Unilateral vocal cord paralysis (UVCP) is a known complication of
thyroid surgery, due to iatrogenic recurrent laryngeal nerve injury,
with reported rates of 2-5% in children. The gold standard for
assessing vocal cord function in flexible nasendoscopy (FNE)
examination, which is considered high-risk for contraction of the
COVID-19 virus. Intraoperative ultrasonographic assessment (IUA) of
vocal cord function is a non-invasive and relatively simple procedure,
performed in a supine position under general anesthesia. Objectives: To
evaluate the validity of IUA modality in children undergoing
thyroidectomy, and to compare it to the standard FNE. Design: A
prospective double-blind study covering 24 months (March 2019-March
2021). Twenty thyroid lobectomies were performed, during 15 surgeries.
Vocal cord function was assessed three times: Preoperatively by FNE,
intraoperative (IUA) following extubation, and a second FNE on the first
post-operative day. Settings: A tertiary pediatric hospital. Results:
The overall accuracy of IUA results in our study was 92%. IUA
sensitivity, specificity, positive and negative predictive values were
100%, 89%, 33%, and 100% respectively. Patient’s age demonstrated
borderline significance (p= 0.08). The resident’s experience was
associated with a better correlation between IUA and FNE results
(p<0.05). Conclusions: IUA of vocal cord motion has a high
accuracy rate for detection of iatrogenic vocal cord paralysis, similar
to FNE. It is easily learned by residents, well tolerated by children,
and it provides a safe and valid alternative modality while ensuring the
safety of the medical staff in treating patients, especially in times of
COVID-19 pandemic.
Evaluation of Vocal Cord Function Before Thyroidectomy: Experience from a Developing Country
