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Role of Ultrasonography in Upper Airway Assessment for Decannulating Tracheostomy in Acquired Brain Injury—A Pilot Study

  • Author Footnotes
    1 Current affiliation for Sikha: Department of Physical Medicine and Rehabilitation, Herbertpur Christian Hospital, Herbertpur, Dehradun, Uttarakhand, India.
    Samuel Barnabas Sikha
    Footnotes
    1 Current affiliation for Sikha: Department of Physical Medicine and Rehabilitation, Herbertpur Christian Hospital, Herbertpur, Dehradun, Uttarakhand, India.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu
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  • Author Footnotes
    2 Current affiliation for Prakash: Department of Neurological Rehabilitation, National Institute of Mental health and Neuroscience, Bangalore, India.
    Navin B. Prakash
    Footnotes
    2 Current affiliation for Prakash: Department of Neurological Rehabilitation, National Institute of Mental health and Neuroscience, Bangalore, India.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu
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  • Naveen Cherian Thomas
    Affiliations
    Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu
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  • Judy Ann John
    Correspondence
    Corresponding author Judy Ann John, MD, PMR, Department of Physical Medicine and Rehabilitation, Christian Medical College, Dr Ida Scudder Rd, Vellore, Tamil Nadu 632004, India.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu
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  • Suma Susan Mathews
    Affiliations
    Department of E.N.T, Christian Medical College, Vellore, Tamil Nadu
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  • Pavithra Mannam
    Affiliations
    Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
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  • Philip George
    Affiliations
    Department of E.N.T, Christian Medical College, Vellore, Tamil Nadu
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  • Author Footnotes
    1 Current affiliation for Sikha: Department of Physical Medicine and Rehabilitation, Herbertpur Christian Hospital, Herbertpur, Dehradun, Uttarakhand, India.
    2 Current affiliation for Prakash: Department of Neurological Rehabilitation, National Institute of Mental health and Neuroscience, Bangalore, India.
Published:February 21, 2022DOI:https://doi.org/10.1016/j.apmr.2022.01.158

      Abstract

      Objective

      To compare the findings of ultrasonography of the upper airway with flexible fiberoptic laryngoscopy and determine the efficacy of transcutaneous laryngeal ultrasonography for decannulation.

      Design

      Prospective cross-sectional study.

      Setting

      Tertiary care referral center in South India.

      Participants

      Twenty-four patients with acquired brain injury (N=24).

      Main Outcome Measures

      Participants underwent an airway assessment by ultrasonography followed by assessment of airway by flexible laryngoscopy done within the next 72 hours.

      Results

      Vocal cord assessment by ultrasonography revealed a sensitivity of 81.2% and specificity of 87.5%. A statistically significant association between vocal cord mobility as assessed by ultrasonography and decannulation was observed (sensitivity of 81.25%, specificity of 87.5%, P=.002). Although aspiration was not assessed by ultrasonography, a statistically significant association was observed between vocal cord mobility on ultrasonography and aspiration as assessed by laryngoscopy (sensitivity of 81.25%, specificity of 87.5%, P=.011).

      Conclusion

      Laryngeal ultrasonography is an emerging diagnostic modality with a potential role for assessing vocal cord mobility and airway prior to decannulation in centers that lack the expertise and the infrastructure to perform a flexible laryngoscopy.

      Keywords

      List of abbreviations:

      ABI (acquired brain injury), ENT (ear, nose, and throat), GCS (Glasgow Coma Scale), TCLUS (transcutaneous laryngeal ultrasonography)
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