Transcutaneous Laryngeal Ultrasound for Vocal Cord Paralysis Assessment in Patients Undergoing Thyroid and Parathyroid Surgery—A Systematic Review and Meta-Analysis

Abstract

Recurrent laryngeal nerve injury is an important complication following thyroid and parathyroid surgery. Recently, Transcutaneous laryngeal ultrasound (TLUSG) has emerged as a non-invasive alternative to laryngoscopic examination for vocal cord (VC) assessment. The aim of the systematic review and meta-analysis was to determine its diagnostic accuracy in reference to laryngoscopy. It was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Scopus, Cochrane library and Web of Science databases were searched to identify relevant articles. Sixteen studies were included in the review. Pooled diagnostic accuracy was calculated based on weighted arithmetic mean and plotting forest plot. The pooled visualization rate was 86.28% and 94.13% preoperatively and postoperatively, respectively. The respective pooled sensitivity and specificity was 78.48% and 98.28%, and 83.96% (CI 95%: 77.24–88.50%) and 96.15% (CI 95%: 95.24–96.88%). The diagnostic accuracy improved if transverse and lateral approaches, and valsalva maneuver were utilized. Male gender and older age were the most crucial risk factors for VC non-visualization. TLUSG is an efficacious screening tool for vocal cord palsy due to its high sensitivity. It is likely to prevent unnecessary laryngoscopic examination in around 80% of patients, with the potential for becoming a gold standard for specific (female/young) patient cohort through assimilative modifications use, increasing expertise and development of objective measurements in the future.

Assessment of vocal fold movement through anterior–posterior view of videofluoroscopic swallowing study

“…This method, however, had limitations in old, male patients, as thyroid cartilage calcification results in lower image quality leading to difficulties assessing vocal folds. 17 As However, other maneuvers may better show the movements of vocal folds. For example, a study on various maneuvers during transcutaneous laryngeal ultrasonography to assess vocal folds found that the valsalva maneuver was preferred.…”

“…Transcutaneous laryngeal ultrasound showed high sensitivity and high NPV in visualizing the vocal fold, implying its value as screening tool. This method, however, had limitations in old, male patients, as thyroid cartilage calcification results in lower image quality leading to difficulties assessing vocal folds 17 …”

Application of Translaryngeal Ultrasound (TLUS) in Patients with Neck Surgery—A Single-Centre, Prospective Cohort Study on Technique Evaluation

“…Interestingly, the diagnostic accuracy of TLUS was higher when the examination was performed by an operating surgeon or anesthesiologist compared to radiologists. In our study, TLUS was performed by the same endocrinology resident (Wolff) [ 14 ].…”

Airway Ultrasound for Anesthesia and in Intensive Care Patients—A Narrative Review of the Literature

“…The transcutaneous approach comprises the trans laryngeal and transtracheal ultrasound windows used to evaluate the upper airway and can be performed using either a low- or a high-frequency transducer. The orientation of the probes can be one of the following: sagittal, parasagittal, oblique, or transverse [ 12 , 13 , 14 ] ( Scheme 1 ).…”