Also known as a breathing tube, an endotracheal tube is placed during surgery to deliver oxygen and anesthetic gases in a controlled fashion. It may also be used in gravely ill persons who need the assistance of a ventilator. Rarely, it may cause injury to the posterior part of the larynx, especially when the tube remains in place for many weeks.
Breathing Tube Injury, not Vocal Cord Paralysis
Breathing Tube Injury may Correlate with Side of Mouth
Nuances of Endotracheal Tube Injury Distinguished from Paralysis
This woman with high-risk comorbidities of diabetes and obesity, was in ventilated in ICU more than a month for pulmonary complications of Covid-19 infection. She had an orotracheal tube in place for 3.5 weeks, and then a tracheotomy tube was placed. Now at her first visit a year later, she remains tracheotomy-dependent, and is told she has bilateral vocal cord paralysis (disproven in the photo series).
The plan here is posterior commissuroplasty, followed by placement of a smaller trach tube and a trial of plugging. If plugging is tolerated during the day, she will need a sleep study with it plugged at night, given the tracheomalacia and her obesity.
Breathing Tube Injury—A Rare Complication of Intubation for General Anesthesia
Conclusion: While we try to explain abnormality due to one cause, here, the patient has a mucosal injury and paresis of right TA and LCA muscles, which can also follow intubation. This explains why the initial postop voice was so weak and whispery, and also the rapid partial improvement. This voice will likely continue to improve and be very functional as a speaking voice. Fortunately, this person is not a singer, as clarity especially in upper notes, will likely be remain impaired even after full recovery.
Supraglottic, Glottic, and Subglottic Endotracheal Tube Injury
Using Your EARS to Understand Airway Narrowing
A narrowing anywhere in the breathing “pipe” that leads to the lungs causes shortness of breath, typically with harsh inspiratory noise on exertion. Such a narrowing can follow injury, intubation, cancer treatment, auto-immune disorders, etc.
It is possible to gain an immediate understanding of the magnitude of the airway narrowing within minutes by using a simple test “graded” with one’s ears. The severity of the problem can be understood before any examination or X-ray evaluation.