Journal of voice : official journal of the Voice Foundation · 2026
Reliability of Transcutaneous Laryngeal Ultrasonography Performed as Point-of-Care Ultrasound (POCUS) of the Larynx: A Preliminary Prospective Cohort Study.
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Patel Agastya, Spychalski Piotr, Kobiela Jarek
Аннотация
BACKGROUND: Transcutaneous laryngeal ultrasonography is an emerging non-invasive method for assessing vocal fold function and has shown promise as a screening tool for vocal fold palsy. Existing evidence, however, is almost exclusively based on high-end conventional ultrasonography. With the increasing adoption of point-of-care ultrasonography (POCUS) devices across diverse clinical settings, understanding their reliability in transcutaneous laryngeal ultrasonography (TLUSG) is essential. To date, no study has directly compared POCUS and conventional ultrasonography for vocal fold visualization or diagnostic accuracy.
METHODS: In this prospective cohort study, six ultrasound-naïve medical students completed a structured TLUSG training program followed by supervised examinations of patients undergoing peri-thyroidectomy vocal fold assessment. Each patient underwent laryngoscopy performed by an otolaryngologist, followed by TLUSG using a handheld POCUS device (Butterfly iQ+) and a conventional ultrasonography (CUS) system (Mindray ME8). Vocal fold visualization rates and diagnostic accuracy metrics were calculated for both modalities, using laryngoscopy as the reference standard. Comparisons were performed using the McNemar test.
RESULTS: A total of 229 TLUSG examinations with each device were performed in 96 patients (mean age 48.05 ± 14.07 years). Vocal fold visualization rates were comparable between POCUS and CUS (94.3% vs 96.1%; P = 0.29). Sensitivity (58.3% vs 65.7%; P = 0.5), specificity (97.8% vs 98.4%), positive predictive value, and negative predictive value did not differ significantly between modalities. Sensitivity improved with operator experience, reaching 61.9%-72.2% with POCUS and 71.4%-77.8% with CUS in later examinations. Only six examinations showed discordant visualization outcomes between devices.
CONCLUSION: Point-of-care ultrasonography demonstrates comparable vocal fold visualization rates and diagnostic performance to conventional ultrasonography for TLUSG, even when performed by novice operators. Given its affordability, portability, and accessibility, point-of-care ultrasound may meaningfully expand the clinical utility and implementation of TLUSG in perioperative and outpatient settings.
METHODS: In this prospective cohort study, six ultrasound-naïve medical students completed a structured TLUSG training program followed by supervised examinations of patients undergoing peri-thyroidectomy vocal fold assessment. Each patient underwent laryngoscopy performed by an otolaryngologist, followed by TLUSG using a handheld POCUS device (Butterfly iQ+) and a conventional ultrasonography (CUS) system (Mindray ME8). Vocal fold visualization rates and diagnostic accuracy metrics were calculated for both modalities, using laryngoscopy as the reference standard. Comparisons were performed using the McNemar test.
RESULTS: A total of 229 TLUSG examinations with each device were performed in 96 patients (mean age 48.05 ± 14.07 years). Vocal fold visualization rates were comparable between POCUS and CUS (94.3% vs 96.1%; P = 0.29). Sensitivity (58.3% vs 65.7%; P = 0.5), specificity (97.8% vs 98.4%), positive predictive value, and negative predictive value did not differ significantly between modalities. Sensitivity improved with operator experience, reaching 61.9%-72.2% with POCUS and 71.4%-77.8% with CUS in later examinations. Only six examinations showed discordant visualization outcomes between devices.
CONCLUSION: Point-of-care ultrasonography demonstrates comparable vocal fold visualization rates and diagnostic performance to conventional ultrasonography for TLUSG, even when performed by novice operators. Given its affordability, portability, and accessibility, point-of-care ultrasound may meaningfully expand the clinical utility and implementation of TLUSG in perioperative and outpatient settings.