Vocal Cord Paralysis In Children Research Articles

Vocal Cord Paralysis in Pediatric Chiari Malformation: A Systematic Review and Meta-analysis.

Arnold-Chiari Malformation is one possible cause of congenital vocal cord paralysis (VCP). The natural history of VCP in children with Chiari malformation has previously been limited to small case studies. This systematic review seeks to better characterize the prognostic factors that may predict symptom severity and resolution of congenital VCP in children with Arnold-Chiari malformation. We hypothesized that the onset of stridor or VCP at a younger age would be associated with a poorer prognosis and earlier intervention with posterior fossa decompression would be associated with better outcomes. PubMed, Web of Science, Cochrane Library, and bibliographic review. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Database search yielded 866 articles. Study abstracts were reviewed by 2 independent examiners. One hundred and seventy-six studies underwent full-text review. The following were extracted: age at onset of stridor or VCP, Chiari malformation type, laryngoscopy findings, type and timing of neurosurgical intervention, and tracheostomy history. Statistical analyses utilized χ2 tests. Younger age at symptom onset showed statistically significant associations with decreased likelihood for symptom resolution and tracheostomy decannulation. The shorter time interval from symptom onset to neurosurgical intervention was not significantly associated with better outcomes. This meta-analysis suggests poorer prognosis in those with earlier-onset symptoms, reinforcing prior case series findings. Additional prospective studies are needed to elucidate the natural history and utility of early intervention in children with vocal cord paralysis secondary to Chiari malformation.

Bilateral Vocal Cord Abduction Paralysis after C1 Laminectomy in a Child with Type 1 Arnold Chiari Malformation.

Background: Type 1 Arnold Chiari is a neurological malformation that may be associated with vocal cord paralysis in Children. In most cases, the vocal cord paralysis is related to protrusion of medulla and cerebellum in the foramen magnum, which led to compression on the vagus nerve.Case report: A 12-year-old child underwent suboccipital decompression and C1 laminectomy for a symptomatic type 1 Arnold Chiari malformation. After the surgery, patient reported severe dyspnea, aphonia, and dysphagia. The videolaryngostroboscopy and neurological examinations reported a postoperative bilateral vocal cord abduction paralysis due to bilateral IX and X cranial nerve paralyzes and a bilateral paralysis of the tongue.Discussion: The type 1 Arnold Chiari malformation clinical picture may present with unilateral or bilateral vocal cord paralysis, which may resolve with an adequate management of the disease. However, the neurosurgical decompression and C1 laminectomy may result in bilateral lesion of the IX, X, and XII cranial nerves, and related severe swallowing, aspiration and vocal cord disorders.Conclusion: We reported the first case of bilateral vocal cord abduction paralysis occurring post-neurosurgical decompression and C1 laminectomy in a child with type 1 Arnold Chiari malformation. This case highlights the importance of surgical steps of the procedure in front of the C1 vertebrae where there are IX, X, and XII cranial nerves.

Usefulness of laryngeal ultrasonography for screening of postoperative vocal cord paralysis in children

Usefulness of laryngeal ultrasonography for screening of postoperative vocal cord paralysis in children

Vocal cord paralysis following lithium button battery ingestion in children.

This study reports on vocal cord paralysis caused by esophageal button battery (BB) ingestion in children. Medical records of children with vocal cord paralysis and esophageal BB ingestion treated at a tertiary referral institute between January 2016 and March 2020 were reviewed. Five patients aged 9-58months were identified; three were male. Each patient had accidentally swallowed a 20-mm-diameter lithium battery (3 CR2032 type and 2 CR2025 type). One battery was removed within 4h after ingestion, and three batteries were removed within 12h. Removal of the battery was achieved with rigid esophagoscopy in four patients and direct laryngoscopy in one patient. Four patients had bilateral, and one had unilateral vocal cord paralysis. Three patients underwent tracheotomy; two were tracheotomy-dependent until follow-up, while the third patient died of multiple organ dysfunction syndrome a month after surgery. The two cases without tracheotomy remain under close follow-up.Conclusion: Accidentally ingested button batteries should be removed promptly to avoid severe complications. Respiratory support and neurotrophic treatment in the early stage of vocal cord paralysis may be beneficial for recovery of vocal cord movement. What is Known: • Button battery ingestion in children is extremely harmful, especially when the diameter of the button battery exceeds 20mm. • Esophageal button battery impaction can cause serious complications such as esophageal perforation, mediastinal infection, tracheoesophageal fistula, vocal cord paralysis, and life-threatening bleeding. What is New: • Vocal cord paralysis in children with button battery ingestion plays an early warning role for identifying the severity of the disease. • Early neurotrophic drugs and glucocorticoid therapy may be helpful for the recovery of vocal cord movement, thereby avoiding tracheotomy.

Diagnostic difficulties in children with iatrogenic vocal cord paralysis in the material of the Department of Pediatric Otolaryngology of the Medical University of Warsaw

Introduction. The causes of vocal cord paralysis in children include congenital malformations, nervous system disorders, and iatrogenic causes. The paralysis may affect one or both cords. The signs of bilateral vocal cord paralysis include respiratory stridor of varying severity, and even acute respiratory failure. The signs and symptoms of unilateral vocal cord paralysis include phonation and swallowing disorders, as well as respiratory stridor associated with partial stenosis of already physiologically narrow airways in children. Diagnosing the cause for vocal cord paralysis in children is difficult. Aim. The aim of the study was to analyze the causes of iatrogenic vocal cord paralysis, as well as to assess the usefulness of diagnostic methods used in children with iatrogenic vocal chords paralysis. Material and methods. A retrospective analysis of clinical data of 20 children with iatrogenic vocal cord paralysis under the care of the Department of Pediatric Otolaryngology of the Medical University of Warsaw in 2017 was conducted. Results. The study group included 13 boys and 7 girls aged from 1 month of age to 10 years of age; median age at the diagnosis was 3 months. In 17 children, bilateral paralysis was diagnosed, and 3 children were diagnosed with unilateral paralysis. The cause of iatrogenic vocal cord paralysis in 7 children was cardiac surgery, in 1 ? thoracic surgery, in 7 ? prolonged intubation, in 3 ? perinatal hypoxia, and in 2 ? vincristine chemotherapy. Conclusions. The diagnosis of iatrogenic vocal cord paralysis is difficult. The applied diagnostic methods require an integrated interpretation. The larynx ultrasound (US) examination remains very useful in the assessment of the vocal cords mobility in children, however, it is not possible to perform this examination in intubated patients. Fiberoscopy, performed under local anesthesia, is widely available, however, performing it on a narrow larynx of a child may cause respiratory disorders. US and fiberoscopy in infants should be supplemented by direct laryngoscopy in order to exclude congenital airway defects that may have symptoms similar to them. In any case, neurological disorders and genetic defects causing vocal cord paralysis must be excluded.

5. Vocal cord paralysis in children: A new neurophysiological approach for diagnosis and functional prognosis

To establish the possibility to use the methodology of recording corticobulbar motor evoked potentials (CoMEPs) from cricothyroid muscles (CTHY) and vocal cord elicited by transcranial electrical stimulation (TES), as diagnostic tool for predicting function recovery in children with vocal fold immobility (VFI). We included six children (mean age: 4.7 years; range: 2–9 years) with diagnosis of cord immobility that underwent video-fibro-endoscopy procedure. Under general anaesthesia, we used TES by stimulation over C3/Cz or C4/Cz to elicit CoMEPs. To record CoMEPs from vocal muscles we used two hook wire electrodes (76 micron diameter) passing through a 27-gauge needle endotracheally placed in the vocal muscles after intubation. Recording of CoMEPs in the vocal muscles after TES was successfully performed bilaterally in 4 patients and monolaterally in two patients. TES over the right or left hemisphere elicited responses bilaterally. The mean onset latency for the vocal muscles was 16.4 ± 3 ms. The possibility to record CoMEP from vocal muscle was a positive prognostic feature for clinical improvement. This method shows the ability to evaluate the functional integrity of corticobulbar pathways in a reliable manner and adds an additional tool in the diagnosis and prognosis of VFI.

Surgical Interventions for Pediatric Unilateral Vocal Cord Paralysis: A Systematic Review.

The most widely used surgical interventions for pediatric unilateral vocal cord paralysis include injection laryngoplasty, thyroplasty, and laryngeal reinnervation. Despite increasing interest in surgical interventions for unilateral vocal cord paralysis in children, the surgical outcomes data in children are scarce. To appraise and summarize the available evidence for pediatric unilateral vocal cord paralysis surgical strategies. MEDLINE (1946-2014) and EMBASE (1980-2014) were searched for publications that described the results of laryngoplasty, thyroplasty, or laryngeal reinnervation for pediatric unilateral vocal cord paralysis. Further studies were identified from bibliographies of relevant studies, gray literature, and annual scientific assemblies. Two reviewers independently appraised the selected studies for quality, level of evidence, and risk of bias as well as extracted data, including unilateral vocal cord paralysis origin, voice outcomes, swallowing outcomes, and adverse events. Of 366 identified studies, the inclusion criteria were met by 15 studies: 6 observational studies, 6 case series, and 3 case reports. All 36 children undergoing laryngeal reinnervation (8 studies) had improvement or resolution of dysphonia. Of 31 children receiving injection laryngoplasty (6 studies), most experienced improvement in voice quality, speech, swallowing, aspiration, and glottic closure. Of 12 children treated by thyroplasty (5 studies), 2 experienced resolution of dysphonia, 4 had some improvement, and 4 had no improvement (2 patients had undocumented outcomes). Thyroplasty resolved or improved aspiration in 7 of 8 patients. Published studies suggest that reinnervation may be the most effective surgical intervention for children with dysphonia; however, long-term follow-up data are lacking. With the exception of polytetrafluoroethylene injections, injection laryngoplasty was reported to be a relatively safe, nonpermanent, and effective option for most children with dysphonia. Thyroplasty appears to have fallen out favor in recent years because of difficulty in performing this procedure in children under local anesthesia, but it continues to be a viable option for children with aspiration.

Management of unilateral true vocal cord paralysis in children

Historically, information gained from the treatment of unilateral true vocal cord paralysis (UVCP) in adults was the same used to treat children. Today, there is a growing body of literature aimed specifically at the treatment of this condition in children. It is an area of growing interest as UVCP can significantly impact a child's quality of life. Children with UVCP may present with stridor, dysphonia, aspiration, feeding difficulties, or a combination of these symptoms. Diagnosis relies on laryngoscopy, but other adjuncts such as ultrasound and laryngeal electromyography may also be helpful in making the diagnosis and forming a treatment plan. In many instances, there is effective compensation by the contralateral vocal fold, making surgical intervention unnecessary. Children who cannot compensate for a unilateral defect may suffer from significant dysphonia that can affect their quality of life because their ability to be understood may be diminished. In these patients, treatment in the form of medialization or reinnervation of the affected recurrent laryngeal nerve may be warranted. UVCP is a well recognized problem in pediatric patients with disordered voice and feeding problems. Some patients will spontaneously recover their laryngeal function. For those who do not, a variety of reliable techniques are available for rehabilitative treatment. Improved diagnostics and a growing understanding of prognosis can help guide therapy decisions along with the goals and desires of the patient and his or her family.

Unilateral Vocal Cord Paralysis in Children: Our Experience

Objective: Review presentations, etiology, management, and outcomes of unilateral vocal cord paralysis (UVCP) managed at a single institution over a 10-year period. Method: Retrospective review at a tertiary care pediatric hospital. Forty-two patients less than 18 years old presented with UVCP between 2002 and 2011. Interventions included injection laryngoplasty, ansa cervicalis to recurrent laryngeal nerve anastomosis (AC-RLNA), and cordotomy. Outcomes measured were vocal cord motility and reports of feeding, aspiration, stridor, and voice. Results: Etiology of UVCP in the 42 patients included: surgical injury (n = 23), birth trauma (n = 10), prolonged intubation (n = 3), neurological origin (n = 2), vincristine chemotherapy (n = 2), and idiopathic (n = 2). Sixteen of the 42 (38%) patients fully recovered vocal cord mobility after an average of 6.03 months. Nine patients underwent injection laryngoplasty with either Gelfoam or Radiesse Voice and saw improvement of symptoms for a median of 2 or 4 months respectively. Two patients underwent AC-RLNA with symptom improvement or resolution beginning 6 months postoperatively. Fifteen patients did not recover motion but were asymptomatic and did not require intervention. Conclusion: Children with UVCP face airway compromise, chronic aspiration, exercise intolerance, and voice abnormalities. This study favors conservative management in the majority of cases and waiting up to 1 year prior to intervention. When spontaneous recovery does not occur, injection laryngoplasty and AC-RLNA can improve symptoms for pediatric patients.

Vocal cord paralysis in children

Vocal fold paralysis (VFP) is an increasingly commonly identified problem in the pediatric patient. Diagnostic and management techniques honed in adult laryngologic practice have been successfully applied to children. Iatrogenic causes, including cardiothoracic procedures, remain a common cause of unilateral VFP. Neurologic disorders predominate in the cause of bilateral VFP. Diagnosis with electromyography is currently being evaluated in children. Treatment of VFP is centered around symptomology, which is commonly divided between voice and airway concerns. Speech therapy shows promise in older children. Surgical management for unilateral VFP with injection laryngoplasty is commonly performed and well tolerated. Laryngeal reinnervation is currently being applied to the pediatric population as a permanent treatment and offers several advantages over laryngeal framework procedures. For bilateral VFP, tracheotomy is still commonly performed. Glottic dilation procedures are performed both openly and endoscopically with a high degree of success. VFP is a well recognized problem in pediatric patients with disordered voice and breathing. Some patients will spontaneously recover their laryngeal function. For those who do not, a variety of reliable techniques are available for rehabilitative treatment.

Vincristine‐induced bilateral vocal cord paralysis in children

Pediatric Blood & CancerVolume 48, Issue 2 p. 248-248 Letter to the Editor Vincristine-induced bilateral vocal cord paralysis in children A. Ahmed MRCPCH, Corresponding Author A. Ahmed MRCPCH [email protected] Paediatric Oncology Department, Addenbrookes Hospital, Cambridge, United KingdomPaediatric Oncology Department, Addenbrookes Hospital, Hills Road, Cambridge, CB2 2QQ, UK.===Search for more papers by this authorD. Williams FRCP, FRCPCH, D. Williams FRCP, FRCPCH Paediatric Oncology Department, Addenbrookes Hospital, Cambridge, United KingdomSearch for more papers by this authorJ. Nicholson MRCP, FRCPCH, J. Nicholson MRCP, FRCPCH Paediatric Oncology Department, Addenbrookes Hospital, Cambridge, United KingdomSearch for more papers by this author A. Ahmed MRCPCH, Corresponding Author A. Ahmed MRCPCH [email protected] Paediatric Oncology Department, Addenbrookes Hospital, Cambridge, United KingdomPaediatric Oncology Department, Addenbrookes Hospital, Hills Road, Cambridge, CB2 2QQ, UK.===Search for more papers by this authorD. Williams FRCP, FRCPCH, D. Williams FRCP, FRCPCH Paediatric Oncology Department, Addenbrookes Hospital, Cambridge, United KingdomSearch for more papers by this authorJ. Nicholson MRCP, FRCPCH, J. Nicholson MRCP, FRCPCH Paediatric Oncology Department, Addenbrookes Hospital, Cambridge, United KingdomSearch for more papers by this author First published: 11 April 2006 https://doi.org/10.1002/pbc.20850Citations: 17Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume48, Issue2February 2007Pages 248-248 RelatedInformation

Miniseminar: Update in endoscopic management of the pediatric airway

Endoscopic techniques are important in the diagnosis and treatment of pediatric airway pathology. Recent medical literature has placed an increasing emphasis on the open surgical management of pediatric airway problems including laryngotracheal reconstruction. This miniseminar is designed to provide an update regarding endoscopic managment of a variety of pediatric airway problems, and discuss the role of endoscopic versus open managment. Specific techniques for management will be discussed by each of the panelists. This will include a review of endoscopic diagnosis of airway problems. The panelsits will discuss endoscopic management of subglottic stenosis, including the role of laser ablation, powered instrumentation, balloon dilation, and stent placement, as well as the role of adjuvant medical therapy. Decision making regarding endoscopic versus open reconstruction will be presented. The endoscopic treatment of laryngeal vascular malformations, including subglottic and supraglotic lesions will be discussed. This will include the use of laser ablation as well as medical treatment. The role of powered instrumentation for papillomas, subglottic stenosis and removal of granulation tissue will be addressed. Powered instrumentation will be compared to laser and non-powered dissection. The endoscopic approach to bilateral vocal cord paralysis in children will also be reviewed. The panelists will then discuss a variety of cases of pediatric airway problems. The format will be a brief presentation by each of the panelists followed by an interactive discussion. Time for questions and comments will be allowed.

Surgery for pediatric vocal cord paralysis: a meta-analysis.

The study goal was to determine the impact of various surgical procedures for bilateral vocal cord paralysis in children by using established principles of meta-analysis. We conducted a retrospective review of the literature in which a predetermined protocol was used to identify articles for meta-analysis. Six articles met inclusion criteria, and pertinent data were extracted. Pooled data analysis demonstrated primary procedure-specific decannulation rates for external arytenoidopexy for 19 of 24 (79%), external arytenoidectomy for 14 of 19 (74%), CO2 laser arytenoidectomy for 4 of 10 (40%), and costal cartilage graft procedures for 2 of 2 (100%). External arytenoid procedures are more efficacious than CO2 laser procedures in terms of primary decannulation (P = 0.02). Meta-analysis of the existing literature reveals that external arytenoidopexy and external arytenoidectomy are equivalently effective procedures and that the two combined are significantly more effective than CO2 ablative procedures. External procedures appear to be more effective as a first-line treatment in pediatric vocal cord paralysis, with arytenoidopexy with or without partial arytenoidectomy offering an attractive first-line surgical option.

Role of ultrasound in the assessment of vocal cord function in infants and children.

The determination of the cause of stridor in the infant and child is an important directive for the otolaryngologist. The limitations of current clinical diagnostic techniques have provided the impetus for pursuing newer, more practical techniques to diagnose vocal cord paralysis in children. The purpose of this paper is to describe a new technique to image the larynx and determine its role in discerning vocal cord paralysis in children. This study began with an animal study (lamb model) demonstrating that computerized ultrasound can accurately delineate laryngeal anatomy and function. The human protocol included 27 patients (age 1 day to 14 years): 15 with normal larynges and 12 with vocal cord paralysis. Recorded ultrasound studies of these subjects were compiled in a randomly ordered videotape and presented twice and viewed in a blinded manner by four expert raters. Statistical analysis of their readings revealed that ultrasound is a highly accurate technique to document vocal cord paralysis, with a high degree of interrater and intrarater reliability. Beyond the accuracy and consistency of computerized ultrasound, there are many other aspects of this technique that make it clinically attractive. Laryngeal ultrasound is noninvasive, painless, and widely accepted. It is relatively safe, with no radiation exposure and no need for sedation or anesthesia. It is well tolerated by patients and their families. The results are easily displayed and recorded and available for hard copy storage. This investigation should not be interpreted as an endorsement for laryngeal ultrasound as a replacement for endoscopy in children. This work does indicate, however, that ultrasound is a technique that can accurately address the special issue of vocal cord mobility in infants and children. At present, this is the primary use for laryngeal ultrasound, although with additional investigation and sophistication it is likely that ultrasound of the larynx may become useful for other purposes.

Vocal cord paralysis in children

Vocal cord paralysis in children

Bilateral vocal cord paralysis in children

Eighteen infantile cases with bilateral vocal cord paralysis were treated at our hospital from 1970 to 1993. All cases were diagnosed using a flexible fiberscope to examine the larynx. Direct laryngoscopy was performed under general anesthesia for the definite diagnosis and differential diagnosis from laryngomalacia, subglottic stenosis, tracheal stenosis, or laryngeal web. Bilateral vocal cord paralysis in children is a rare disease, there have been few and reported cases. Eight cases were male and 10 cases were female. Thirteen cases were congenital, 4 cases acquired and 1 case was unknown. The characteristic symptoms of bilateral vocal cord paralysis include normal or near normal phonation with inspiratory stridor which may progress to complete respiratory obstruction. Associated anomalies and diseases included 3 cases of immature infant, 2 of myelomeningocele, and single cases of Arnold-Chiari malformation, cerebral palsy, hydrocephalus, laryngomalacia, William's syndrome, Wiedemann-Beckwith syndrome, hypoxia, esophageal hiatus hernia, gastroesophageal reflex, spina bifida, COFS syndrome, and cerebral atrophy. Laryngeal function was completely recovered in seven cases following growth of the children incompletely recovered in five cases, and 2 cases retained right vocal cord paralysis. Tracheostomy was performed in 2 cases. One case died from the original disease, and the other one case was unknown. Swallowing function, phonation and development were good. Our experience suggests that the airway with bilateral vocal cord paralysis in children can be managed well without the need for tracheostomy.

Vocal cord paralysis in children deborah

Bilateral vocal cord paralysis is a common cause of stridor in infants and children. There are significant differences in this entity between children and adults with regard to etiology, diagnosis, management, and outcome. A review of 10 years' experience at Children's Hospital of Philadelphia identified 51 children seen with the diagnosis of vocal cord paralysis. These cases were evaluated with respect to etiology of paralysis, whether unilateral or bilateral, delay in diagnosis, need for tracheotomy, abnormality of voice, surgical treatment, and outcome. Guidelines for management for a child with vocal cord paralysis are presented with emphasis on flexible endoscopic evaluation and conservative management.

Vocal cord paralysis in children studied by monopolar electromyography

Twelve children with symptoms of vocal cord paralysis were studied by monopolar needle electromyography. Recordings were used to verify complete or partial paralysis as well as to evaluate the etiology of the problem, paralytic or mechanical. These results then were useful in patient management. The monopolar electromyographic technique is of value in evaluating and treating vocal cord problems.

Vocal cord paralysis in children.

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Vocal cord paralysis in small children: principles in management.

Vocal cord paralysis in children is an uncommon but often disabling problem. It may be congenital or acquired either in the immediate period surrounding birth or as a postpartum event. Because even unilateral vocal cord paralysis can result in severe respiratory distress in the newborn and in small children, recognition of this problem can be critical. A logical approach to diagnosis and management requires not only that the physician be alert to the problem but also that several procedures be established that can be used together or singly to address the problem, as is most appropriate to the individual case. The usefulness of intubation, tracheotomy, surgical lateralization of the vocal folds, and reinnervation in the management of these problems is discussed, and 30 cases of vocal cord paralysis in children under the age of 5 years are presented.