Outcomes of Intubation-induced Vocal Fold Motion Impairment

  • Debbie R. Pan
    Correspondence
    Address correspondence and reprint requests to Debbie R. Pan, University of Miami, Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136-1015.
    Affiliations
    University of Miami, Miller School of Medicine, Miami, Florida

    The Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, Oakland, California
    Search for articles by this author
  • Nancy Jiang
    Affiliations
    The Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, Oakland, California
    Search for articles by this author
Published:October 08, 2018DOI:https://doi.org/10.1016/j.jvoice.2018.09.015

      Abstract

      Objective

      Vocal fold motion impairment (VFMI) is a potential consequence of intubation. Studies describing the natural course of this complication are largely case reports. This study aims to evaluate outcomes for a cohort of patients who endured varying degrees of vocal fold immobility or hypomobility post-intubation.

      Study Design

      Retrospective chart review.

      Methods

      Upon excluding known causes of VFMI, such as surgeries and tumors involving the head and neck, VFMI cases (ICD-9 diagnosis code 478.3) were identified from 2008 to 2014 at a regional healthcare institution. A total of 2,387 were identified and of those, 25 were intubation-induced VFMI cases. This cohort was then examined for notable features.

      Results

      With a mean prolonged intubation duration of 6.55 days, 68% of cases resulted in left unilateral, 8% right unilateral, and 24% bilateral VFMI. Overall, 80% of patients experienced a recovery outcome (voice improvement or restoration of vocal fold mobility). Median recovery time was 4.31 months (mean, 6.51 months; range, 19-715 days). In cases of unilateral VFMI, 95% of cases had a recovery outcome. In cases of bilateral VFMI, 33% of cases had a recovery outcome. Additionally, bilateral cases showed a statistically significant association with an approximately 36-fold lower odds of recovery than unilateral cases (odds ratio, 0.0278; 95% confidence interval, 0.0020-0.3868; P value, 0.0077).

      Conclusions

      Intubation-induced VFMI is rare. In this cohort, most cases resulted from prolonged intubation. While spontaneous recovery was the most common outcome, full remission was not guaranteed in every case. A sizable proportion of cases revealed bilateral motion impairment which was less likely to resolve. Our results are informative for tracheostomy decision-making and differential diagnoses for post-intubation laryngeal symptomatology.

      Key Words

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