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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2022; 26(04): e524-e532
DOI: 10.1055/s-0041-1741435
Original Research

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility

Erin Rachel Cohen 
1   Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
,
Cortney Lee Dable 
1   Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
,
Thomas Iglesias 
1   Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
,
Eshita Singh
1   Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
,
Ruixuan Ma
2   Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
,
David Edward Rosow 
1   Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
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Abstract

Introduction Iatrogenic bilateral vocal fold immobility (BVFI) often arises from posterior glottic stenosis (PGS) after endotracheal intubation, whereby posterior commissure mucosal disruption leads to fibrosis and ankylosis of the cricoarytenoid joints. Sequelae can be devastating, resulting in dyspnea, stridor, and death due to asphyxiation.

Objectives We sought to review features associated with PGS to better understand how to prevent this condition. A secondary aim is to analyze factors correlating to tracheostomy dependence.

Methods Charts from January 2010 to November 2020 were retrospectively reviewed, and adult patients with the diagnosis of BVFI after intubation were included. Data on comorbidities, duration of intubation, laryngoscopy, and decannulation status was analyzed.

Results Out of the 68 patients included in the present study, 60.3% were male, and the mean duration of intubation 14.3 ± 8.5 days. A total of 94% of the patients were intubated for at least 7 days, diabetic, and/or obese. Although association with prolonged intubation >7 days was not significant (p = 0.064), complete BVFI on fiberoptic exam (n = 47) was significantly associated with tracheostomy dependence both in the entire cohort (p = 0.036) and in the 56 patients with tracheostomy (p = 0.0086). Patients without cardiovascular disease (CVD) were less likely to be tracheostomy dependent compared with those with CVD (odds ratio [OR]: 0.23 [0.053–0.79]; p = 0.028).

Conclusions We identified duration of intubation, DM, and obesity as potential risk factors for PGS. Complete immobility and CVD were significantly associated with tracheostomy dependence. Our findings may have important implications for earlier tracheostomy in high-risk intubated patients, as well as for closer monitoring of disease progression and earlier intervention in those predisposed to tracheostomy dependence.

Keywords

vocal cord paralysis - tracheostomy - device removal - laryngostenosis - glottis

Supplementary Material



Publication History

Received: 15 July 2021

Accepted: 19 September 2021

Article published online:
04 February 2022

© 2022. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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