Vocal Fold Palsy Following Endotracheal Intubation – Diagnosis, Management, and Outcomes: Case Series

Author(s): Mohd Sharin Fakhruzzaman, Norazila Abdul Rahim, Maryam Ali AlQaydi, Marina Mat Baki.

Background: Endotracheal intubation is a routine procedure for an elective operation under general anesthesia (GA) or an emergency case for airway protection. No matter being lifesaving or routinely performed, endotracheal intubation can cause vocal fold palsy (VFP) which may result in undesirable morbidities.

Goal: To spotlight the significance of the early diagnosis of VFP following endotracheal intubation, plan of management, and outcomes.

Method: We present consecutive 7 patients who developed VFP following endotracheal intubation for various kinds of surgeries. The VFP was identified on a flexible nasopharyngolaryngoscope (FNPLS) when they were referred to otolaryngology surgeons for hoarseness post-extubation. Data collections include the patient’s demographic data, diagnosis, type of intubation (elective vs emergency), laterality of VFP, intervention, and duration of functional recovery. Objective and subjective voice assessments were performed to evaluate pre and post-treatment outcomes.

Results: Hoarseness and aspiration are the early symptoms of VFP in this review. Examination using FNPLS found left VFP in 5 patients, 1 patient with right VFP, and 1 patient with bilateral VFP. Two patients had undergone injection laryngoplasty (IL) with hyaluronic acid, three patients had self-recovery of function while the other two patients passed away due to acute illness before receiving any interventions. Duration of functional recovery ranges from 3-4 months in the intervention group while the non-intervention group ranges from 4-6 months. Malay Voice Handicap Index-10 (mVHI-10), Maximum Phonation Time (MPT), and Eating Assessment Tool (EAT 10) showed significant improvement at 1 month in the post-intervention group. The mVHI-10 showed a reduction from 33/