Pediatric Vocal Fold Paralysis

TLDR

The study reviews pediatric vocal fold paralysis, focusing on etiological factors, airway pathology, and treatment and prognostic outcomes. A retrospective case review of 102 consecutive pediatric VFP patients at Great Ormond Street Hospital over 14 years (1980‑1994) with an almost equal split of unilateral and bilateral cases. Iatrogenic causes accounted for 43% of cases, followed by idiopathic (35%), neurological (16%) and birth trauma (5%); 66% of tracheotomized patients had associated airway pathology, tracheotomy was required in 57% of bilateral VFP, and recovery varied by etiology, with neurological VFP showing 71% recovery, iatrogenic 46%, and idiopathic bilateral VFP recovering up to 11 years, highlighting implications for lateralization procedures.

Abstract

To review our experience of pediatric vocal fold paralysis (VFP), with particular emphasis on etiological factors, associated airway pathologic conditions, and treatment and prognostic outcomes.Retrospective case review of a cohort of patients presenting with VFP.Tertiary referral center.A consecutive sample of 102 patients presenting with VFP to Great Ormond Street Hospital for Children, London, England, over a 14-year period from 1980 to 1994.There was an almost equal distribution of unilateral (52% [n = 53]) and bilateral (48% [n = 49]) VFP. Iatrogenic causes (43% [n = 44]) formed the largest group, followed by idiopathic VFP (35% [n = 36]), neurological causes (16% [n = 16]), and finally birth trauma (5% [n = 5]). Associated upper airway pathologic conditions were noted in 66% (n = 23) of patients who underwent tracheotomy. Tracheotomy was necessary in only 57% (n = 28) of children with bilateral VFP. Prognosis was variable depending upon the cause, with neurological VFP having the highest rate of recovery (71% [5/7]) and iatrogenic VFP the lowest rate (46% [12/26]).Recovery after an interval of up to 11 years was seen in idiopathic bilateral VFP; this has significant implications when considering lateralization procedures in these patients.