Vocal Injury from Intubation

About Liam Landon

Liam Landon is an attending senior at Loyola High School. He is currently involved in the school's newspaper, a leader in the Ignatian Scholars program, and the president of the Loyola Rowing Club. He plans to attend a four-year university in pre-medicine studies. Liam researched and wrote this article as part of the Medical Scholars Program, sponsored by the Osborne Head and Neck Foundation.

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About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

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While surgery of the head and neck is becoming safer as medical technology and surgeons advance, there are always risks associated with surgery. One of the main concerns of patients who are undergoing surgery are those associated with intubation and general anesthesia. Intubation is a delicate procedure and, while there usually are not complications when inserting and removing the soft, plastic tube known as an endotracheal tube (ET), it is not without risk. One of the most common complications of intubation is injury to the larynx (voice box).

What is intubation and why is it necessary?

Intubation is the process of inserting a soft, flexible tube, called an endotracheal tube, into the trachea during surgery. This is required for ventilation, which allows the patient to continue to receive oxygen during surgery. Ventilation is a positive pressure system that mimics the action of breathing while the patient is under anesthesia. The anesthetist uses a device known as a laryngoscope to pull back the tongue and epiglottis and illuminate the larynx, allowing for visualization for effective intubation. Once inserted successfully bewteen the vocal cords into the trachea, a small cuff at the end of the tube is inflated to create a seal in the patient’s trachea, which is necessary for safe air exchnage. Intubation is necessary during procedures that require general anesthesia because the paralyzing and sedative agents that are necessary to complete the surgery also render the patient unable to breathe on their own. 

What are the risks of intubation and how can it affect the voice?

The process of intubation involves placing a flexible tube between the delicate vocal cords and inherently, comes with risks to the trachea, larynx, and vocal cords. If special care is not taken when inserting the endotracheal tube, the vocal cords can be bruised, scratched or otherwise injured in the process of intubation. 

Intubation nearly always results in swelling of the larynx, causing hoarseness or sore throat in the patient post opeartively, especially after longer procedures. However, in rare cases, longer lasting vocal damage can occur. The majority of vocal injuries due to the blunt force of the endoctracheal tube coming in contact with the vocal cords. This is far less common in planned surgery; however, in emergency situations when the patient is suddenly unable to breathe on their own and the careful precautions of a surgical setting cannot be taken, laryngeal injury is more common. These conditions are best managed by a laryngologist, an ENT with specialized training in the larynx and voice. 

vocal injury intubation

While vocal injury from intubation is possible, is is unlikely, especially in a surgical setting with experienced anesthetists. A successful, trouble-free intubation is essential to a successful surgery and allows for the patient to undergo general anesthesia, reducing pain for the patient and making the procedure easier to execute for the surgeons. Intubation is a relatively safe, necessary process that keeps the patient stable during surgery. If a patient is experiencing vocal pain or discomfort after any procedure, an appointment with a laryngologist or vocal specialist should be made to address and treat the issue.