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1 Vocal Cord Paralysis as a -Evman, Melis Endotracheal intubation is a commonly used method for -Intubation La parálisis
Complication of Demirag MD securing airway. It is considered to be safe but it can still -Surgical vocal es un
Endotracheal Intubation lead to some complications of the airway. Recurrent nerve complicacio
-Selcuk, Ayse Adin paralysis due to endotracheal intubation is a rare -Complication rara de una
PhD complication. Pathophysiology is explained as neuropraxia of Vocal cord paralysis endotraque
RLN's compression between the tube and the lamina of the parálisis un
thyroid cartilage or between arytenoid and cricoid cartilages las cuerdas
due to tube cuff pressure or tube itself. In literature, más común
unilateral vocal cord paralysis (VCP) due to intubation is parálisis bil
more common than bilateral paralysis. In the presented case
report, a young patient stayed intubated for only 3 days in
intensive care unit who experienced bilateral VCP 2 days
after extubation. He had total recovery 5 days after
emergency tracheotomy suggesting neuropraxia of the
nerve. Neuropraxia of RLN resulting in bilateral VCP due to
inappropriate size or excess cuff pressure of the intubation
tube may be the underlying reasons. The clinicians must be
aware of complications of intubation and should apply
appropriate treatment method as soon as possible.
Appropriate size and cuff pressure should be chosen for
endotracheal intubation.
2 Effect of Endotracheal -Derya Abes Department of Objectives -Intubation Este artícu
Intubation on Voice -Kemal Tuzun Otolaryngology Following endotracheal intubation (ETI), voice changes can el impacto
-Birgul Tuhanioglu be observed quite frequently. Considering that the pressure -Endotracheal intubación
-Sanem Oksan Erjan that occurs increases as the duration of anesthesia with ETI endotraqu
-Talih Ozdas increases, with the aim to contribute to literature, we -Acoustic analysis; y cuánto
-Ozgul Akin Senkal realized objective acoustic analysis by grouping patients Voice mediante
according to the length of surgical periods. We wanted to realización
investigate both the impact of endotracheal intubation on de voz en
the voice and how long this impact lasted by performing preoperat
 voice analyzes on the preoperative, postoperative first day posoperat
and postoperative fifth day. quinto día
posoperat
Material and methods
Patients were examined in three groups comprised of
operations lasting less than 60 minutes depending on the
operation time (1st group, n = 21), operations lasting
between 60-120 minutes (2nd group, n = 21) and operations
lasting longer than 120 minutes (3rd group, n = 18). For
patients in all three groups, preoperative, postoperative first
day and postoperative fifth day voice analyzes have been
performed and compared statistically.

Results
With the evaluation made on the postoperative first day, it
was found that the jitter%, shimmer% and shimmer dB
values increased significantly as the operation time
increased and it was observed that the HNR values
decreased significantly (for jitter% P = 0,008, for shimmer% P
= 0,027, for shimmer dB P = 0,025, for HNR P = 0,028). There
was no significant difference between the postoperative first
day F0 values and postoperative fifth day F0, jitter%,
shimmer%, shimmer dB and HNR values in all three groups.

Conclusion
It is possible to state that ETI makes changes in the voice in
the early period, but the changes are normalized in the long
term. However, multidisciplinary studies with larger patient
groups are needed for more precise and clear judgments.
3 Effects of short-term -Robert Mayo MS University of the Transient voice change associated with endotracheal En este ar
endotracheal intubation -Neal S. Beckford MD Tennessee intubation has generally been attributed to vocal fold diseñó un
on vocal function -Albert Wilkinson III trauma. To assess the role of altered vocal fold function in evaluar la
MD transient voice change, a study was designed to evaluate the caracterís
-Michael Tierney DO audio-acoustic, endoscopic, and laryngostroboscopic audioacús
characteristics of the postintubation voice. Vocal function of endoscóp
10 patients undergoing short-term outpatient surgical laringoest
procedures using general anesthesia and endotracheal s de la voz
intubation were studied preoperatively and postoperatively. postintuba
A second group of 10 patients that did not have surgery or
general anesthesia was used as an age-matched control.
Fundamental frequency, frequency perturbation,
electroglottography, en-doscopy (including laryngeal
stroboscopy), and subjective speech analysis by experienced
listeners were used to assess vocal function.
No consistent differences in fundamental frequency were
observed, although patient-to-patient variation was marked.
Statistically significant increases in cycle-to-cycle
fundamental frequency variation (jitter) were found
postoperatively in the majority of the postintubation
patients (P<0.05). Electroglottography, laryngeal endoscopy,
and stroboscopic laryngoscopy did not demonstrate
consistent changes in glottic mucosal function. Listener
judgments characterized the postintubation voice change by
decreased intensity, increased roughness, and lowered
affect without consistent changes in pitch. The perception of
decreased affect in the voices (characterized by reduction in
pitch variation, vocal stress, and increases in pause times)
was a strong perceptual marker for change in the
postintubation voice. Objective measures of laryngeal
function suggest that the glottic contribution to
postintubation voice change is minimal and that this
dysphonia is probably multifactorial.
4 Laryngeal Complications -Bruce Benjamin Department of An endotracheal tube placed in the larynx, even for a short laryngeal Este articu
of Endotracheal -Lauren D. Holinger Otolaryngology – time, causes at least superficial mucosal damage, an injury trauma, laryngosco las compli
Intubation Head and Neck that normally heals readily. Long-term intubation, on the py, long-term post intub
Surgery. other hand, may cause pressure necrosis that can extend intubation, posteri corto y lar
Northwestern into submucosa, perichondrium, and eventually cartilage. or glottic sirve para
University The sites of involvement include the medial surface of the stenosis, subglottic distintas p
Feinberg School arytenoid cartilages, vocal processes, cricoarytenoid joints, stenosis base al tie
of Medicine. posterior glottis, and subglottis. We review the intubación
pathogenesis, endoscopic recognition, classification, and
progression of intubation injuries and examine the many
variables that influence them. Diagrammatic flow charts
trace the acute injuries through to their chronic sequelae,
including subglottic stenosis, which is commoner in infants
and children, and posterior glottic stenosis, which is
commoner in adults. Systematic endoscopic assessment,
under general anesthesia, using rigid telescopes to evaluate
laryngeal damage during intubation is recommended and
critically discussed. Endoscopy permits an informed
judgment with regard to continuation of intubation.
Depending on the severity and depth of ulceration,
intubation can be continued (sometimes with a tube of
smaller diameter) or tracheotomy performed, with an
awareness of the attendant risks and benefits. Unnecessary
tracheotomies may be avoided. Further, it may be possible
to minimize untoward outcomes of prolonged intubation by
using management techniques directed at known risk
factors.
5 Videolaryngoscopy after -Gregory J. Gallivan Tufts University In a Critical Care setting, videolaryngoscopic techniques Videolaryngoscopy Con una
endotracheal intubation: -John A. Dawson School of document nearly universal vocal fold lesions in patients after Endotracheal videolarin
Part II. A critical care -Amy P. Opfell Medicine endotracheal intubation. A miniaturized, moderately priced, intubationMiniaturi puedo obs
 perspective of lesions transportable system, utilizing rigid and flexible fiberoptic zed transportable daño sobr
affecting voice laryngoscopes, coupled with a compact 8-mm camcorder, is system“Key-hold” vocales.
featured. Laryngeal damage begins within 1 h of placement and granulation
of an endotracheal tube. Posterior erosions at the level of lesionsDysphoniaAi
the vocal processes appear within 24 h, characteristic “key- rway
hole” lesions in the posterior glottis appear within 48 h, obstructionTracheo
granulations are seen within 72 h, and granulomatous stomy
polyps occur by 144 h after endotracheal intubation.
Nasogastric intubation promotes gastroesophageal reflux
laryngitis. Acute dysphonia, permanent voice problems, and
airway obstruction occur with greater frequency than
previously suspected. Early tracheostomy, within 6 days of
endotracheal intubation, appears to prevent permanent
vocal fold damage and provides comfortable, effective
airways toilette
6 Arytenoid Dislocation -Cedric A. Quick University of The reported incidence of arytenoid cartilage dislocation is
-Gerald E. Merwin Minnesota low. This may be due to the wide range and orientation of
Hospital motion allowed by the cricoarytenoid articulation and the
laxity of its joint capsule. In two previously reported
instances of arytenoid dislocation, the authors have
suggested that endotracheal intubation is generally not
sufficient to cause dislocation of an arytenoid cartilage, but
that, in their cases, a predisposing factor had set the
occasion for dislocation.

In this communication, three cases of arytenoid cartilage

dislocation, which each followed a single instance of
endotracheal intubation are presented. In all three cases,
painful swallowing was the main presenting symptom.
Clinical features that differentiate arytenoid cartilage
dislocation from vocal cord paresis are summarized. Early
 reduction of the dislocation, while the patient is under local
anesthesia, is recommended, and the techniques are
described in detail.
7 Long-term functional -Eui Suk Sung -Department of Purpose The aim of this study was to evaluate long-term Long-term · Voice
voice outcomes after -Ki Young Kim Otolaryngology- functional voice outcomes after thyroidectomy, and the outcome ·
thyroidectomy, and -Bo Ram Yun Head and Neck effect of Thyroidectomy ·
effect of endotracheal -Chang Myeon Song Surgery, College endotracheal intubation on post-operative voice Post-
intubation on voice -Yong Bae Ji of Medicine, impairment. thyroidectomy
-Jin Choon Lee Hanyang Methods We prospectively analyzed the voice outcomes of syndrome ·
-Kyung Tae University, 155 serial thyroidectomy patients for up to 2 years. The Acoustic analysis ·
222 Wangsimni- control Endotracheal
ro, Seongdong- group consisted of 69 patients who underwent intubation
gu, Seoul 04763, parotidectomy. Patients with post-operative recurrent
Republic of Korea laryngeal nerve palsy or
palsy of the external branch of the superior laryngeal nerve
- Department of were excluded. Self-assessment voice symptom scores (VSS)
Otolaryngology, by
Head and Neck questionnaire, and objective acoustic parameters and
Surgery, maximum phonation times, were evaluated pre-operatively
College of and 1 day,
Medicine and 3 days, 1 week, 1 month, 3, 6, 12, 18, and 24 months after
Research Institute surgery.
for Convergence Results VSS increased from day 1 after surgery in both
of Biomedical groups, and returned to pre-operative levels by 24 months in
Science and the
Technology, thyroidectomy group and after 1 week post-operatively in
Pusan National the parotidectomy (control) group. The post-operative VSS
University, of
Yangsan, Republic the thyroidectomy group was significantly higher than that
of Korea of the control group up to 12 months post-operatively.
Highest
 frequency decreased immediately after surgery in the
thyroidectomy group, and recovered to pre-operative levels
by 12 and
18 months in females and males, respectively, whereas it
recovered to pre-operative levels after the first week in the
control
group.
Conclusion Impairment of voice function may persist for
more than 18 months after thyroidectomy even in patients
without
RLN palsy. Endotracheal intubation can affect voice
outcomes adversely for 1 week post-operatively
8 A Prospective -Byung-Joon Chun The Catholic Background
Randomized Controlled -Ja-Sung Bae University of The present study was performed to determine whether
Trial of the Laryngeal -So-Hui Lee Korea thyroidectomy patients undergoing general anesthesia
Mask Airway Versus the -Jin Joo provided with a laryngeal mask airway (LMA) have a lower
Endotracheal Intubation -Eun-Sung Kim risk of voice-related complications and laryngopharyngeal
in the Thyroid Surgery: -Dong-II Sun symptoms than those undergoing endotracheal intubation
Evaluation of (ETI).
Postoperative Voice, and
Laryngopharyngeal Materials and methods
Symptom In a prospective, double-blinded, randomized clinical trial,
we studied 64 patients undergoing elective thyroid
lobectomy between July 2013 and February 2014. Acoustic
analyses were performed preoperatively and at 48 h and 2
weeks postoperatively. The voice handicap index (VHI), M.D.
Anderson dysphagia index (MDADI), and laryngopharyngeal
symptom score (LPS) were determined preoperatively and at
24 h, 48 h, 1 week, and 2 weeks post-thyroidectomy.

Results
In acoustic analysis, jitter, shimmer and noise-to-harmonic
ratio showed significantly better results in the LMA group
than the ETI group 48 h after surgery, but there was no
difference at 2 weeks. The incidence of postoperative lower-
pitched voice in the LMA group was also significantly lower
than that in the ETI group. In the LMA group, the VHI,
MDADI, and LPS were better compared to those in the ETI
group at 24 h postoperatively, and improved to the
preoperative state within 1 week. However, those in the ETI
group remained poorer than the preoperative values 1 week
after surgery.

Conclusions
Use of the LMA in general anesthesia for thyroid surgery has
advantages over the ETI in decreasing patients’ subjective
and objective voice symptoms, reducing the duration of
symptoms, and relieving the laryngopharyngeal symptoms.