Abstract
Vocal fold immobility is a common cause of voice and swallowing disorders in children. The etiology of vocal fold immobility can be iatrogenic, idiopathic, neurological, or traumatic. Unilateral vocal fold immobility manifests as a weak or breathy voice and swallowing disorders such as aspiration. In contrast, bilateral vocal fold immobility typically presents with stridor or respiratory distress. Treatment for vocal fold immobility is based on symptoms. Patients with respiratory distress due to bilateral vocal fold immobility often require a tracheotomy, vocal cordotomy, arytenoidectomy, arytenoid abduction, or procedures to open the glottic airway. Surgical intervention for unilateral vocal fold immobility can include injection laryngoplasty, type 1 thyroplasty, or laryngeal reinnervation procedures. Timing for intervention with unilateral vocal fold immobility is difficult to determine for iatrogenic, traumatic, or neurologic injuries. Laryngeal electromyography (EMG) can help differentiate a neurologic etiology from vocal fold immobility from arytenoid dislocation. This diagnostic and prognostic information can help determine timing for definitive procedures such as laryngeal reinnervation.
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