Feasibility of transcutaneous vocal cord ultrasonography in identifying pharyngo-laryngeal mobility

IntroductionUltrasound have an important place in ICU [1], both for invasive and diagnostic acts. It could play a role in the early diagnosis of laryngeal dysfunction, whose frequency is estimated at 41% after intubation >48h [2], without waiting for the completion of a naso-endoscopy. Indeed, the mobility of the vocal cords may be evaluated transcutaneously [3] with a good sensitivity.ObservationA 32-year-old man was hospitalized in intensive care for multiple trauma after high kinetics bike accident. After extubation, it is highlighted dysphonia and swallowing disorders requiring enteral nutrition. The nasal endoscopy found a right vocal cord immobility, also visualized on ultrasound where we highlight a lesser mobility in right pharynx.DiscussionThe pharyngolaryngeal motricity seems to be evaluated by bedside ultrasound track. According to the literature, mainly from pediatrics or cervical endocrine surgery in adults [3], the sensitivity of the vocal cord mobility exploration is good (>90%), positioning the ultrasound as test before using the nasal endoscopy.A prospective evaluation of ultrasound versus nasal endoscopy is necessary in intensive care unit before positioning as a screening tool for pharyngolaryngeal dysfunction; tissue injury of the vocal cords being more frequent than immobility [2]