Transcutaneous laryngeal ultrasound shows potential as a noninvasive and accurate alternative to laryngoscopy for screening and postoperative review of vocal cord polyps, according to research published online June 23 in Ultrasound in Medicine & Biology.
In a study of 87 adult participants undergoing surgery at a hospital in China, transcutaneous laryngeal ultrasonography identified almost 90% of the polyps found on laryngoscopy. The modality was particularly effective in patients whose thyroid cartilage had little or no calcification.
"In this patient group, ultrasound can yield an accurate diagnosis, be noninvasive and safe, and be an effective supplement to laryngoscopy for the initial screening of vocal fold polyps and postoperative review," wrote the authors, led by Dr. Hua Wang from the department of ultrasound at the Second Affiliated Hospital of Xi'an Jiatong University in Xi'an.
As ultrasound becomes more prominent in clinical practice, studies have found the modality to be beneficial for visualizing numerous vocal cord issues, such as paralysis and nodules. However, few studies have evaluated the use of laryngeal ultrasound for vocal cord polyps, one of the most common benign vocal fold lesions seen in clinical practice, according to the authors.
The study included 87 participants undergoing surgery for vocal fold polyps at a single hospital in China. Before surgery, the patients underwent both laryngoscopy and transcutaneous laryngeal ultrasonography.
Ultrasound detected 81 polyps, compared with 92 detected by laryngoscopy. The rate of detection on ultrasound was higher for circular polyps (92%) than noncircular ones (71%), but the difference was not statistically significant.
The amount of thyroid cartilage had a substantial effect on ultrasound's ability to visualize the vocal folds of some patients. While the authors could visualize the folds for most patients, visibility decreased dramatically for patients with higher ratios of thyroid calcification to cartilage.
Notably, the authors visualized 100% of vocal folds for patients with little to no calcification and 90% of vocal folds in participants with a thyroid calcification-to-cartilage ratio of 34% to 66%. But the percentage of visualized folds fell to just 37.5% for patients with a calcification-to-cartilage ratio exceeding 66%.
"We found that thyroid cartilage calcification at the level of the glottis was the real influence on the vocal fold visualization," the authors wrote.
To help mitigate the effect of calcification and improve depth visualization, the authors placed the ultrasound probe at the side of the patients' neck at the level of the glottis. They also asked patients to hold their breath, which closed the vocal folds.
The authors intend to build upon their research in future studies with a larger number of participants and new imaging techniques. Their hope is to improve diagnostic accuracy even further, especially for noncircular polyps.
"We aim to find ways to improve the diagnostic accuracy of ultrasound for noncircular vocal fold polyps, develop ultrasound for the diagnosis of various benign and malignant lesions of vocal folds, and provide supportive data for voice and other related research," they wrote.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
