Pediatric Unilateral Vocal Fold Paralysis: Workup and Management

Abstract

This paper will examine recent advances in the assessment and management of pediatric unilateral vocal fold motion impairment (VFMI). Unilateral VFMI can have a considerable impact on pediatric voice, swallowing, and pulmonary hygiene. In addition, postoperative VFMI in children undergoing congenital cardiac procedures is associated with longer lengths of stay. Laryngeal ultrasound (LUS) is an adjunctive tool that can be used to assess vocal fold mobility in patients who cannot tolerate traditional flexible nasolaryngoscopy (FNL) or for those in whom FNL is non-diagnostic. Laryngeal electromyography (LEMG) can help differentiate neuronal causes of vocal fold paralysis from mechanical cricoarytenoid joint fixation. Recent data suggests that preoperative LEMG may be used to predict voice outcomes after non-selective laryngeal reinnervation (NSLR). NSLR is a promising treatment modality for permanent vocal fold medialization in children. An emphasis on early diagnostic and prognostic techniques, such as the use of LUS and LEMG, can inform decision-making in unilateral VFMI treatment. NSLR is emerging as the preferred treatment modality for pediatric unilateral VFMI due to neuronal injury.