Post-intubation Glottic Insufficiency

Shih, Michael C.; Devore, Danielle; Hollas, Sarah; Ongkasuwan, Julina

doi:10.1007/978-3-030-26191-7_39

Cited by 1 publication

(2 citation statements)

References 30 publications

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“…The length of intubation can permanently affect the structure of the posterior glottis, with longer intubation times, 29 larger diameter endotracheal tube size, 18 and repeated intubation/extubation attempts as additional risk factors, particularly in the premature infant. Mucosal changes have been reported in as little as 4 days of intubation with a typical pattern of laryngeal damage consisting of mucosal ulcerations along the posterior‐medial aspects of both vocal cords and varying degrees of laryngeal edema in 77 patients (94%) 30 …”

Section: Discussionmentioning

confidence: 99%

“…Any evidence or history of laryngopharyngeal reflux (LPR) or gastroesophageal reflux (GERD) was also documented due to the potential impact on the posterior glottic region. The exclusion criteria include: 1) Subjects with past laryngotracheal reconstruction (LTR) due to higher risk for posterior glottic diastasis that is inherent after most types of LTR, 18–19 and 2) Subjects with conditions that could affect vocal fold strength (such as Emery‐Dreifuss muscular dystrophy).…”

Section: Methodsmentioning

confidence: 99%

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Intubation‐Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients

2021

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Objectives/Hypothesis We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability. Study Design Retrospective Study. Methods Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale. Results Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0–3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS‐2 and BDSS‐3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS‐1 (mild) or BDSS‐2. History of multiple and prolonged intubations were seen more frequently in BDSS‐2 or BDSS‐3. Post‐op pVHI reduced an average of 15 points for BDSS‐0 to BDSS‐2, but only 3 points for BDSS‐3. Post‐op pVHI matched normal values for preintervention dysphonic children. Conclusions The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher‐grade BDs, whereas low GA is more likely to be associated with BDSS‐1 to BDSS‐2. Level of Evidence 4 Laryngoscope, 131:2550–2557, 2021

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%