Pediatric laryngology committee: Controversies in the diagnosis and management of pediatric vocal cord paralysis

Abstract

Pediatric vocal cord paralysis represents a relatively common cause of airway obstruction presenting to the pediatric otolaryngologist. Depending on whether the paralysis is unilateral or bilateral, the child may present with symptoms of stridor, vocal dysphonia or aphonia, and/or aspiration. A thorough search for a possible underlying disorder is critical. Exact timing of intervention and the method of intervention vary according to symptoms and remain controversial. This seminar will consist of talks from established pediatric otolaryngologists with a wide scope of experience with these disorders. Diagnostic evaluation including flexible fiberoptic evaluation of swallowing (FEES) as well as flexible digital stroboscopy will be discussed. Surgical treatment options including vocal fold injection, thyroplasty, laser cordotomy/arytenoidectomy, vocal fold pexy, posterior costal cartilage graft, and nerve reinervation procedures will be discussed as treatment options. Digital video will be used to demonstrate the various procedures. Timing of such interventions will be discussed as well as this remains a key controversy.