Effect of endotracheal intubation versus laryngeal mask airway on patient’s quality of voice and swallowing
Keywords:Endotracheal intubation, Laryngeal mask airway, Voice, Swallowing
Background: The aim of our study was to evaluate postoperative voice and swallowing disorders during the first postoperative week and to compare these findings between two anesthesia methods: endotracheal intubation tube (ETI) and laryngeal mask airway (LMA).
Methods: We conducted a prospective cohort study of patients who underwent laparoscopic cholecystectomy with ETI (n=103) and patients who underwent open hernioplasty or lower extremity varicectomy with LMA (n=100). All subjects underwent preoperatively and during the first postoperative week laryngeal imaging by videolaryngostroboscopy (VLS), filled in subjective evaluations of voice and swallowing complaints. In addition, acoustic voice analysis (AVA), maximum phonation time (MPT) measurement and perceptual voice evaluation were conducted.
Results: VLS showed visual changes in pharyngeal and laryngeal anatomy in 4 (4%) patients of the LMA group and 14 (13.6%) patients of the ETI group (p=0.02). No statistically significant postoperative subjective voice and swallowing changes were found in either group. In female patients AVA showed a statistically significant increase of the SPI value in the ETI group (p=0.037). In male patients we noted an increase in mean fundamental frequency (F0) and decrease in MPT with both ventilation methods.
Conclusions: Both investigated ventilation methods can be regarded as practically equal. Although clinical signs showed more intense trauma in the ETI group, objective measurements and patient subjective evaluation of voice and swallowing function were similar in both groups.
Mendels EJ, Brunings JW, Hamaekers AW, Stokroos RJ, Kremer B, Baijens LJ. Adverse laryngeal effects following short-term general anesthesia: A systematic review. Arch Otolaryngol Neck Surg. 2012;138(3):257-64.
Pröschel U, Eysholdt U. Kurzzeit-Veränderungen an Kehlkopf und Stimme nach Intubation. Laryngol Rhinol Otol. 2008;72(02):93-7.
Rieger A, Brunne B, Hass I, Brummer G, Spies C, Striebel HW, et al. Laryngo-pharyngeal complaints following laryngeal mask airway and endotracheal intubation. J Clin Anesth. 1997;9(1):42-7.
Friedrich T, Hansch U, Eichfeld U, Steinert M, Staemmler A, Schonfelder M. Recurrent laryngeal nerve paralysis as intubation injury? Chir Z Alle Geb Oper Medizen. 2000;71(5):539-44.
Chun B-J, Bae J-S, Lee S-H, Joo J, Kim E-S, Sun D-I. A prospective randomized controlled trial of the laryngeal mask airway versus the endotracheal intubation in the thyroid surgery: evaluation of postoperative voice, and laryngopharyngeal symptom. World J Surg. 2015;39(7):1713-20.
Van Esch BF, Stegeman I, Smit AL. Comparison of laryngeal mask airway vs tracheal intubation: a systematic review on airway complications. J Clin Anesth. 2017;36:142-50.
Hamdan A, Kanazi G, Rameh C, Rifai H, Sibai A. Immediate post-operative vocal changes in patients using laryngeal mask airway versus endotracheal tube. J Laryngol Otol. 2008;122(8):829-35.
Radu AD, Miled F, Marret E, Vigneau A, Bonnet F. Pharyngo-laryngeal discomfort after breast surgery: comparison between orotracheal intubation and laryngeal mask. Breast. 2008;17(4):407-11.
Safaeian R, Hassani V, Movasaghi G, Alimian M, Faiz HR. Postoperative respiratory complications of laryngeal mask airway and tracheal tube in ear, nose and throat operations. Anesthesiol Pain Med. 2015;5(4):e25111.
Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS, et al. The voice handicap index (vhi) development and validation. Am J Speech Lang Pathol. 1997;6(3):66-70.
Lombardi CP, Raffaelli M, D’Alatri L, Marchese MR, Rigante M, Paludetti G, et al. American Association of Endocrine Surgeons: Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006;140:1026-34.
Hirano M. Clinical examination of voice. Disord Hum Commun. 1981;5:1-99.
Dejonckere PH, Obbens C, de Moor GM, Wieneke GH. Perceptual evaluation of dysphonia: reliability and relevance. Folia Phoniatr (Basel). 1993;45(2):76-83.
DeJonckere PH, Crevier-Buchman L, Marie JP, Moerman M, Remacle M, Woisard V. Implementation of the European Laryngological Society (ELS) basic protocol for assessing voice treatment effect. Rev Laryngol Otol Rhinol. 2003;124(5):279-83.
De Bodt MS, Wuyts FL, Van de Heyning PH, Croux C. Test-retest study of the GRBAS scale: influence of experience and professional background on perceptual rating of voice quality. J Voice Off J Voice Found. 1997;11(1):74-80.
Stojadinovic A, Henry LR, Howard RS, Gurevich-Uvena J, Makashay MJ, Coppit GL, et al. Prospective trial of voice outcomes after thyroidectomy: evaluation of patient-reported and clinician-determined voice assessments in identifying postthyroidectomy dysphonia. Surgery. 2008;143(6):732-42.
Sariego J. Vocal fold hypomobility secondary to elective endotracheal intubation: a general surgeon’s perspective. J Voice Off J Voice Found. 2010;24(1):110-2.
Gaynor EB, Greenberg SB. Untoward sequelae of prolonged intubation. Laryngoscope. 1985;95(12):1461-7.
Maktabi MA, Smith RB, Todd MM. Is routine endotracheal intubation as safe as we think or wish? Anesthesiology. 2003;99(2):247-8.
Kitahara S, Masuda Y, Kitagawa Y. Vocal fold injury following endotracheal intubation. J Laryngol Otol. 2005;119(10):825-7.
Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, et al. Laryngeal Morbidity and Quality of Tracheal IntubationA Randomized Controlled Trial. Anesthesiology. 2003;98(5):1049-56.
Karcz M, Papadakos PJ. Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Can J Respir Ther. 2013;49(4):21-9.
Zimmert M, Zwirner P, Kruse E, Braun U. Effects on vocal function and incidence of laryngeal disorder when using a laryngeal mask airway in comparison with an endotracheal tube. Eur J Anaesthesiol. 2007;16(8):511-5.
Fu S, Lin W, Zhao X, Ge S, Xue Z. Quantitative Relationships between pulmonary function and residual neuromuscular blockade. BioMed Res Int. 2018;2018:9491750.
Koreman J and Putzer M. Finding correlates of vocal fold adduction deﬁciencies. Phonus 1997;3:155–78
Mathew MM, Bhat JS. Soft phonation index: a sensitive parameter? Indian J Otolaryngol Head Neck Surg Off Publ Assoc Otolaryngol India. 2009;61(2):127-30.
Bhuta T, Patrick L, Garnett JD. Perceptual evaluation of voice quality and its correlation with acoustic measurements. J Voice Off J Voice Found. 2004;18(3):299-304.
Hunter EJ, Tanner K, Smith ME. Gender differences affecting vocal health of women in vocally demanding careers. Logoped Phoniatr Vocol. 2011;36(3):128-36.
Bangasser DA, Valentino RJ. Sex differences in stress-related psychiatric disorders: neurobiological perspectives. Front Neuroendocrinol. 2014;35(3):303-19.
Kessler RC, Brown RL, Broman CL. Sex differences in psychiatric help-seeking: evidence from four large-scale surveys. J Health Soc Behav. 1981;22(1):49-64.
Venugopal A, Jacob RM, Koshy RC. A randomized control study comparing the pharyngolaryngeal morbidity of laryngeal mask airway versus endotracheal tube. Anesth Essays Res. 2016;10(2):189-94.
Park SK, Ko G, Choi GJ, Ahn EJ, Kang H. Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis. In: Hanaoka. K, ed. Baltimore: Medicine. 2016;95(33):e4598.