title: Correlation of glottal closure using concurrent ultrasonography and nasolaryngoscopy in children: a novel approach to evaluate glottal status.
abstract: OBJECTIVE
  Endoscopic procedures to assess aerodigestive symptoms by evaluating glottal motion are not practical in neonates because of small nares, respiratory difficulties, or additional stress. Our objective was to determine the temporal correlation between concurrent nasolaryngoscopy (NLS) and ultrasonography (USG) evaluation of glottal motion.
  
  
  METHODS
  Simultaneous USG of the glottis was performed in 10 subjects (5 males, 5 females, age = 4.5 months to 7.1 years) that underwent diagnostic flexible outpatient NLS. The USG transducer was placed on the anterior neck at the level of the vocal cords. The video signals from NLS and USG were integrated and synchronized into real-time cine loops of 1-min duration.
  
  
  RESULTS
  Frame-by-frame evaluation of 10,800 frames identifying glottal opening and closure time was compared between the two modalities by three observers and the timing of glottal closure was marked. Two investigators, blinded to NLS images, identified ultrasonographically determined glottal closure with 99% and 100% accuracy, and the mean probability of missing a closure frame was 0.007 (95% CI = 0.0008-0.024).
  
  
  CONCLUSIONS
  Temporal characteristics of glottal motion can be quantified by USG with perfect reliability and safety. This method can be useful in measuring the presence and the duration of laryngeal adduction.
authors.affiliation: Section of Neonatology, Pediatric Gastroenterology and Nutrition, Columbus Children's Hospital, Columbus, Ohio 43205, USA. jadcherlas@pediatrics.ohio-state.edu
authors.forename: Sudarshan R
authors.initials: SR
authors.lastname: Jadcherla
authors.forename: Alankar
authors.initials: A
authors.lastname: Gupta
authors.forename: Erin
authors.initials: E
authors.lastname: Stoner
authors.forename: Brian D
authors.initials: BD
authors.lastname: Coley
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wiet
authors.forename: Reza
authors.initials: R
authors.lastname: Shaker
mesh_terms: D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003679:Deglutition / Q000502:physiology*; D005260:Female; D005931:Glottis / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D010699:Phonation / Q000502:physiology*; D015203:Reproducibility of Results; D013997:Time Factors; D014463:Ultrasonography; D014827:Vocal Cords / Q000502:physiology; D014833:Voice Quality