Ultrasonography of the larynx: Novel use during the SARS-CoV-2 pandemic (Review)

Abstract

Few articles have been published on the subject of laryngeal ultrasonography. However, considering the increased power and accuracy of ultrasound technology, this imaging modality should be reevaluated. The present review aimed to increase the awareness of fellow specialists regarding the use of this imaging tool in healthcare units that do not benefit from onsite ear, nose and throat (ENT) service. We illustrate the ultrasonographic examination protocol for the larynx along with the relevant anatomic landmarks. We review cases with laryngeal tumoral pathology that underwent ultrasonographic examination for improved management. All findings were confirmed through computerized tomography (CT) and endoscopy performed by the ENT specialist. The ultrasound of the larynx has potential utility in diagnosis (e.g., laryngeal abnormalities, speech and swallowing abnormalities, identification of endotracheal tube placement), treatment (e.g., guidance of percutaneous tracheostomy and cricothyrotomy) and prognosis (e.g., prediction of postextubation stridor and difficult intubation). This imaging modality could be useful in the current SARS-CoV-2 pandemics in reducing the exposure to invasive maneuvers producing aerosol, such as endoscopy.

Keywords: COVID-19; ENT; SARS-CoV-2; larynx; ultrasound.

Figure 1

Longitudinal midline view of the larynx. H, hyoid bone; E, epiglottis; T, thyroid cartilage; C, cricoid cartilage; G, thyroid gland isthmus; TRAH, trachea.

Figure 2

Transverse view at the level of vestibular folds. MPL, anterior muscles of the neck; T, thyroid; V, vestibular folds.

Figure 3

Ultrasonographic view of the vocal cords. MPL, anterior muscles of the neck; T, thyroid cartilage; CV, vocal cords; ARI, arytenoid cartilage.

Figure 4

Endolaryngeal tumor computerized tomography (CT) and ultrasound (US) view.

Figure 5

Resection piece and microscopy pathology result, squamous carcinoma, in the same case as shown in Fig. 4. H&E; magnification, x100. H&E, hematoxylin and eosin.

Figure 6

Upper view of the tumor at the base of the tongue and epiglottis, middle view of the tumor at the level of the vestibular folds and lower view of the tumor invading the vocal cord.

Figure 7

Microscopy pathology result, acantholytic squamous carcinoma, from the same case as shown in Fig. 6. H&E magnification, x100. H&E, hematoxylin and eosin.

Figure 8

Vocal fold paresis confirmed through ultrasound (US).