Postintubation phonatory insufficiency: An elusive diagnosis

OBJECTIVE: To describe postintubation phonatory insufficiency, a routinely overlooked complication of prolonged intubation. This entity results from a n erosive injury with permanent divots of the medial surfaces of the aryten oid cartilages and/or scarring of the anterior cricoarytenoid joint capsule so that during phonation there is incomplete adduction and a glottic gap r emains. 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 laborat ory using a diagnostic model composed of pertinent history, elicited vocal capabilities and limitations, and an intense fiberoptic laryngeal examinati on 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 int ubation injury are reviewed, and prevention and treatment of the condition are discussed.