Laryngeal Ultrasound for Vocal Cord Palsy in Adults: A Meta-Analysis of Diagnostic Studies.

BACKGROUND: The standard test to diagnose vocal cord palsy in adults is laryngoscopy, which is invasive, whereas laryngeal ultrasound (LUS) is an alternative, non-invasive method. We conducted a systematic review to determine the accuracy of LUS in diagnosing VCP in adults. METHODS: PubMed, EMBASE, CINAHL and Cochrane databases were searched in September 2025. We used a bivariate mixed-effects regression model to conduct a meta-analysis using Stata 18.0 software. We used the QUADAS-2 tool to assess the risk of bias and GRADE guidelines to assess the certainty of evidence. RESULTS: We included 41 studies (7818 patients) in the meta-analysis. A total of 27 studies were performed in patients undergoing thyroid surgeries. The remaining 14 studies involved patients undergoing oesophageal surgery or routine laryngeal assessment or mediastinal surgeries. In 28 studies, blinding of at least one investigator was achieved. The pooled sensitivity of LUS for diagnosing VCP was 0.90 (95% CI: 0.85-0.93), with a specificity of 0.98 (95% CI: 0.97-0.99). The positive likelihood ratio (LR+) was 47.8 (95% CI 26.8-85.3) and the negative likelihood ratio (LR-) was 0.10 (95% CI 0.07-0.16). The AUC for LUS was 0.98 (95% CI: 0.97-0.99). Certainty of evidence was graded as moderate in view of heterogeneity and the possibility of publication bias and lack of blinding in nearly 35% of the studies. CONCLUSIONS: Laryngeal ultrasound may be a useful tool to diagnose VCP in adults. Additional high-quality studies meeting the stringent QUADAS-2 guidelines are needed to confirm these findings.