Surgeon-performed transcutaneous laryngeal ultrasonography after thyroidectomy: Diagnostic accuracy and learning curve.

Abstract

Vocal cord paralysis is an uncommon complication after thyroidectomy, reported in approximately 3% to 4% of procedures. Flexible laryngoscopy is the gold standard for assessing postoperative vocal cord mobility, but its usage is limited because of expense, discomfort, and availability. Transcutaneous laryngeal ultrasonography has evolved as a noninvasive and widely available alternative. We conducted a prospective cross-sectional study on adult patients receiving total or partial thyroidectomy by head and neck surgeons. The operating surgeon performed transcutaneous laryngeal ultrasonography postoperatively and compared the results to a blinded laryngoscopic examination. The sensitivity, specificity, predictive value, and likelihood ratios were calculated. For nondiagnostic tests, best- and worst-case scenarios were evaluated. A learning curve study was also conducted. A total of 146 patients with 239 nerves at risk were included. Vocal cord paralysis was observed in 2.1% of nerves at risk. Transcutaneous laryngeal ultrasonography demonstrated a sensitivity of 80% and a specificity ranging from 94.4% to 99.6%, depending on the clinical scenario. The negative predictive value remained high (99.6%), whereas the positive predictive value ranged from 23.5% to 80%. After about 50 examinations, the learning curve stabilized, and the median examination length was 26.9 seconds. Surgeons may conduct transcutaneous laryngeal ultrasonography with good diagnostic accuracy and efficiency, making it a cost-effective technique for postoperative vocal cord evaluation in thyroidectomy patients.