Abstract
Introduction
Transcutaneous laryngeal ultrasound (TLUSG) is an innovative, non-invasive tool in detecting post-thyroidectomy vocal cord palsy (VCP). However, TLUSG failed to detect about 6–15% laryngoscopic examination (LE)-confirmed VCP. It is unclear whether the outcome of patients with VCP missed by TLUSG [false negative (FN)] is different from those with VCP diagnosed by TLUSG [true positive (TP)]. Therefore, this study aimed to compare the clinical outcome and prognosis between patients with FN results and TP results.
Methods
Over 46 months, all consecutive patients undergoing thyroidectomy or endocrine-related neck procedure were recruited. They underwent pre-operative and post-operative voice assessments on symptoms, voice-specific questionnaire [voice handicap index questionnaire (VHI-30)], TLUSG and LE. For patients with post-operative vocal cord palsy, reassessment LE would be arranged at second, fourth, sixth and twelfth months post-operatively until VCP recovered.
Results
In total, 1196 patients, including 74 post-thyroidectomy VCP, were recruited. For those with assessable vocal cords (VC), 58 VCP were correctly diagnosed by TLUSG (TP) and 10 VCP were missed by TLUSG (FN). Sensitivity and specificity of detecting a VCP by TLUSG were 85.3% and 94.7%, respectively. VHI-30 score was significantly increased after operation in TP group [31 (range − 6–105), p < 0.001] but not in FN group [20 (14–99), p = 0.089]. Comparing to TP group, VCP recovered earlier (69 vs. 125 days, p < 0.001) and less patients suffered from permanent VCP in patients with FN results. (34.5% vs. 0.0%, p = 0.027).
Conclusion
The VCP missed by TLUSG had a milder course of disease. Early recovery of VC function and non-permanent palsy were expected.
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References
Yung KC, Likhterov I, Courey MS (2011) Effect of temporary vocal fold injection medialization on the rate of permanent medialization laryngoplasty in unilateral vocal fold paralysis patients. Laryngoscope 121:2191–2194
Sinclair CF, Bumpous JM, Haugen BR, et al (2016) Laryngeal examination in thyroid and parathyroid surgery: an American Head and Neck Society consensus statement: AHNS Consensus Statement. Head Neck 38(6):811–819
Paul BC, Rafii B, Achlatis S et al (2012) Morbidity and patient perception of flexible laryngoscopy. Ann Otol Rhinol Laryngol 121:708–713
Seccia V, Dallan I, Massimetti G et al (2014) Patient-related and ENT-related predictive factors based on the pain experienced during flexible nasendoscopy. Laryngoscope 124:1648–1652
Maniakas A, Christopoulos A, Bissada E et al (2017) Perioperative practices in thyroid surgery: an international survey. Head Neck 39:1296–1305
Carneiro-Pla D, Miller BS, Wilhelm SM et al (2014) Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: a multi-institutional experience. Surgery 156:1597–1604
Borel F, Delemazure AS, Espitalier F et al (2016) Transcutaneous Ultrasonography in Early Postoperative Diagnosis of Vocal Cord Palsy After Total Thyroidectomy. World J Surg 40:665–671. https://doi.org/10.1007/s00268-015-3393-x.
Kandil E, Deniwar A, Noureldine SI et al (2016) Assessment of vocal fold function using transcutaneous laryngeal ultrasonography and flexible laryngoscopy. JAMA Otolaryngol Head Neck Surg 142:74–78
Woo JW, Park I, Choe JH et al (2017) Comparison of ultrasound frequency in laryngeal ultrasound for vocal cord evaluation. Surgery 161(4):1108–1112
de Miguel M, Pelaez EM, Caubet E et al (2017) Accuracy of transcutaneous laryngeal ultrasound for detecting vocal cord paralysis in the immediate postoperative period after total thyroidectomy. Minerva Anestesiol 83:1239–1247
Lazard DS, Bergeret-Cassagne H, Lefort M et al (2018) Transcutaneous laryngeal ultrasonography for laryngeal immobility diagnosis in patients with voice disorders after thyroid/parathyroid surgery. World J Surg. https://doi.org/10.1007/s00268-017-4428-2
Sidhu S, Stanton R, Shahidi S et al (2001) Initial experience of vocal cord evaluation using grey-scale, real-time, B-mode ultrasound. ANZ J Surg 71:737–739
Wang CP, Chen TC, Yang TL et al (2012) Transcutaneous ultrasound for evaluation of vocal fold movement in patients with thyroid disease. Eur J Radiol 81:e288–e291
Wong KP, Lang BH, Ng SH et al (2013) A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery 154:1158–1164 discussion 1164–1155
Woo JW, Suh H, Song RY et al (2016) A novel lateral-approach laryngeal ultrasonography for vocal cord evaluation. Surgery 159(1):52–56
Wong KP, Lang BH, Lam S et al (2016) Determining the learning curve of transcutaneous laryngeal ultrasound in vocal cord assessment by cusum analysis of eight surgical residents: when to abandon laryngoscopy. World J Surg 40:659–664. https://doi.org/10.1007/s00268-015-3348-2
Wong KP, Woo JW, Youn YK et al (2014) The importance of sonographic landmarks by transcutaneous laryngeal ultrasonography in post-thyroidectomy vocal cord assessment. Surgery 156:1590–1596 discussion 1596
Carneiro-Pla D, Solorzano CC, Wilhelm SM (2016) Impact of vocal cord ultrasonography on endocrine surgery practices. Surgery 159:58–64
Wong KP, Woo JW, Li JY et al (2016) Using transcutaneous laryngeal ultrasonography (TLUSG) to assess post-thyroidectomy patients’ vocal cords: which maneuver best optimizes visualization and assessment accuracy? World J Surg 40:652–658. https://doi.org/10.1007/s00268-015-3304-1
Wong KP, Au KP, Lam S et al (2017) Lessons learned after 1000 cases of transcutaneous laryngeal ultrasound (TLUSG) with laryngoscopic validation: is there a role of TLUSG in patients indicated for laryngoscopic examination before thyroidectomy? Thyroid 27:88–94
Fukuhara T, Donishi R, Matsuda E et al (2018) A novel lateral approach to the assessment of vocal cord movement by ultrasonography. World J Surg 42:130–136. https://doi.org/10.1007/s00268-017-4151-z
Jacobson BH, Johnson A, Grywalski C et al (1997) The voice handicap index (VHI)—development and validation. Am J Speech Lang Pathol 6:66–70
Rubin AD, Sataloff RT (2008) Vocal fold paresis and paralysis: what the thyroid surgeon should know. Surg Oncol Clin N Am 17:175–196
Wong KP, Lang BH, Ng SH et al (2013) A prospective assessor-blind evaluation of surgeons-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery 154(6):1164–1165
Wong KP, Lang BH, Chang YK et al (2015) Assessing the validity of transcutaneous laryngeal ultrasonography (TLUSG) after thyroidectomy: what factors matter? Ann Surg Oncol 22:1774–1780
Sulica L, Blitzer A (2007) Vocal fold paresis: evidence and controversies. Curr Opin Otolaryngol Head Neck Surg 15:159–162
Syamal MN, Benninger MS (2016) Vocal fold paresis: a review of clinical presentation, differential diagnosis, and prognostic indicators. Curr Opin Otolaryngol Head Neck Surg 24:197–202
Wu AP, Sulica L (2015) Diagnosis of vocal fold paresis: current opinion and practice. Laryngoscope 125:904–908
Koufman JA, Postma GN, Cummins MM et al (2000) Vocal fold paresis. Otolaryngol Head Neck Surg 122:537–541
Woo P, Parasher AK, Isseroff T et al (2016) Analysis of laryngoscopic features in patients with unilateral vocal fold paresis. Laryngoscope 126:1831–1836
Estes C, Sadoughi B, Mauer E et al (2017) Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis. Laryngoscope 127:2100–2105
Wong KP, Lang BH, Ng SH et al (2014) Is vocal cord asymmetry seen on transcutaneous laryngeal ultrasonography a significant predictor of voice quality changes after thyroidectomy? World J Surg 38:607–613. https://doi.org/10.1007/s00268-013-2337-6
Ongkasuwan J, Ocampo E, Tran B (2017) Laryngeal ultrasound and vocal fold movement in the pediatric cardiovascular intensive care unit. Laryngoscope 127(1):167–172
Schneider R, Sekulla C, Machens A et al (2015) Postoperative vocal fold palsy in patients undergoing thyroid surgery with continuous and intermittent nerve monitoring. Br J Surg 102(11):1380–1387
Wu CW, Hao M, Tian M et al (2017) Recurrent laryngeal nerve injury with incomplete loss of electromyography signal during monitored thyroidectomy-evaluation and outcome. Langenbeck Arch Surg 402:691–699
Acknowledgements
This paper was presented as a poster presentation at the 47th World Congress of Surgery 2017 in Basel, Switzerland.
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Wong, KP., Au, K.P., Lam, S. et al. Vocal Cord Palsies Missed by Transcutaneous Laryngeal Ultrasound (TLUSG): Do They Experience Worse Outcomes?. World J Surg 43, 824–830 (2019). https://doi.org/10.1007/s00268-018-4826-0
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DOI: https://doi.org/10.1007/s00268-018-4826-0