Our Summary

This research paper is about a condition called vocal cord paralysis, which can cause breathing and feeding issues in children. Often, this condition is caused by accidental damage to a nerve in the throat during heart surgery. This paralysis can lead to problems with swallowing, increase the risk of lung infections, and often make it necessary to feed the child through a tube in the nose or stomach.

Traditionally, a procedure called a flexible nasopharyngolaryngoscopy is used to diagnose this condition, which involves inserting a thin, flexible tube through the nose and down into the throat. However, this method has its downsides – it’s uncomfortable, can potentially cause heart problems in children with unstable heart conditions, and can be difficult to both perform and interpret.

As a result, this paper highlights the use of laryngeal ultrasound (US) - a type of scan that uses sound waves to create images of the vocal cords. This method is easier and safer to perform, less uncomfortable for the patient, and simpler to interpret. The paper argues that laryngeal ultrasound is an effective and cost-efficient way to diagnose vocal cord paralysis. The paper goes on to describe the structure of the throat, the causes and symptoms of vocal cord paralysis, how to perform a laryngeal ultrasound, and how to interpret the results.

FAQs

  1. What is the most frequent cause of vocal cord paralysis in children?
  2. What is the gold standard for diagnosing vocal cord paralysis and what are its drawbacks?
  3. How does laryngeal ultrasound compare to flexible nasopharyngolaryngoscopy in diagnosing vocal cord paralysis?

Doctor’s Tip

A helpful tip a doctor might give a patient about vocal cord surgery is to follow post-operative care instructions carefully, including resting the voice, avoiding straining the vocal cords, and attending follow-up appointments for monitoring and rehabilitation. It is also important to communicate any concerns or changes in symptoms to the doctor promptly.

Suitable For

Patients who are typically recommended for vocal cord surgery are those with vocal cord paralysis that is causing respiratory and feeding problems, particularly in the pediatric population. The most frequent cause of vocal cord paralysis is iatrogenic injury of the recurrent laryngeal nerve after cardiovascular surgery. Patients with vocal cord paralysis are at increased risk of swallowing dysfunction, tracheal aspiration, pneumonia, and may require nasoenteric feeds or gastrostomy tube placement.

Flexible nasopharyngolaryngoscopy is the gold standard for diagnosing vocal cord paralysis, but it can be uncomfortable, challenging to perform, and have significant drawbacks. Laryngeal ultrasound (US) has become a popular imaging modality to evaluate vocal cord function as it is well-tolerated, easy to perform, simple to interpret, and has a lower physiological impact compared to nasopharyngolaryngoscopy. Laryngeal US is an accurate and low-cost diagnostic test for vocal cord paralysis.

In summary, patients who are experiencing symptoms of vocal cord paralysis, such as respiratory and feeding difficulties, may be recommended for vocal cord surgery, especially if other conservative treatments have been unsuccessful.

Timeline

Before vocal cord surgery:

  1. Patient experiences symptoms such as hoarseness, difficulty speaking or swallowing, shortness of breath, or a weak voice.
  2. Patient undergoes diagnostic tests such as laryngoscopy or laryngeal ultrasound to confirm vocal cord paralysis.
  3. Patient consults with an otolaryngologist or laryngologist to discuss treatment options, including vocal cord surgery.
  4. Patient may undergo pre-operative evaluations to assess overall health and fitness for surgery.

After vocal cord surgery:

  1. Patient undergoes vocal cord surgery, which may involve procedures such as vocal cord injection, medialization laryngoplasty, or nerve reinnervation.
  2. Patient experiences post-operative symptoms such as throat pain, hoarseness, or difficulty speaking.
  3. Patient undergoes post-operative follow-up visits with the surgeon to monitor healing and vocal cord function.
  4. Patient may undergo speech therapy to improve voice quality and strength post-surgery.
  5. Patient gradually recovers vocal cord function and experiences improvement in symptoms such as hoarseness or difficulty speaking.

What to Ask Your Doctor

  1. What is the specific reason for recommending vocal cord surgery in my case?
  2. What are the potential risks and complications associated with vocal cord surgery?
  3. What is the expected outcome of the surgery in terms of improving my vocal cord function?
  4. What is the recovery process like after vocal cord surgery?
  5. Will I need any additional therapy or rehabilitation after the surgery?
  6. How long will it take for me to regain full use of my voice after the surgery?
  7. Are there any lifestyle changes or restrictions I should be aware of post-surgery?
  8. How many of these surgeries have you performed, and what is your success rate?
  9. Are there any alternative treatments or procedures that could be considered instead of surgery?
  10. How long will the effects of the surgery last, and will I need further treatment in the future?

Reference

Authors: Sanchez-Jacob R, Cielma TK, Mudd PA. Journal: Pediatr Radiol. 2022 Aug;52(9):1619-1626. doi: 10.1007/s00247-021-05235-0. Epub 2021 Nov 29. PMID: 34841448