Skip to main content
SpringerLink
Log in

Pediatric Bilateral Vocal Fold Paralysis

  • LARYNGOLOGY: Management of Vocal Cord Paralysis (D Chhetri and JL Long, Section Editors)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Pediatric bilateral vocal fold paralysis (BVFP) is a rare but impactful diagnosis. Stridor and respiratory distress are common presenting symptoms, often requiring airway intervention. Historically, tracheostomy has been the mainstay of management of BVFP in children, but alternative interventions have more recently been described in an attempt to avoid or minimize the morbidity associated with pediatric tracheostomy. This review aims to summarize current knowledge surrounding etiology, workup, and management options for children with bilateral vocal fold immobility.

Recent Findings

The past several years have seen an increase in the understanding of, and range of, surgical options for pediatric patients with BVFP. Early studies have demonstrated that endoscopic interventions, including anterior-posterior cricoid split and suture lateralization, may be effective means of airway management in this population.

Summary

Further studies are needed on the topic, but alternative surgical techniques may aid in reducing the frequency of tracheostomy for pediatric patients with BVFP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Rutter MJ, Hart CK, de Alarcon A, Daniel SJ, Parikh SR, Balakrishnan K, et al. Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis: Endoscopic APCS for vocal fold paralysis. The Laryngoscope. 2018;128:257–63 This paper describes and reports outcomes for a surgical technique for the management of BVFP that helps circumvent tracheostomy in this population.

    Article  Google Scholar 

  2. Miyamoto RC, Parikh SR, Gellad W, Licameli GR. Bilateral congenital vocal cord paralysis: A 16-year institutional review. Otolaryngol Neck Surg. 2005;133:241–5.

    Article  Google Scholar 

  3. Jabbour J, North LM, Bougie D, Robey T. Vocal fold immobility due to birth trauma: A systematic review and pooled analysis: Otolaryngol Neck Surg [Internet]. SAGE PublicationsSage CA: Los Angeles, CA; 2017 [cited 2020 Oct 19]; Available from: https://journals-sagepub-com.laneproxy.stanford.edu/doi/10.1177/0194599817726773?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed

  4. Sedaghat S, Tapia M, Fredes F, Rojas P. Endoscopic management of bilateral vocal fold paralysis in newborns and infants. Int J Pediatr Otorhinolaryngol. 2017;97:13–7.

    Article  Google Scholar 

  5. Funk RT, Jabbour J, Robey T. Factors associated with tracheotomy and decannulation in pediatric bilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol. 2015;79:895–9.

    Article  Google Scholar 

  6. Sztanó B, Bach Á, Matievics V, Erdélyi E, Szegesdi I, Wootten CT, et al. Endoscopic arytenoid abduction lateropexy for the treatment of neonatal bilateral vocal cord paralysis: Long-term results. Int J Pediatr Otorhinolaryngol. 2019;119:147–50.

    Article  Google Scholar 

  7. • Lee JW, Bon-Mardion N, Smith ME, Marie J-P. Bilateral selective laryngeal reinnervation for bilateral vocal fold paralysis in children. JAMA Otolaryngol--Head Neck Surg. 2020;146:401–7 This study reports a technique for management of bilateral vocal fold paralysis, which has previously been used in the adult population but now has been pioneered in the pediatric population.

    Article  Google Scholar 

  8. Hsu AK, Rosow DE, Wallerstein RJ, April MM. Familial congenital bilateral vocal fold paralysis: A novel gene translocation. Int J Pediatr Otorhinolaryngol. 2015;79:323–7.

    Article  Google Scholar 

  9. Lesnik M, Thierry B, Blanchard M, Glynn F, Denoyelle F, Couloigner V, et al. Idiopathic bilateral vocal cord paralysis in infants: Case series and literature review: Idiopathic bilateral laryngeal palsy. The Laryngoscope. 2015;125:1724–8.

    Article  Google Scholar 

  10. Jabbour J, Martin T, Beste D, Robey T. Pediatric vocal fold immobility: Natural history and the need for long-term follow-up. JAMA Otolaryngol Neck Surg. 2014;140:428–33.

    Article  Google Scholar 

  11. Shen S-P, Chang H-Y, Chang J-H, Hsu C-H, Peng C-C, Lee K-S. Bilateral vocal fold immobility in a single tertiary hospital in northern Taiwan: A 23-year retrospective review. Med (Baltimore). 2019;98:e14691.

    Article  Google Scholar 

  12. Zur KB. Vocal fold motion impairment. Curr Probl Pediatr Adolesc Health Care. 2018;48:124–8.

    Article  Google Scholar 

  13. Zavala H, Roby BB, Day A, Bostrom B, Sidman J, Chinnadurai S. Vincristine-induced vocal cord paresis and paralysis in children. Int J Pediatr Otorhinolaryngol. 2019;123:1–4.

    Article  Google Scholar 

  14. Dal’Astra APL, Quirino AV, de Sousa Caixêta JA, MAG A. Tracheostomy in childhood: Review of the literature on complications and mortality over the last three decades. Braz J Otorhinolaryngol. 2017;83:207–14.

    Article  Google Scholar 

  15. Nagy P, Beckmann N, Cox S, Sheyn A. Management of vocal fold paralysis and dysphagia for neurologic malignancies in children. Ann Otol Rhinol Laryngol. 2019;128:1019–22.

    Article  Google Scholar 

  16. Hsu J, Tibbetts KM, Wu D, Nassar M, Tan M. Swallowing function in pediatric patients with bilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol. 2017;93:37–41.

    Article  Google Scholar 

  17. Bowe SN, Wentland CJ, Hartnick CJ. Pediatric laryngeal electromyography technique for vocal fold immobility using bipolar double hookwire electrodes. Int J Pediatr Otorhinolaryngol. 2019;119:75–8.

    Article  Google Scholar 

  18. Maturo SC, Hartnick CJ. Pediatric laryngeal electromyography. Pediatr Airw Surg. Karger Publishers. 2012;73:86–9.

    Article  Google Scholar 

  19. Maturo SC, Braun N, Brown DJ, Chong PST, Kerschner JE, Hartnick CJ. Intraoperative laryngeal electromyography in children with vocal fold immobility: Results of a multicenter longitudinal study. Arch Otolaryngol Head Neck Surg. 2011;137:1251–7.

    Article  Google Scholar 

  20. • Montague GL, Bly RA, Nadaraja GS, Conrad DE, Parikh SR, Chan DK. Endoscopic percutaneous suture lateralization for neonatal bilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol. 2018;108:120–4 This study describes another surgical option for primary airway management in pediatric BVFP that is reversible in nature and non-destructive.

    Article  Google Scholar 

  21. Madani S, Bach Á, Matievics V, Erdélyi E, Sztanó B, Szegesdi I, et al. A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy. The Laryngoscope. 2017;127:1608–14.

    Article  Google Scholar 

  22. Lagier A, Nicollas R, Sanjuan M, Benoit L, Triglia J-M. Laser cordotomy for the treatment of bilateral vocal cord paralysis in infants. Int J Pediatr Otorhinolaryngol. 2009;73:9–13.

    Article  Google Scholar 

  23. Aubry K, Leboulanger N, Harris R, Genty E, Denoyelle F, Garabedian E-N. Laser arytenoidectomy in the management of bilateral vocal cord paralysis in children. Int J Pediatr Otorhinolaryngol. 2010;74:451–5.

    Article  Google Scholar 

  24. Dahl JP, Purcell PL, Parikh SR, Inglis AF. Endoscopic posterior cricoid split with costal cartilage graft: A fifteen-year experience. The Laryngoscope. 2017;127:252–7.

    Article  Google Scholar 

  25. Inglis AF, Perkins JA, Manning SC, Mouzakes J. Endoscopie posterior cricoid split and rib grafting in 10 children. The Laryngoscope. 2003;113:2004–9.

    Article  Google Scholar 

  26. Sidell DR, Zacharias S, Balakrishnan K, Rutter MJ, de Alarcón A. Surgical management of posterior glottic diastasis in children. Ann Otol Rhinol Laryngol. 2015;124:72–8.

    Article  Google Scholar 

  27. Daniel SJ, Cardona I. Cricothyroid onabotulinum toxin A injection to avert tracheostomy in bilateral vocal fold paralysis. JAMA Otolaryngol Neck Surg. 2014;140:867–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Stanford University School of Medicine, 801 Welch Rd, Stanford, CA, 94305, USA

    Jocelyn Kohn

  2. Lucile Packard Children’s Hospital of Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA

    Jocelyn Kohn, Karthik Balakrishnan & Douglas Sidell

  3. Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Pediatric Aerodigestive and Airway Reconstruction Program, Stanford University, Stanford, CA, 94305, USA

    Karthik Balakrishnan & Douglas Sidell

Authors
  1. Jocelyn Kohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karthik Balakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Douglas Sidell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jocelyn Kohn.

Ethics declarations

Conflict of Interest

Jocelyn Kohn and Douglas Sidell declare they have no conflict of interest. Karthik Balakrishnan gets royalties from a Springer, Inc. textbook.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical collection on LARYNGOLOGY: Management of Vocal Cord Paralysis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kohn, J., Balakrishnan, K. & Sidell, D. Pediatric Bilateral Vocal Fold Paralysis. Curr Otorhinolaryngol Rep 9, 127–133 (2021). https://doi.org/10.1007/s40136-021-00334-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-021-00334-w

Keywords

Search

Navigation