Intensive Care Medicine

, Volume 44, Issue 12, pp 2145–2152 | Cite as

Assessment of vocal cord movement by ultrasound in the ICU

  • Zhengshang Ruan
  • Rongrong Ren
  • Wenwen Dong
  • Junjie Ma
  • Zhenyu Xu
  • Yanfei MaoEmail author
  • Lai JiangEmail author



Ultrasound can be used to non-invasively and rapidly examine airway conditions, but vocal cord visualization with the traditional approaches is poor. Our aim was to compare the accuracies of front-side transverse-axis ultrasound (FTU), lateral-side longitudinal-axis ultrasound (LLU), and the combination of both approaches for vocal cord movement disorder diagnoses (e.g., vocal cord paralysis or arytenoid cartilage dislocation).


We compared FTU, LLU, and the combination of both methods for patients in the intensive care unit (ICU). We used nasal fiber-optic endoscopy to confirm vocal cord injury.


Among the 120 patients examined, 24 (20%) had vocal cord paralysis. The visualization rate of vocal cords for FTU was 71.7% (assessable, 86; non-assessable, 34), that for LLU was 88.3% (assessable, 106; non-assessable, 14), and that for the combined approach was 96.7% (assessable, 116; non-assessable, 4). The sensitivities and specificities were 58.3% (14/24) and 75% (72/96) for FTU, 91.7% (22/24) and 87.5% (84/96) for LLU, and 100% (24/24) and 95.8% (92/96) for the combined approach. Visualization rates for LLU were significantly higher than for FTU (P = 0.002); FTU + LLU rates were higher than those for FTU (P = 0.001). The difference between LLU and FTU + LLU was not statistically significant (P = 0.025).


LLU can be used to evaluate arytenoid cartilage activity in ICUs, and the results are highly correlated with the diagnosis of nasal fiber-optic endoscopy. The combination of FTU and LLU shows promise as a rapid primary screening method for vocal cord injury.


Lateral-side longitudinal-axis ultrasound Arytenoid cartilage movement Airway 



This work was supported by the Shanghai Sailing Program (No. 16YF1407300) and Medical cross project of Shanghai Jiao Tong University (No. YG2016QN75).

Compliance with ethical standards

Conflicts of interest

All authors declare having no conflicts of interest.

Supplementary material

134_2018_5469_MOESM1_ESM.avi (20.2 mb)
Supplementary material 1 Video (a) shows an ultrasound examination demonstrating right vocal cord paralysis (AVI 20694 kb)
134_2018_5469_MOESM2_ESM.avi (18.9 mb)
Supplementary material 2 Video (b) shows the left vocal cord (uninjured side) (AVI 19,327 kb)
134_2018_5469_MOESM3_ESM.mp4 (516 kb)
Supplementary material 3 Video (c) shows the nasal fiber-optic endoscope demonstrating right vocal cord paralysis (MP4 516 kb)
134_2018_5469_MOESM4_ESM.mp4 (84.5 mb)
Supplementary material 4 Video (d) explains the operating procedures (MP4 86,506 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua HospitalShanghai Jiaotong University School of MedicineShanghaiPeople’s Republic of China
  2. 2.Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese Medicine (Minhang Branch)ShanghaiPeople’s Republic of China
  3. 3.Department of Pharmacotherapy, College of PharmacyUniversity of UtahSalt Lake CityUSA

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