Original ContributionApplication of Transcutaneous Laryngeal Ultrasonography in the Diagnosis of Vocal Fold Polyps
Introduction
Vocal fold polyps are a benign proliferative disease of the superficial lamina propria of the vocal folds, with hoarseness as the main symptom. They are the most common benign vocal fold lesions in clinical practice (Nunes et al. 2013; You et al. 2016; Ogawa and Inohara 2018). At present, laryngoscopy is the main method used to diagnose the disease, although the method is not suitable for some adult patients and children (Zou and Ge 2016). Ultrasound imaging has gradually become a very convenient and powerful tool in examining the head and neck regions because of its low cost, non-ionizing radiation, non-invasiveness and real-time capability (Tsui et al. 2011). High-frequency ultrasound is effective for visualizing the structure of the larynx (Lin and Hua 2018). Prasad et al. (2011) reported that transcutaneous laryngeal ultrasonography can clearly reveal the soft tissues around the upper airways of adults and, thus, has several potential clinical applications. Although high-frequency ultrasound has been used primarily in the diagnosis of vocal fold paralysis and vocal fold nodules in children (Bisetti et al. 2009; Ongkasuwan et al. 2017a and to assess vocal fold function before and after thyroidectomy in adults (Kandil et al. 2016), it has not been widely used for other laryngeal lesions (Wu et al. 2017). Tamura et al. (2001), using intralaryngeal ultrasonography to diagnose vocal fold lesions, summarized the imaging features of vocal polyps, cysts and cancers and reported that laryngeal lesions can be diagnosed by intralaryngeal ultrasonography. However, this method is invasive and requires general anesthesia. Many otolaryngology head and neck surgeons are concerned about the non-invasive diagnosis of vocal fold lesions. However, few studies have involved the application of transcutaneous laryngeal ultrasonography in the diagnosis of vocal fold lesions (Bisetti et al. 2009; Tsui et al. 2011; Kandil et al. 2016; Ongkasuwan et al. 2017b; Fukuhara et al. 2018; Dacosta et al. 2019; Derlatka-Kochel et al. 2019; Dubey et al. 2019), and there are few reports on the characteristics of ultrasound images of vocal fold polyps. The purposes of this study were to explore how to clearly visualize vocal folds by transcutaneous laryngeal ultrasonography, to summarize the ultrasonic image characteristics of vocal fold polyps and to explore the value of transcutaneous laryngeal ultrasonography in the diagnosis of vocal fold polyps.
Section snippets
General information
We recruited 87 patients who were diagnosed with vocal fold polyps by post-operative pathology in the Otolaryngology Head and Neck Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University from December 2016 to June 2019. Participants included 38 males and 49 females, and patient age ranged from 20–73 y, with an average age of 37.3 y. On the same day before operation, the patients were examined by electronic laryngoscopy first and then by transcutaneous laryngeal
Results
In this study, we found that images of the side sections of the neck revealed the vocal fold layers and vocal folds more clearly than images of the median section (Fig. 1), so all data in this study were collected from side sections
Discussion
Vocal fold polyps are a benign proliferative disease of the superficial lamina propria of the vocal fold. They are the most common benign vocal fold lesions in clinical practice (Nunes et al. 2013; Ogawa and Inohara 2018). Laryngoscopy is currently the primary means of diagnosing the disease; however, in both adults and infants, flexible nasolaryngoscopy, with or without a strobe, can be uncomfortable, causing statistically significant changes in heart rate, blood pressure and oxygen saturation
Conclusions
The thyroid cartilage side section clearly reveals the structure of the larynx, allowing identification of the morphology, location and size of vocal fold polyps. This is particularly beneficial for patients with thyroid cartilage without calcification and a calcification length percentage <33%. In this patient group, ultrasound can yield an accurate diagnosis, be non-invasive and safe and be an effective supplement to laryngoscopy for the initial screening of vocal fold polyps and
Conflict of interest disclosure
All the authors declare that they have no conflicts of interest.
References (32)
- et al.
Coexisting vocal fold polyps and sulcus vocalis: Coincidence or coexistence? Characteristics of 14 patients
J Voice
(2018) - et al.
Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: A multi-institutional experience
Surgery
(2014) - et al.
Clinical diagnosis and histological analysis of vocal nodules and polyps
Braz J Otorhinolaryngol
(2013) - et al.
Is voice therapy effective for the treatment of dysphonic patients with benign vocal fold lesions?
Auris Nasus Larynx
(2018) - et al.
Non-invasive assessment of benign vocal folds lesions in children by means of ultrasonography
Int J Pediatr Otorhinolaryngol
(2009) Diagnostic and therapeutic pitfalls in benign vocal fold diseases
Laryngo-rhino-otologie
(2013)- et al.
Influence of thyroid cartilage ossification in laryngeal ultrasound
Laryngo-rhino-otologie
(2007) - et al.
Transcutaneous laryngeal ultrasonography for the assessment of laryngeal function after thyroidectomy: A review
Ear Nose Throat
(2019) - et al.
Assessment of vocal fold mobility using dynamic magnetic resonance imaging and ultrasound in healthy volunteers
Pol J Radiol
(2019) - et al.
Functional analysis of vocal folds by transcutaneous laryngeal ultrasonography in patients undergoing thyroidectomy
Acta Anaesthesiol Scand
(2019)
Defining phonosurgery: A proposal for classification and nomenclature by the Phonosurgery Committee of the European Laryngological Society (ELS)
Eur Arch Otorhinolaryngol
A Novel lateral approach to the assessment of vocal cord movement by ultrasonography
World J Surg
Ossification of laryngeal structures as indicators of age
J Forensic Sci
Exudative lesions of Reinke's space: A terminology proposal
Eur Arch Otorhinolaryngol
Laryngeal polyp associated with reflux disease: A case report
J Med Case Rep
Assessment of vocal fold function using transcutaneous laryngeal ultrasonography and flexible laryngoscopy
JAMA Otolaryngol Head Neck Surg
Cited by (5)
Woman With Voice Changes and Cough
2022, Annals of Emergency MedicineCitation Excerpt :Traditional diagnosis is by laryngoscopy, but transcutaneous laryngeal ultrasound is useful in assessing vocal cord paralysis, motility, and polyps.3,4
Value of laryngeal ultrasound in comparison with flexible laryngoscope in diagnosis of various laryngeal masses: a cross-sectional study
2022, Egyptian Journal of Radiology and Nuclear MedicinePreliminary study of high-frequency ultrasound in the diagnosis of vocal cord polyps
2022, Chinese Journal of UltrasonographyThe Application of Grow Model in Vocal Music Teaching
2022, 2nd IEEE International Conference on Advanced Technologies in Intelligent Control, Environment, Computing and Communication Engineering, ICATIECE 2022