Annals of Surgical Oncology

, Volume 22, Issue 6, pp 1774–1780 | Cite as

Assessing the Validity of Transcutaneous Laryngeal Ultrasonography (TLUSG) After Thyroidectomy: What Factors Matter?

  • Kai-Pun Wong
  • Brian Hung-Hin LangEmail author
  • Yuk-Kwan Chang
  • Kam Cheung Wong
  • Felix Che-Lok Chow
Endocrine Tumors



Although transcutaneous laryngeal ultrasound (TLUSG) is an excellent, noninvasive way to assess vocal cord (VC) function after thyroidectomy, some patients simply have “un-assessable” or “inaccurate” examination. Our study evaluated what patient and surgical factors affected assessability and/or accuracy of postoperative TLUSG.


Five hundred eighty-one consecutive patients were analyzed. All TLUSGs were done by one operator using standardized technique, whereas direct laryngoscopies (DL) were done by an independent endoscopist to confirm TLUSG findings. Their findings were correlated. TLUSG was “unassessable” if ≥1 VC could not be clearly visualized, whereas it was “inaccurate” if the TLUSG and DL findings were discordant. Demographics, body habitus, neck anthropometry, and position of incision were correlated with assessability and accuracy of TLUSG.


Twenty-nine (5.0 %) patients had “unassessable” VCs; among the “assessable” patients, 29 (5.3 %) patients had “inaccurate” TLUSG. More than one-third (38.5 %) of VC palsies (VCPs) were “inaccurate.” Older age (odds ratio [OR] = 1.055, 95 % confidence interval [CI] 1.016–1.095, p = 0.005), male sex (OR = 13.657, 95 % CI 2.771–67.315, p = 0.001), taller height (OR = 1.098, 95 % CI 1.008–1.195, p = 0.032), and shorter distance from cricoid cartilage to incision (OR = 0.655, 95 % CI 0.461–0.932, p = 0.019) were independent factors for “unassessable” VCs, whereas older age (OR = 1.028, 95 % CI 1.001–1.056, p = 0.040) was the only factor of incorrect assessment.


Older age, male sex, tall in height, and incision closer to the thyroid cartilage were independent contributing factors for unassessable VCs, whereas older age was the only contributing factor for inaccurate postoperative TLUSG. Because more than one-third of VCPs were actually normal, patients labeled as such on TLUSG would benefit from laryngoscopic validation.


Vocal Cord Body Habitus Direct Laryngoscopic Vocal Cord Palsy Thyroid Cartilage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This paper was presented as a poster presentation at the Annual Congress of the 2014 American Association of Endocrine Surgeons in Boston, MA.


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Kai-Pun Wong
    • 1
  • Brian Hung-Hin Lang
    • 1
    Email author
  • Yuk-Kwan Chang
    • 1
  • Kam Cheung Wong
    • 1
  • Felix Che-Lok Chow
    • 1
  1. 1.Division of Endocrine Surgery, Department of SurgeryThe University of Hong Kong, Queen Mary HospitalHong Kong SARChina

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