility can be also evaluated during phonation: the diagnostic criterion for a vocal fold paralysis is the asymmetric abduction and adduction movements of the vocal folds [ 5 ]. If the vocal folds are not visible from a midline approach due to acute shape or calcification of the thyroid cartilage, each vocal fold can be assessed laterally to the cartilage [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Transcutaneous laryngeal ultrasonography: A promising tool for otolaryngologists during COVID-19

Sciancalepore

Anzivino²,

Petrone³

et al. 2021

American Journal of Otolaryngology

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Purpose With the current COVID-19 outbreak, otolaryngologists are most exposed to the risk of infection due to the nature of the specialty.This is why they are required to find safer diagnostic alternatives minimizing aerosol-generating procedures. The aim of this study is to explore the accuracy of transcutaneous laryngeal ultrasonography (TLUSG) in order to assess vocal fold movement. Materials and methods We performed blindly both TLUSG and flexible fiberoptic laryngoscopy(FFL) on 38 patients, from March to June 2020. Patients were divided into two groups:the former with normally mobile vocal folds and the latter with unilateral vocal fold paralysis. Results On FFL findings, 10/38 patients (26,31%) had unilateral vocal fold paralysis; on TLUSG results, 9/38 patients (23.68%) presented impaired vocal fold motion. In comparison to laryngoscopy, the sensitivity, specificity, positive predictive value and negative predictive value of TLUSG for assessment of vocal fold mobility was 80%, 96.42%, 88.88%, 93.10% respectively. A significant association between the two techniques was found on the Chi-square test: X 2 = 19.7722 ( p value <0.00001). Cohen's K value showed a substantial agreement: K = 0,79. Conclusion Although TLUSG could undoubtedly not replace laringoscopy, it represents a noninvasive and useful diagnostic tool for otolaryngologists especially during covid-19 pandemic.Data collected about its high sensitivity and specificity suggest that TLUSG could be a reliable method to screen vocal fold paralysis without performing aerosol-generating procedures, thus providing clear visualization of laryngeal real-time movements, even in non-compliant or high-risk infection patients. Our results allow us to consider TLUSG as part of the preoperative assessment of vocal folds in patients undergoing thyroidectomy.

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Transcutaneous ultrasound: An adjunct way to evaluate the intra–false vocal cord pathology—learning from a case of laryngeal Rosai‐Dorfman disease

Wang

Chen

2021

Clinical Case Reports

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Transcutaneous laryngeal ultrasonography: a reliable, non-invasive and inexpensive preoperative method in the evaluation of vocal cords motility—a prospective multicentric analysis on a large series and a literature review

Cited by 52 publications

References 22 publications

Utility of ultrasound in the assessment of swallowing and laryngeal function: A rapid review and critical appraisal of the literature

Utility of ultrasound in the assessment of swallowing and laryngeal function: A rapid review and critical appraisal of the literature

Transcutaneous laryngeal ultrasonography: A promising tool for otolaryngologists during COVID-19

Transcutaneous ultrasound: An adjunct way to evaluate the intra–false vocal cord pathology—learning from a case of laryngeal Rosai‐Dorfman disease

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