Skip to main content
SpringerLink
Log in

Decision-Making in Pediatric Unilateral Vocal Fold Movement Impairment

  • Chapter
  • First Online:
Decision Making in Vocal Fold Paralysis

  • 534 Accesses

Abstract

Unilateral vocal fold movement impairment (VFMI) in infants and children may be due to congenital, iatrogenic, or idiopathic causes and can result in stridor, dysphagia, and/or dysphonia. As a result, these patients may have longer hospital length of stays, recurrent pulmonary infections, and/or impaired psychosocial functioning. Diagnosis may be delayed because glottic incompetence can be overshadowed by other comorbid conditions such as prematurity or congenital heart disease. Iatrogenic injury is the most common cause of VFMI due to the meandering route the recurrent laryngeal nerve takes through the neck and chest. Flexible nasolaryngoscopy is typically used to diagnose VFMI, but visualizing the larynx may be challenging due to patient cooperation or anatomic limitations. Transcervical laryngeal ultrasound can be used as another means of assessing vocal fold mobility. Spontaneous vocal fold movement recovery or vocal fold compensation is frequently seen but may take months or even years to achieve. Treatment options for persistent VFMI include voice therapy, injection laryngoplasty, laryngeal framework surgery, and laryngeal reinnervation. Each of these modalities has its own advantages and disadvantages, and each may be applied in isolation or combination.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ELBW:

Extremely low birth weight

FEES:

Flexible endoscopic evaluation of swallow

FNL:

Flexible nasolaryngoscopy

LEMG:

Laryngeal electromyography

NSLR:

Nonselective laryngeal reinnervation

PDA:

Patent ductus arteriosus

RLN:

Recurrent laryngeal nerve

VFMI:

Vocal fold movement impairment

VFSS:

Videofluoroscopic swallow study

References

  1. King EF, Blumin JH. Vocal cord paralysis in children. Curr Opin Otolaryngol Head Neck Surg. 2009;17:483–7.

    Article  PubMed  Google Scholar 

  2. Zbar RIS, Chen AH, Behrendt DM, Bell EF, Smith RJH. Incidence of vocal fold paralysis in infants undergoing ligation of patent ductus arteriosus. Ann Thorac Surg. 1996;61:814–6.

    Article  CAS  PubMed  Google Scholar 

  3. Averin K, Uzark K, Beekman RH, Willging PJ, Pratt J, Manning PB. Postoperative assessment of laryngopharyngeal dysfunction in neonates after Norwood operation. Ann Thorac Surg. 2012;94:1257–61.

    Article  PubMed  Google Scholar 

  4. Pereira KD, Webb BD, Blakely ML, Cox CS Jr, Lally KP. Sequelae of recurrent laryngeal nerve injury after patent ductus arteriosus ligation. Int J Pediatr Otorhinolaryngol. 2006;70:1609–12.

    Article  PubMed  Google Scholar 

  5. Benjamin JR, Smith PB, Cotten CM, Jaggers J, Goldstein RF, Malcolm WF. Long-term morbidities associated with vocal cord paralysis after surgical closure of a patent ductus arteriosus in extremely low birth weight infants. J Perinatol. 2010;30:408–13.

    Article  CAS  PubMed  Google Scholar 

  6. Clement WA, El-Hakim H, Phillipos EZ. Unilateral vocal cord paralysis following patent ductus arteriosus ligation in extremely low-birth-weight infants. Arch Otolaryngol Head Neck Surg. 2008;134:28–33.

    Article  PubMed  Google Scholar 

  7. Dewan K, Cephus C, Owczarzak V, Ocampo E. Incidence and implication of vocal fold paresis following neonatal cardiac surgery. Laryngoscope. 2012;122:2781–5.

    Article  PubMed  Google Scholar 

  8. Skinner ML, Halstead LA, Rubinstein CS, Atz AM, Andrews D, Bradley SM. Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg. 2005;130:1293–301.

    Article  PubMed  Google Scholar 

  9. Grundfast K, Harley E. Vocal cord paralysis. Otolaryngol Clin N Am. 1989;22:569–97.

    CAS  Google Scholar 

  10. Xu W, Wang H, Cao H, Fan Z, Yue Z, Lu Z. Recurrent laryngeal nerve decompression. Chin J Otorhinolaryngol Head Neck Surg. 2006;41:408–11.

    Google Scholar 

  11. Chhabra A, Ahlawat S, Belzberg A, Adreseik G. Peripheral nerve injury grading simplified on MR neurography: as referenced to Seddon and Sunderland classifications. Indian J Radiol Imaging. 2014;24:217–24.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Blitzer A, Crumley RL, Dailey SH, et al. Invited article: recommendations of the neurolaryngology study group on laryngeal electromyography. Otolaryngol Head Neck Surg. 2009;140:782–93.

    Article  PubMed  Google Scholar 

  13. Aynehchi BB, McCoul ED, Sundaram K. Systematic review of laryngeal reinnervation techniques. Otolaryngol Head Neck Surg. 2010;143:749–59.

    Article  PubMed  Google Scholar 

  14. Liu Y-CC, Varier I, Ongkasuwan J. Use of audiometric measurement for assessment of vocal-fold function in post-extubation infants. JAMA Otolaryngol Head Neck Surg. 2017;143:908–11.

    Article  PubMed  Google Scholar 

  15. Zur KB, Carroll LM. Recurrent laryngeal nerve reinnervation in children: acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options. Laryngoscope. 2015;125:1–15.

    Article  Google Scholar 

  16. Smith ME, Houtz DR. Outcomes of laryngeal reinnervation for unilateral vocal fold paralysis in children: associations with age and time since injury. Ann Otol Rhinol Laryngol. 2016;125:433–8.

    Article  PubMed  Google Scholar 

  17. Minoru H. Clinical examination of voice. New York: Springer-Verlag; 1981.

    Google Scholar 

  18. Kempster G, Gerratt B, Verdolini Abbott K, Barkmeier-Kraemer J, Hillman R. Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol. Am J Speech Lang Pathol. 2009;18:124–32.

    Article  PubMed  Google Scholar 

  19. Zur KB. Recurrent laryngeal nerve reinnervation for unilateral vocal fold immobility in children. Laryngoscope. 2012;122:S82–3.

    Article  PubMed  Google Scholar 

  20. Boseley M, Cunningham M, Volk M, Hartnick C. Validation of the pediatric voice-related quality-of-life survey. Arch Otolaryngol Head Neck Surg. 2006;132:717–20.

    Article  PubMed  Google Scholar 

  21. Zur K, Cotton S, Kelchner L, Baker S, Weinrich B, Lee L. Pediatric voice handicap index (pVHI): a new tool for evaluating pediatric dysphonia. Int J Pediatr Otorhinolaryngol. 2007;71:77–82.

    Article  PubMed  Google Scholar 

  22. Friedman E. Role of ultrasound in the assessment of vocal cord function in infants and children. Ann Otol Rhinol Laryngol. 1997;106:199–209.

    Article  CAS  PubMed  Google Scholar 

  23. Ongkasuwan J, Ocampo E, Tran B. Laryngeal ultrasound and vocal fold movement in the pediatric cardiovascular intensive care unit. Laryngoscope. 2016;127:167–72.

    Article  PubMed  Google Scholar 

  24. Smith MM, Kuhl G, Carvalho PRA, Marostica PJC. Flexible fiber-optic laryngoscopy in the first hours after extubation for the evaluation of laryngeal lesions due to intubation in the pediatric intensive care unit. Int J Pediatr Otorhinolaryngol. 2007;71:1423–8.

    Article  PubMed  Google Scholar 

  25. Liu Y-CC, McElwee T, Musso M, Rosenberg TL, Ongkasuwan J. The reliability of flexible nasolaryngoscopy in the identification of vocal fold movement impairment in young infants. Int J Pediatr Otorhinolaryngol. 2017;100:157–9.

    Article  PubMed  Google Scholar 

  26. Hamdan A, Sabra O, Rameh C, El-Khatib M. Persistent dysphonia following endotracheal intubation. Middle East J Anaesthesiol. 2007;19:5–13.

    PubMed  Google Scholar 

  27. Daniero JJ, Garrett CG, Francis DO. Framework surgery for treatment of unilateral vocal fold paralysis. Curr Otorhinolaryngol Rep. 2014;2:119–30.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Snow JB Jr, Rogers KA Jr. Bilateral abductor paralysis of the vocal cords secondary to the Arnold-Chiari malformation and its management. Laryngoscope. 1965;75:316–21.

    Article  PubMed  Google Scholar 

  29. Wald NJ, Bridges BA, Little MP, et al. Risk of solid cancers following radiation exposure: estimates for the UK population. Report of the independent Advisory Group on Ionising Radiation, Documents. Health Protection Agency, London, UK; 2011.

    Google Scholar 

  30. Cartwright RA, Little MP, Stather JW, et al. Risk of leukaemia and related malignancies following radiation exposure: estimates for the UK population. Report of an Advisory Group on Ionising Radiation, Documents. National Radiological Protection Board/Health Protection Agency, London, UK; 2003.

    Google Scholar 

  31. Mathews JD, Forsythe AV, Brady Z, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013;346:f2360. https://doi.org/10.1136/bmj.f2360.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ongkasuwan J, Yung KC, Courey MS. The physiologic impact of transnasal flexible endoscopy. Laryngoscope. 2012;122:1131–4.

    Google Scholar 

  33. Vats A, Worley GA, de Bruyn R, Porter H, Albert M, Bailey CM. Laryngeal ultrasound to assess vocal fold paralysis in children. J Laryngol Otol. 2004;118:429–31.

    Article  CAS  PubMed  Google Scholar 

  34. Gould S, Howard S. The histopathology of the larynx in the neonate following endotracheal intubation. J Pathol. 1985;146:301–11.

    Article  CAS  PubMed  Google Scholar 

  35. Chen DW, Price MD, LeMaire SA, Coselli JS, Liou NE, Ongkasuwan J. Early versus late inpatient awake transcervical injection laryngoplasty after thoracic aortic repair. Laryngoscope. 2017;128:144–7.

    Article  PubMed  Google Scholar 

  36. Khadivi E, Akbarian M, Khazaeni K, Salehi M. Outcomes of autologous fat injection laryngoplasty in unilateral vocal cord paralysis. Iran J Otorhinolaryngol. 2016;28:215–9.

    PubMed  PubMed Central  Google Scholar 

  37. Wang W, Chen D, Chen S, Li D, Li M, Xia S, Zheng H. Laryngeal reinnervation using ansa cervicalis for thyroid surgery-related unilateral vocal fold paralysis: a long-term outcome analysis of 237 cases. PLoS One. 2011;6:e19128.

    Article  CAS  PubMed  Google Scholar 

  38. Wang W, Chen S, Chen D, Xia S, Qiu X, Liu Y, Zheng H. Contralateral ansa cervicalis-to-recurrent laryngeal nerve anastomosis for unilateral focal fold paralysis: a long-term outcome analysis of 56 cases. Laryngoscope. 2011;121:1027–34.

    Article  PubMed  Google Scholar 

  39. Smith ME. Pediatric ansa cervicalis to recurrent laryngeal nerve anastomosis. Adv Otorhinolaryngol. 2012;73:80–5.

    PubMed  Google Scholar 

  40. Li M, Chen D, Song X, Wang W, Zhu M, Liu F, et al. The effect of patient age on the success of laryngeal reinnervation. Eur Arch Otorhinolaryngol. 2014;271(12):3241–7. https://doi.org/10.1007/s00405-014-3091-6. Epub 2014 Jun 10.

    Article  PubMed  Google Scholar 

  41. Li M, Chen S, Wang W, Chen D, Zhu M, Lui F, et al. Effect of duration of denervation on outcomes of ansa-recurrent laryngeal nerve reinnervation. Laryngoscope. 2014;124:1900–5.

    Article  PubMed  Google Scholar 

  42. Andropoulos DB, Greene MF. Anesthesia and developing brains – implications of the FDA warning. N Engl J Med. 2017;376:905–7.

    Article  PubMed  Google Scholar 

  43. Lee WT, Milstein C, Hicks D. Results of ansa to recurrent laryngeal nerve reinnervation. Otolaryngol Head Neck Surg. 2007;136:450–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, Baylor College of Medicine, Houston, TX, USA

    Nicole L. Alexander

  2. Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA

    Julina Ongkasuwan

Authors
  1. Nicole L. Alexander
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julina Ongkasuwan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julina Ongkasuwan .

Editor information

Editors and Affiliations

  1. NYU Swallowing Disorders Center, New York University, New York, NY, USA

    Milan R. Amin

  2. USC Voice Center, University of Southern California, Los Angeles, CA, USA

    Michael M. Johns

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Alexander, N.L., Ongkasuwan, J. (2019). Decision-Making in Pediatric Unilateral Vocal Fold Movement Impairment. In: Amin, M., Johns, M. (eds) Decision Making in Vocal Fold Paralysis. Springer, Cham. https://doi.org/10.1007/978-3-030-23475-1_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-23475-1_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23474-4

  • Online ISBN: 978-3-030-23475-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation