Pediatric vocal cord mobility: Translaryngeal ultrasound application for resource-limited laryngologists

Abstract

Background: Flexible fibreoptic laryngoscopy (FFL) is currently the gold standard for assessment of true vocal cord (TVC) mobility but is invasive and not without risk. The aim of this study was to determine the accuracy of an application-based translaryngeal ultrasonography (TLUS) as a screening tool for mobility of TVCs and to assess the feasibility of its use by an otolaryngologist not formally trained in ultrasonography.

Methods: Forty children were recruited at the ear, nose and throat (ENT) clinic at Red Cross War Memorial Children’s Hospital (RCWMCH). The first author (DR), an ENT trainee, was trained by a consultant radiologist (MJ) on the use of an ultrasound probe to assess TVC mobility. Two qualified ENT specialists (neither trained in ultrasonography) consented to evaluate TLUS and FFL videos for TVC mobility.

Results: In total, 135 videos were obtained from 40 participants. Ages ranged from 10 days to 9 years, and the genders were equally represented. The overall accuracy of TLUS evaluation was 95.5% (sensitivity of 100%, specificity of 60%). The reliability of TLUS when compared to FFL showed a p < 0.001 and a 100% agreement between ENT specialists evaluating the shared videos.

Conclusion: Our study shows TLUS to be a reliable method of assessing TVC mobility.

Contribution: Translaryngeal ultrasonography is portable, noninvasive and easy to use, making it a potentially useful screening tool for practitioners other than radiologists, for example, otolaryngologists, who have a good understanding of laryngeal anatomy, especially in resource-limited settings, where FFL might not be readily available.