Comparison of the effectiveness of direct laryngoscopy fiberoptic laryngoscopy and ultrasonography in the assessment of vocal cord mobility after thyroid surgery [Tiroidektomi sonrasi vokal kord hareketinin deʇerlendirilmesinde direkt laringoskopi fiberoptik laringoskopi ve ultrasonografi yöntemlerinin karşilaştirilmasi]

Objective: direct laringoscopy (dl),fiberoptic laryngoscopy (fl) and ultrasonography (us) techniques were compared in terms of effectiveness and incidence of adverse events during the assessment of vocal cord (vc) mobility after thyroid surgery. method: after obtaining ethical approval and informed consent,75 adult patients were randomized into 3 groups and the mobility of the vocal cords were assessed after extubation according to group allocation. group usg: ultrasonography by placing a 5-12 mhz lineer transducer horizontally-midline on the thyroid cartilage; group dl: laringoscopy with a curved laryngoscope; group fl: laringoscopy with a fiberoptic laryngoscope,meanwhile a remifentanil infusion was maintained. the vocal cord visualization score (1: visible; 0: not visible),the patient reactivity score (prs: 1: no grimace,2: grimacing facial expression,3: head movements,4: protective head and limb movements,5: coughing and gagging),hemodynamic parameters,adverse events and the duration of the assessment were compared between groups. results: groups were different with regard to the ability of the techniques to visualize the vocal cords. symmetrical abductive and adductive vocal cord motion could be visualized in n: 25 (100%); n: 16 (64%); n: 22 (76%) patients in group usg,group dl and in group fl respectively (p= 0.005). the prs was the highest in group dl and the incidence of adverse events concerning both the respiratory and circulatory system (hypertension,tachycardia desaturation,coughing breath-holding) were higher in the groups dl and fl (p < 0.001). conclusion: ultrasonography is an effective method for the assessment of vocal cord mobility after thyroid surgery whereas assessment with dl andfl is associated with a high incidence of adverse events.