Pediatric Unilateral Vocal Fold Movement Impairment: Diagnostic Tools and Management Strategies

Abstract

Unilateral vocal fold movement impairment (VFMI) in the pediatric population presents unique challenges. Thoughtful and innovative methods of diagnosis, prognostication, and intervention have recently influenced the management of VFMI in children. This article presents updates on the natural history of pediatric VFMI, use of laryngeal ultrasound (LUS) and laryngeal electromyography (LEMG) as diagnostic tools, and optimal management strategies for pediatric unilateral VFMI. Long-term follow-up studies for pediatric patients diagnosed with VFMI described a substantial number of children that have recovery of VFMI well after 12 months, contradicting the conventional teaching that recovery after 1 year is unlikely. LUS performs well compared to the gold standard flexible nasolaryngoscopy (FNL) in identifying VFMI with significantly less physiologic impact. LEMG can be used to assist in determining etiology of VFMI and may play a role in predicting recovery and outcomes of interventions. Recent data has demonstrated that reinnervation is highly effective in managing dysphonia and aspiration in children with VFMI. Children diagnosed with VFMI should be followed at regularly scheduled intervals until resolution of their VFMI. LUS is an alternate tool that should be considered in medically fragile children susceptible to alterations in physiologic parameters. LEMG is a useful adjunct for elucidating neuronal versus mechanical VFMI. Recent data suggests that reinnervation should be considered as a primary surgical intervention for neuronal unilateral VFMI.