{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T14:36:33Z","timestamp":1777991793086,"version":"3.51.4"},"reference-count":11,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,11,9]],"date-time":"2015-11-09T00:00:00Z","timestamp":1447027200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,11,9]],"date-time":"2015-11-09T00:00:00Z","timestamp":1447027200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>To assess vocal cord (VC) movement with transcutaneous laryngeal ultrasound (TLUSG), three maneuvers, namely passive (quiet respiration), active (phonation), and Valsalva maneuvers have been described. It remains unclear which maneuver or using more maneuvers provides better visualization and assessment accuracy. We prospectively evaluated 342 post\u2010thyroidectomy patients from two centers. They underwent TLUSG with direct laryngoscopic (DL) validation afterwards. During TLUSG, patients were instructed to perform all three maneuvers (passive, active, and Valsalva). VC visualization rate and accuracy between three maneuvers were compared. Visualization rate tended to be higher in Valsalva maneuver than that in other two maneuvers (92.1 % vs. passive: 91.5 %; active: 89.8 %). While 19 patients had post\u2010operative VC palsy, passive maneuver had lower test specificity than active (94.3 vs. 97.6 %, <jats:italic>p<\/jats:italic> = 0.01) and Valsalva maneuvers (94.3 vs. 97.4 %, <jats:italic>p<\/jats:italic> = 0.02). In assessable VCs, passive maneuver has a higher ability to differentiate between mobile VCs and VC palsy (Area under ROC curve\u2014passive: 0.942, active: 0.863, Valsalva: 0.893). TLUSG with more maneuvers did not improve sensitivity or specificity. On applying TLUSG as a screening tool (i.e., only selected patient with \u201cunassessable\u201d VCs or VCP on TLUSG for DL), Valsalva maneuver (85.96 %) saved more patients from DL than passive (81.87 %) or active (84.81 %) maneuver. Passive maneuver has a higher ability to differentiate VC palsy from normal. Using TLUSG as a screening tool, Valsalva was the preferred maneuver as it was more specific, had high visualization rate, and saved more patients from DL.<\/jats:p>","DOI":"10.1007\/s00268-015-3304-1","type":"journal-article","created":{"date-parts":[[2015,11,9]],"date-time":"2015-11-09T18:39:30Z","timestamp":1447094370000},"page":"652-658","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Using Transcutaneous Laryngeal Ultrasonography (TLUSG) to Assess Post\u2010thyroidectomy Patients\u2019 Vocal Cords: Which Maneuver Best Optimizes Visualization and Assessment Accuracy?"],"prefix":"10.1002","volume":"40","author":[{"given":"Kai\u2010Pun","family":"Wong","sequence":"first","affiliation":[{"name":"Division of Endocrine Surgery, Department of Surgery The University of Hong Kong, Queen Mary Hospital 102 Pokfulam Road, Pokfulam Hong Kong SAR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung\u2010Woo","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Surgery Seoul National University Hospital, College of Medicine Seoul Korea"},{"name":"Cancer Research Institute Seoul National University College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason Yu\u2010Yin","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Endocrine Surgery, Department of Surgery The University of Hong Kong, Queen Mary Hospital 102 Pokfulam Road, Pokfulam Hong Kong SAR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyu Eun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery Seoul National University Hospital, College of Medicine Seoul Korea"},{"name":"Cancer Research Institute Seoul National University College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeo Kyu","family":"Youn","sequence":"additional","affiliation":[{"name":"Department of Surgery Seoul National University Hospital, College of Medicine Seoul Korea"},{"name":"Cancer Research Institute Seoul National University College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian Hung\u2010Hin","family":"Lang","sequence":"additional","affiliation":[{"name":"Division of Endocrine Surgery, Department of Surgery The University of Hong Kong, Queen Mary Hospital 102 Pokfulam Road, Pokfulam Hong Kong SAR China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,11,9]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/110241599750007018"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/000348941212101102"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010013\u20102259\u20103"},{"key":"e_1_2_7_5_2","doi-asserted-by":"crossref","unstructured":"WongKPet al. A prospective assessor\u2010blind evaluation of surgeons\u2010performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy.Surgery(2013)","DOI":"10.1016\/j.surg.2013.04.063"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2011.09.020"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2014.08.071"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2014.08.061"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445\u20101433.2001.02257.x"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010010\u20100694\u20102"},{"key":"e_1_2_7_11_2","doi-asserted-by":"crossref","unstructured":"Eran BraunerB.H.\u2010H.L. Kai\u2010PunWong James A.Burns RoyPhitayakorn andSarehParangi Learning Laryngeal Ultrasound. Video Endocrinology (2015) . March 2015 (Vol 2. 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