Postintubation phonatory insufficiency: An elusive diagnosis

Objective: To describe postintubation phonatory insufficiency, a routinely overlooked complication of prolonged intubation. This entity results from an erosive injury with permanent divots of the medial surfaces of the arytenoid cartilages and/or scarring of the anterior cricoarytenoid joint capsule so that during phonation there is incomplete adduction and a glottic gap remains. Setting: Tertiary care center. Study design/results: We present a retrospective review of the findings of 138 patients evaluated for chronic intubation injuries in our voice laboratory using a diagnostic model composed of pertinent history, elicited vocal capabilities and limitations, and an intense fiberoptic laryngeal examination directed at revealing the suspected injuries. Conclusion/significance: In many patients, the diagnosis of postintubation phonatory insufficiency was made years after the intubation injury occurred and after numerous nondiagnostic examinations elsewhere. Mechanisms of intubation injury are reviewed, and prevention and treatment of the condition are discussed. (Otolaryngol Head Neck Surg 2001;124:625-33.)