Laryngeal ultrasound and vocal fold movement in the pediatric cardiovascular intensive care unit

Abstract

3b. Laryngoscope, 127:167-172, 2017.

Laryngeal ultrasound and pediatric vocal fold nodules

“…Newer high‐frequency probes allow for improved resolution of small laryngeal lesions. Previous work has demonstrated that laryngeal ultrasound can be used to evaluate vocal fold mobility in neonates with much less physiologic impact compared to FNL . A limitation of LUS is resolution at the air–soft tissue interface.…”

“…4 In both adults and infants, flexible nasolaryngoscopy (FNL), with or without strobe, can be uncomfortable and cause statistically significant changes in heart rate, blood pressure, and oxygen saturation. 5,6 In addition, 25% of adults undergoing FNL have reported gagging, and 10% have dyspnea with the procedure. 7 For young children, FNL often requires two or more adults to restrain the child.…”

“…Laryngeal ultrasound (LUS) has been used to identify vocal fold mobility in neonates and children with much less physiologic impact compared to FNL. 6 A few small studies in both adults and children have attempted to use LUS for the identification of a variety of vocal fold lesions with limited success. [13][14][15][16][17] The difficulty appears to be resolving superficial lesions at the air-soft tissue interface.…”

Laryngeal ultrasound for the diagnosis of laryngomalacia in infants

“…In addition, a high degree of inter‐rater and intra‐rater reliability was demonstrated in a blinded study assessing US as the diagnostic technique for pediatric vocal cord paralysis . Moreover, Ongkasuwan et al have recently demonstrated that LUS is comparable to flexible nasolaryngoscopy for evaluating vocal fold mobility as well as for identifying vocal fold nodules in the pediatric population …”

“…17 In addition, a high degree of inter-rater and intra-rater reliability was demonstrated in a blinded study assessing US as the diagnostic technique for pediatric vocal cord paralysis. 14 18,19 The value of LUS in the diagnosis of laryngomalacia in infants with congenital stridor has not been investigated. We hypothesize that LUS can accurately and reliably diagnose laryngomalacia in infants with congenital stridor in comparison to FLB and thus may replace FLB in selected cases of congenital stridor and can be used as a valuable screening method in others.…”