B1.2 Implementation of a screening tool and action plan for suspected vocal cord palsy

Background We review the implementation of a screening tool for suspected vocal cord palsy using ultrasound (US). This is used at our institution to evaluate children with changes to their voice or cry who are not under the primary care of otolaryngology services. Methods A retrospective review (1 st Jan 2015 – 1 st June 2017) of patients referred for US screening of vocal cord function at a single specialist paediatric centre. Results In thirty months, 36 children underwent US assessment of vocal cord function (aged 8 days – 16 years). It was possible to assess vocal cord mobility in all patients. Cases included 22 following cardiothoracic surgery. 21 of 36 had normal US and no subsequent endoscopy. 15 had abnormal function detected (11 left vocal cord palsy, 2 right, 2 bilateral). 12 of the 15 abnormal scans had subsequent endoscopic laryngeal assessment as per the screening protocol. 11 of 12 endoscopic assessments were concordant with US findings. One suspected left VC palsy was not evident at endoscopy. 3 cases lacked sufficient documentation of endoscopy to evaluate concordance. No cases with a negative US scan had a subsequent diagnosis of vocal palsy. Discussion Ultrasonography has been considered an adjunct for evaluation of vocal cord function. The largest cohort of patients in our screening process presented following cardiothoracic surgery. The implementation of this ultrasound screening protocol allowed 58% of cases to avoid endoscopic laryngeal evaluation with no false negatives. Concordance between positive US and endoscopic findings was high (92%). We suggest this is a reliable screening tool to identify vocal cord palsy and avoid unnecessary endoscopic assessment of the larynx.