A Novel Lateral Approach to the Assessment of Vocal Cord Movement by Ultrasonography

TLDR

Ultrasonography is a non‑invasive thyroid imaging tool that has been explored for vocal‑cord assessment, yet prior studies report low visualization success. The authors aimed to develop a novel lateral‑vertical ultrasonographic technique that indirectly visualizes vocal‑cord motion by observing arytenoid movement. In a cohort of 188 subjects (23 with paralysis, 13 with paresis), the study compared the conventional middle‑transverse procedure to the new lateral‑vertical approach. The lateral‑vertical method achieved a 98.4 % visualization rate, detecting all 23 paralysed patients and all but one of the 13 paresis cases, outperforming the conventional technique and showing no false positives, indicating its utility for screening vocal‑cord paralysis.

Abstract

Abstract Background Ultrasonography is a non‐invasive technique that is commonly used by endocrinologists and endocrine surgeons to examine the thyroid region and could be useful for the assessment of vocal cord movement by these specialists. However, previous studies reported a low rate of successful visualization of vocal cord movement by ultrasonography. To address this issue, we devised a novel ultrasonographic procedure for assessing vocal cord movement indirectly by observing the arytenoid movement from a lateral view. Methods Subjects were 188 individuals, including 23 patients with vocal cord paralysis and 13 with vocal cord paresis. We performed ultrasonographic assessment of vocal cord movement using two different procedures: the conventional middle transverse procedure and the novel lateral vertical procedure. Results The rate of visualization of vocal cords with the middle transverse procedure was 70.2% and that of the arytenoid cartilage with the lateral vertical procedure was 98.4%. The lateral vertical procedure enabled visualization of all patients with vocal cord paresis/paralysis and detected all 23 patients with vocal paralysis; only one of 13 patients with vocal cord paresis was positively identified. The conventional procedure enabled visualization of 21 of 36 patients with vocal cord paresis/paralysis with high accuracy. There was no false‐positive case in either procedure. Conclusion The proposed lateral vertical procedure improved the rate of visualization of vocal cord movement by ultrasonography, suggesting that it is a useful technique to screen for vocal cord paralysis by ultrasonography.