Ultrasound of the vocal cords in infants

Abstract

Vocal cord paralysis is a common cause of respiratory and feeding problems in the pediatric population. While the causes of vocal cord paralysis are multiple, iatrogenic injury of the recurrent laryngeal nerve after cardiovascular surgery is the most frequent cause. Vocal cord paralysis increases the risk of swallowing dysfunction, tracheal aspiration and pneumonia. It also increases the need for nasoenteric feeds and gastrostomy tube placement. Flexible nasopharyngolaryngoscopy is considered the gold standard for diagnosing vocal cord paralysis, but it has significant drawbacks: it is uncomfortable, it can trigger a cardiovascular event in children with unstable cardiovascular status, it can be challenging to perform, and it can be difficult to interpret. Laryngeal US has become a popular imaging modality to evaluate the function of the vocal cords. Laryngeal US is well-tolerated, easy to perform, simple to interpret and has a lower physiological impact compared to flexible nasopharyngolaryngoscopy. Laryngeal US is an accurate and low-cost diagnostic test for vocal cord paralysis. In this review, we describe the anatomy of the larynx and recurrent laryngeal nerve; the causes, symptoms and pathophysiology of vocal cord paralysis; laryngeal US technique; diagnostic criteria for vocal cord paralysis; and a reporting system.

Comparison of the diagnostic and prognostic abilities of flexible laryngoscopy and dynamic digital radiography for vocal cord paralysis: A prospective observational study

“…In recent years, several studies have demonstrated the usefulness of ultrasound for evaluating vocal cords of children. 22,23 The ultrasound examination is better tolerated than FL by children, but this is dependent on the skills of the physician performing the examination. Furthermore, bilateral VCP has been reported to be difficult to evaluate by ultrasound examination.…”

“…The advantages of DDR, such as the absence of pain, ease of use by non‐otolaryngologists, and absence of the risk of droplet infection, are expected to increase its use in clinical settings. In recent years, several studies have demonstrated the usefulness of ultrasound for evaluating vocal cords of children 22,23 . The ultrasound examination is better tolerated than FL by children, but this is dependent on the skills of the physician performing the examination.…”