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World Journal of Surgery
Published in: World Journal of Surgery 3/2019

01-03-2019 | Original Scientific Report (including Papers Presented at Surgical Conferences)

Vocal Cord Palsies Missed by Transcutaneous Laryngeal Ultrasound (TLUSG): Do They Experience Worse Outcomes?

Authors: Kai-Pun Wong, Kin Pan Au, Shi Lam, Yuk Kwan Chang, Brian Hung Hin Lang

Published in: World Journal of Surgery | Issue 3/2019

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Abstract

Introduction

Transcutaneous laryngeal ultrasound (TLUSG) is an innovative, non-invasive tool in detecting post-thyroidectomy vocal cord palsy (VCP). However, TLUSG failed to detect about 6–15% laryngoscopic examination (LE)-confirmed VCP. It is unclear whether the outcome of patients with VCP missed by TLUSG [false negative (FN)] is different from those with VCP diagnosed by TLUSG [true positive (TP)]. Therefore, this study aimed to compare the clinical outcome and prognosis between patients with FN results and TP results.

Methods

Over 46 months, all consecutive patients undergoing thyroidectomy or endocrine-related neck procedure were recruited. They underwent pre-operative and post-operative voice assessments on symptoms, voice-specific questionnaire [voice handicap index questionnaire (VHI-30)], TLUSG and LE. For patients with post-operative vocal cord palsy, reassessment LE would be arranged at second, fourth, sixth and twelfth months post-operatively until VCP recovered.

Results

In total, 1196 patients, including 74 post-thyroidectomy VCP, were recruited. For those with assessable vocal cords (VC), 58 VCP were correctly diagnosed by TLUSG (TP) and 10 VCP were missed by TLUSG (FN). Sensitivity and specificity of detecting a VCP by TLUSG were 85.3% and 94.7%, respectively. VHI-30 score was significantly increased after operation in TP group [31 (range − 6–105), p < 0.001] but not in FN group [20 (14–99), p = 0.089]. Comparing to TP group, VCP recovered earlier (69 vs. 125 days, p < 0.001) and less patients suffered from permanent VCP in patients with FN results. (34.5% vs. 0.0%, p = 0.027).

Conclusion

The VCP missed by TLUSG had a milder course of disease. Early recovery of VC function and non-permanent palsy were expected.
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Metadata
Title
Vocal Cord Palsies Missed by Transcutaneous Laryngeal Ultrasound (TLUSG): Do They Experience Worse Outcomes?
Authors
Kai-Pun Wong
Kin Pan Au
Shi Lam
Yuk Kwan Chang
Brian Hung Hin Lang
Publication date
01-03-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 3/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4826-0

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