Pediatric Vocal Fold Immobility: An 11-Year Review

Abstract

Objectives:

1) Describe the etiologies, manifestations, clinical course, and prognosis of vocal fold immobility (VFI) in a pediatric population. 2) Recognize the morbidities associated with neonatal VFI.

Methods:

Retrospective review of patients at a private pediatric otolaryngology practice in a metropolitan area. All patients seen between July 15, 2001, and September 1, 2012, with a diagnosis of complete or partial VFI were included. Records were reviewed for data regarding demographics, etiologies, symptomatology, follow-up, and resolution.

Results:

A total of 418 patients were identified. Left VFI was present in 66.0%, right VFI in 7.9%, and bilateral VFI in 26.1%. Median age at presentation was 90 days. Major etiological categories included cardiac surgery in 68.2%, neurologic disease in 8.1%, idiopathic causes in 11.7%, and paralysis associated with prematurity/prolonged neonatal intubation in 9.1%. On presentation, 61.7% experienced dysphonia, 54.1% respiratory symptoms, and 49.3% dysphagia. Tracheostomies were performed in 25.8% and gastrostomies in 40.7%. Outpatient follow-up occurred in 90.7% of patients, with median follow-up of 16 months. Resolution evidenced by laryngoscopy was found in 35.6%, with median time to resolution of 5 months. In patients without laryngoscopic resolution, median follow-up was 20 months, and 24.1% reported symptomatic resolution.

Conclusions:

Vocal fold injury early in life, often secondary to cardiac surgery, may lead to lasting VFI and considerable morbidity. In this large database, the majority of patients did not experience resolution. This warrants further investigation into predictors of VFI and possible interventions to reduce morbidity.