loading page

Intraoperative Ultrasonographic Assessment of Vocal Cord motion following pediatric thyroidectomy in the Era of COVID-19, a double-blind study
  • +3
  • Ofir Zavdy,
  • Michael Schwarz,
  • Dror Gilony,
  • Gideon Bachar,
  • Hanna Gilat,
  • Roy Hod
Ofir Zavdy
Rabin Medical Center
Author Profile
Michael Schwarz
Schneider Children's Medical Center of Israel
Author Profile
Dror Gilony
Rabin Medical Center
Author Profile
Gideon Bachar
Rabin Medical Center
Author Profile
Hanna Gilat
Rabin Medical Center
Author Profile
Roy Hod
Rabin Medical Center
Author Profile

Abstract

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.

Peer review status:IN REVISION

28 Mar 2021Submitted to Clinical Otolaryngology
31 Mar 2021Submission Checks Completed
31 Mar 2021Assigned to Editor
03 Apr 2021Reviewer(s) Assigned
30 May 2021Review(s) Completed, Editorial Evaluation Pending
30 May 2021Editorial Decision: Revise Major
07 Jun 20211st Revision Received
16 Jun 2021Assigned to Editor
16 Jun 2021Submission Checks Completed