Objective: Vocal fold immobility (VFI) is a cause of significant morbidity and mortality in the paediatric population. Laryngoscopy is the current first-line investigation for patients with suspected VFI. Laryngeal ultrasound (LUS) has recently emerged as an alternative method of identifying VFI. Compared to laryngoscopy, LUS is less invasive, does not require anaesthesia, and can be performed by non-otolaryngologists. The primary objective of this study is to evaluate LUS as a diagnostic method for the identification of unilateral VFI in a cohort of paediatric patients in Aotearoa New Zealand (NZ). The secondary objective is to estimate the frequency of use of LUS in the paediatric population around the world. Methods: A retrospective, single-centre cohort study was performed on all paediatric patients who had undergone laryngoscopy and LUS at Starship Children’s Health between 2020 to 2023 in Auckland, NZ. An eight-question survey was also developed and distributed to better understand clinicians’ use of LUS to diagnose paediatric VFI globally. Results: Twenty-three paediatric patients met the inclusion criteria. LUS demonstrated high sensitivity (100%), specificity (63%), positive predictive value (83%), and negative predictive value (100%) for detecting unilateral VFI within our patient population. Out of the eighty-seven respondents to the survey, nearly half utilise LUS in their clinical practice in the paediatric population. The main barrier for those who do not is lack of expertise, equipment, and training. Conclusions: These findings support the use of LUS as a safe and accurate diagnostic tool for the detection of unilateral VFI. Further studies in non-surgical populations and standardised guidelines for LUS technique and reporting are required.

Background Airway obstruction in a child requires expedite management in addition to comprehensive discussion between the Otolaryngology and Anaesthesiology team to formulate a treatment plan to ensure safe airway. Juvenile-onset recurrent respiratory papillomatosis (JORRP) is an exophytic benign laryngeal lesion which poses a great challenge when presented with respiratory distress. Objective: This paper presents a novel, safe and cost-effective approach to temporary tracheal ventilation of the obstructed airway in a child with juvenile-onset recurrent respiratory papillomatosis using the laryngeal suction tube connected to general anaesthetic (GA) machine. Result and Conclusion Rigid laryngeal suction tube is placed through the side-port of Lindholm laryngoscope and connected to breathing circuit of GA machine via modification of the suction tubing and endotracheal tube (ETT) 15mm male connector. Manual bagging ventilation with 100% FiO2 achieved good oxygenation throughout the debulking of the papilloma without hindering the surgical field. Our technique utilizes the readily available equipment whilst enabling safe anaesthesia and providing good surgical field during excision of obstructive papillomatous airway lesion.