Intubation is a medical procedure involving the insertion of a flexible tube, known as an endotracheal tube, into the windpipe to help a person breathe. While this intervention is often life-saving, it can potentially cause damage to the vocal cords. This article explores how vocal cord injury can occur, its symptoms, and options for diagnosis, recovery, and treatment.
Mechanisms of Vocal Cord Injury
Vocal cord injury during intubation can happen through direct trauma during tube insertion or removal. The tube or laryngoscope, a tool used to visualize the airway, might scrape or bruise delicate vocal cord tissue. More severe direct injuries can include dislocated arytenoid cartilages, small structures that help move the vocal cords.
Another mechanism involves pressure and friction from prolonged intubation. When an endotracheal tube remains in place for an extended period, continuous pressure against the vocal cords and surrounding structures can lead to swelling, inflammation, and ulcer formation. This sustained irritation can result in granulomas, small lumps of inflamed tissue. Movement or coughing against the tube can intensify friction, further contributing to tissue damage.
Signs and Diagnosis of Injury
After extubation, patients might experience symptoms indicating vocal cord injury. Hoarseness, or dysphonia, is a common sign, presenting as a raspy, weak, or breathy voice. Other vocal changes can include alterations in pitch. Patients may also report difficulty swallowing (dysphagia) or throat discomfort and pain. In severe instances, breathing difficulties, such as stridor (a high-pitched, noisy breath sound), can occur.
These symptoms typically appear immediately after extubation or within a few days. A healthcare provider diagnoses vocal cord injury primarily through visual examination. This often involves a laryngoscope or endoscope, allowing direct visualization of the larynx and vocal cords to assess damage. A review of the patient’s medical history and vocal quality evaluation also contribute to diagnosis.
Factors Affecting Injury Risk
Several factors can influence the likelihood and severity of vocal cord injury from intubation. Duration of intubation is a significant factor, with longer periods increasing damage risk. The endotracheal tube size relative to the patient’s airway also plays a role, as larger tubes exert more pressure.
Certain patient-specific factors can heighten the risk. These include pre-existing vocal cord conditions, patient age (pediatric patients are more susceptible), and body mass index (BMI). Acid reflux can further contribute to vocal cord irritation and vulnerability. Procedure-related factors, such as multiple intubation attempts, emergency intubation scenarios, excessive tube movement, or overly inflated cuff pressure, can also increase injury risk.
Recovery and Treatment Options
Many vocal cord injuries sustained during intubation are mild and resolve on their own. Recovery often involves conservative management, such as vocal rest and good hydration. Avoiding activities that strain the voice, like shouting or whispering, is recommended.
For persistent issues, various treatments are available. Medical interventions may address underlying conditions like reflux or infections. Voice therapy, with a speech-language pathologist, helps patients learn techniques to improve vocal function and reduce strain. This can involve breathing exercises and vocal warm-ups.
In severe or chronic cases, surgical interventions may be necessary. These procedures can address issues like granulomas, scarring, or vocal cord paralysis. Examples include laser removal of lesions, injections, or procedures designed to improve vocal cord movement. Surgical options are typically reserved for cases where conservative or medical treatments have not been effective. Recovery timeline varies depending on injury severity, ranging from a few days for mild cases to several months for more complex conditions.