Reinnervation for Vocal Fold Paralysis: Results in Children

Abstract

Objective: 1) Exhibit long-term follow-up results of patients with unilateral vocal fold immobility who underwent ANSA reinnervation of the recurrent laryngeal nerve. 2) Demonstrate the appropriate studies that should be performed at the time of follow-up.

Method: Retrospective review in a tertiary care otolaryngology practice. Four patients with symptomatic unilateral vocal fold paralysis who underwent recurrent laryngeal nerve reinnervation by a single surgeon were reviewed between September 2005 and December 2011. Postoperative measurements were obtained, both subjective (voice questionnaire) and objective (acoustic measurements and aerodynamics).

Results: The study group included 3 girls and 1 boy ages 2 to 12 years. Mean follow-up time was 4.25 years. Causes for vocal fold paralysis were cardiac surgery (3) and skull base neoplasm (1). Voice questionnaire results (0 = severely abnormal, 100 = normal) were 100 in 2 patients, 98 in 1 patient, and 96 in 1 patient indicating a high level of satisfaction postoperatively in all patients. Mean maximum phonation time was 7.7 seconds, mean s/z ratio was 2.15, and mean subglottal pressure was 8.8 cm H₂O.

Conclusion: Children who undergo ANSA reinnervation of the recurrent laryngeal nerve have normal or near normal subjective voice scores. Objective scores may not reflect the same change. In this population, it may be beneficial for the practitioner to rely upon subjective measures rather than objective measures to determine treatment success.