School of Medicine, Baylor College of Medicine, Houston, Texas, U.S.A.
Department of Pediatric Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, U.S.A.
Laryngoscope. 2021 Nov;131(11):2545-2549. doi: 10.1002/lary.29582. Epub 2021 Apr 23.
OBJECTIVES/HYPOTHESIS: Vocal fold movement impairment (VFMI) in infants and children is most commonly evaluated by flexible nasolaryngoscopy (FNL). FNL in this population can be challenging due to movement, floppy supraglottic structures, or secretions. Laryngeal ultrasound (LUS) may be an alternative, less invasive means of evaluating VFMI that also decreases aerosolization during the COVID-19 pandemic. The primary objective was to examine LUS interpretation proficiency for VFMI via an educational module. A secondary outcome was to determine whether quantitative measurements increase interpretation accuracy.
Prospective cohort trial.
Medical students, residents, fellows, faculty, and staff were recruited to complete the module, composed of a 13-minute teaching video followed by 20 cases. Participants determined both qualitatively (subjective assessment) and then quantitatively (through protractor measurements of the vocal fold to arytenoid angle) whether there was normal versus impaired vocal fold mobility.
Thirty participants completed the LUS training module, and about one-third were otolaryngology residents. On average, each participant correctly identified 18 cases. The mean rank percent correct for quantitative measurements was significantly higher than that of qualitative interpretations (P < .0001). Measurements significantly caused participants to change their answer correctly compared to incorrectly (P < .0001). As the module progressed, there was no significant trend of more correct interpretations (P = .30). The sensitivity was higher for quantitative interpretations (89.0% vs. 87.3%) but specificity remained unchanged (92.6%).
Quantitative measurements may increase LUS interpretation accuracy. There was not a specific number of cases interpreted to achieve learning proficiency. LUS is an easily learned method to evaluate for VFMI across all training levels.
3 (local cohort study nonrandomized) Laryngoscope, 131:2545-2549, 2021.
目的/假设：婴儿和儿童的声带运动障碍（VFMI）最常通过软性鼻咽喉镜检查（FNL）进行评估。由于运动、软腭结构或分泌物，该人群的 FNL 可能具有挑战性。喉超声（LUS）可能是一种替代的、侵入性较小的评估 VFMI 的方法，也可以减少 COVID-19 大流行期间的气溶胶化。主要目的是通过教育模块检查 LUS 对 VFMI 的解释能力。次要结果是确定定量测量是否会提高解释准确性。
前瞻性队列试验。
招募医学生、住院医师、研究员、教师和工作人员完成该模块，该模块由 13 分钟的教学视频和 20 个病例组成。参与者根据定性（主观评估）和定量（通过声带至杓状软骨角的量角器测量）来确定是否存在正常或受损的声带运动。
30 名参与者完成了 LUS 培训模块，其中约三分之一是耳鼻喉科住院医师。平均而言，每位参与者正确识别了 18 个病例。定量测量的平均正确百分比明显高于定性解释（P <.0001）。与不正确相比，测量显著导致参与者正确改变答案（P <.0001）。随着模块的进展，正确解释的数量没有明显增加的趋势（P =.30）。定量解释的敏感性更高（89.0%比 87.3%），但特异性保持不变（92.6%）。
定量测量可能会提高 LUS 解释的准确性。没有具体的解释案例数量来实现学习能力。LUS 是一种易于学习的方法，可用于评估各级培训的 VFMI。
3（局部队列研究非随机）喉镜，131：2545-2549，2021。
