These New Developments in Otolaryngology Are Revolutionizing the Management of Pediatric Patients

Ultrasound for Assessing Vocal Fold Motion of Neonates

Vocal fold motion impairment is a common and known sequela of cardiovascular surgery (Laryngoscope. 2017;127:167-172). If the recurrent laryngeal nerve is impacted by surgery, the affected child may have significant difficulty in breathing, swallowing, and feeding.

To date, pediatric otolaryngologists have used flexible nasolaryngoscopy to assess vocal fold motion in neonates. But babies don’t like the procedure, and neither do physicians, who may be exposed to infectious organisms during the aerosol-generating procedure.

Physicians have explored the use of ultrasound to assess vocal fold motion for decades, but the results have been disappointing—until recently. Julina Ongkasuwan, MD, director of the Pediatric Voice Clinic at Texas Children’s Hospital in Houston, has successfully used ultrasound to noninvasively assess vocal fold motion. A 2020 study demonstrated near-perfect agreement between laryngeal ultrasound and flexible nasolaryngoscopy in the assessment of 30 pediatric patients (Int J Pediatr Otorhinolaryngol. 2020;129:109773).

“The use of ultrasound to assess vocal fold mobility is super exciting,” said Kathleen Sie, MD, division chief of otolaryngology–head and neck surgery at Seattle Children’s Hospital. “I hope that the resolution improves so that we can assess vocal fold mobility more easily.”

Julie Wei, MD, president elect of the American Society of Pediatric Otolaryngology, agreed. “If you’re a pediatric otolaryngologist in a busy children’s hospital, you may not have time to assess every patient with laryngoscopy,” she said, noting that the use of ultrasound may allow nonphysicians to conduct assessments. “Ultrasound evaluation of vocal fold mobility may have wide applicability.”