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Updated: Oct 11, 2025

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways
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Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

Published on: April 7, 2023

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Ultrasound of the vocal cords in infants

Ramon Sanchez-Jacob1,2, Tara K Cielma3, Pamela A Mudd4,5

  • 1George Washington School of Medicine, Washington, DC, USA. rsanchezja@childrensnational.org.

Pediatric Radiology
|November 29, 2021
PubMed

Insights

Pediatric vocal cord paralysis, often from heart surgery, causes breathing and feeding issues. Laryngeal ultrasound (US) offers a safe, accurate, and easy alternative to traditional laryngoscopy for diagnosis.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Pulmonology
  • Pediatric Cardiology

Background:

  • Vocal cord paralysis is a significant cause of respiratory and feeding difficulties in children.
  • Iatrogenic recurrent laryngeal nerve injury post-cardiovascular surgery is the leading cause in this population.
  • Complications include dysphagia, aspiration pneumonia, and increased need for feeding tubes.

Purpose of the Study:

  • To review the causes, symptoms, and pathophysiology of pediatric vocal cord paralysis.
  • To evaluate laryngeal ultrasound (US) as a diagnostic tool for vocal cord paralysis.
  • To compare laryngeal US with flexible nasopharyngolaryngoscopy.

Main Methods:

  • Review of relevant literature on pediatric vocal cord paralysis.
  • Description of laryngeal anatomy and recurrent laryngeal nerve.
  • Detailed explanation of laryngeal US technique, diagnostic criteria, and reporting.

Main Results:

  • Flexible nasopharyngolaryngoscopy, the gold standard, has limitations including discomfort and potential cardiovascular events.
  • Laryngeal US is well-tolerated, easy to perform, and simple to interpret.
  • Laryngeal US is demonstrated as an accurate, low-cost, and low-physiological-impact diagnostic modality.

Conclusions:

  • Laryngeal US presents a superior alternative to flexible nasopharyngolaryngoscopy for diagnosing pediatric vocal cord paralysis.
  • This imaging modality offers a safe, effective, and accessible diagnostic approach.
  • The review provides a comprehensive guide to laryngeal US for vocal cord paralysis evaluation.

Keywords:
CardiovascularInfantLarynxNeonateParalysisRecurrent laryngeal nerveSurgeryUltrasoundVocal cord

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