Hoarseness after cardiac surgery

Objective. To investigate the incidence, severity, and duration of hoarseness after adult cardiac surgery and to examine movement of the endotracheal tube (ETT) during neck extension for sternotomy. Design. Prospective study. Setting. University hospital. Patients. Seventy-two adults undergoing elective cardiac surgery (assessment of hoarseness was completed in 68), Interventions. An ETT with an internal diameter of 8.0 mm and 7.5 mm was used for men and women, respectively. After surgical positioning, the ETT was placed with its tip about 3 cm above the carina. Measures. ETT migration during positioning for sternotomy was measured using a fiberoptic bronchoscope. Hoarseness was examined at 6-12 hrs after extubation. Results. The ETT moved away from the carina during surgical positioning and the migration was 11+/-6 (1-27) mm [mean+/-SD (range)], Hoarseness occurred in 32% of the patients (22/68), of whom five (23%) were grade 1 on a four-point scale (0-3), 14 (64%) were grade 2, and three (14%) were grade 3 (aphonic). The duration of hoarseness was 4+/-3 (1-14) days, except in one patient with left vocal cord paralysis (60 days). When this patient was excluded, intubation time was an independent predictor of the severity of hoarseness (p=0.0001). Conclusions. Hoarseness after cardiac surgery is common, Most hoarseness is transient and its severity is predicted by duration of intubation. Positioning for sternotomy displaces the ETT cuff away from the carina. This may cause persistent hoarseness because displaced cuff from trachea to larynx may damage the recurrent laryngeal nerve or vocal cords.