Skip to main content
SpringerLink
Log in

Vocal Fold Paralysis and Dysphagia: Challenges and Controversies

  • Chapter
  • First Online:
Pediatric Dysphagia

Abstract

The term vocal fold paralysis (VFP) has a spectrum of entities within the literature, including vocal fold motion impairment, vocal fold immobility, adductor or abductor paralysis, and vocal fold paresis. VFP is known to be a major cause of dysphagia, dysphonia, and respiratory problems. The degree to which these are manifested often depends on whether the patient has unilateral VFP or bilateral VFP, as well as etiology of the VFP, patient age, and other patient characteristics. While the majority of pediatric studies that have focused on the management of VFP have emphasized respiratory and voice outcomes, dysphagia and impaired swallowing function are important consequences of VFP. This chapter focuses on the relationship between VFP and dysphagia in the pediatric patient, focusing specifically on the challenges the otolaryngologist faces in the workup and management of this entity.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
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

References

  1. Crumley RL. Laryngeal synkinesis revisited. Ann Otol Rhinol Laryngol. 2000;109:365–71.

    Article  CAS  Google Scholar 

  2. Bhattacharyya N. The prevalence of pediatric voice and swallowing problems in the United States. Laryngoscope. 2015;125:746–50.

    Article  Google Scholar 

  3. Dedo DD. Pediatric vocal cord paralysis. Laryngoscope. 1979;89:1378–84.

    Article  CAS  Google Scholar 

  4. Brigger MT, Hartnick CJ. Surgery for pediatric vocal cord paralysis: a meta-analysis. Otolaryngol Head Neck Surg. 2002;126:349–55.

    Article  Google Scholar 

  5. Holinger LD, Holinger PC, Holinger PH. Etiology of bilateral abductor vocal cord paralysis. Ann Otol Rhinol Laryngol. 1976;85:428–36.

    Article  CAS  Google Scholar 

  6. Parikh SR. Pediatric unilateral vocal fold immobility. Otolaryngol Clin N Am. 2004;37:203–15.

    Article  Google Scholar 

  7. Hsu J, Tibbetts KM, Wu D, Nassar M, Tan M. Swallowing function in pediatric patients with bilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol. 2017;93:37–41.

    Article  Google Scholar 

  8. Sachdeva R, Hussain E, Moss MM, Schmitz ML, Ray RM, Imamura M, et al. Vocal cord dysfunction and feeding difficulties after pediatric cardiovascular surgery. J Pediatr. 2007;151(3):312–5, e1–e2

    Article  Google Scholar 

  9. Truong MT, Messner AH, Kerschner JE, Scholes M, Wong-Dominguez J, Milczuk HA, et al. Pediatric vocal fold paralysis after cardiac surgery: rate of recovery and sequelae. Otolaryngol Head Neck Surg. 2007;137(5):780–4.

    Article  Google Scholar 

  10. Benjamin JR, Smith PB, Cotton CM, Jaggers J, Goldstein RF, Malcolm WF. Long-term morbidities associated with vocal cord paralysis after surgical closure of a patent ductus arteriosis in extremely low birth weight infants. J Perinatol. 2010;30(6):408–13.

    Article  CAS  Google Scholar 

  11. Jabbour J, Martin T, Beste D, Robey T. Pediatric vocal fold immobility natural history and the need for long-term follow-up. JAMA Otolaryngol Head Neck Surg. 2014;140(5):428–33.

    Article  Google Scholar 

  12. Pemberton J, Frankfurter C, Bailey K, Jones L, Walton JM. Gastrostomy matters-the impact of pediatric surgery on caregiver quality of life. J Pediatr Surg. 2013;48(5):963–70.

    Article  Google Scholar 

  13. Rosin DF, Handler SD, Potsic WP, Wetmore RF, Tom LWC. Vocal cord paralysis in children. Laryngoscope. 1990;100:1174–9.

    Article  CAS  Google Scholar 

  14. Tibbetts KM, Wu D, Hsu JV, Burton WB, Nassar M, Tan M. Etiology and long-term functional swallow outcomes in pediatric unilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol. 2016;88:179–83.

    Article  Google Scholar 

  15. Randolph C, Lapey A, Shannon DC. Bilateral abductor paresis masquerading as asthma. J Allergy Clin Immunol. 1988;81:1122–5.

    Article  CAS  Google Scholar 

  16. Chen EY, Inglis AF Jr. Bilateral vocal cord paralysis in children. Otolaryngol Clin N Am. 2008;41:889–901.

    Article  Google Scholar 

  17. Raza SA, Mahendran S, Rahman N, Williams RG. Familial vocal fold paralysis. J Laryngol Otol. 2002;116:1047–9.

    PubMed  Google Scholar 

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

    CAS  Google Scholar 

  19. Setlur J, Hartnick CJ. Management of unilateral true vocal cord paralysis in children. Curr Opin Otolaryngol Head Neck Surg. 2012;20:497–501.

    Article  Google Scholar 

  20. Bogaard JM, Pauw KH, Versprille A, Stam H, Verbraak AF, Maas AJ. Maximal expiratory and inspiratory flow-volume curves in bilateral vocal-cord paralysis. Changes after surgical treatment and comparison with glottis resistance characteristics. ORL J Otorhinolaryngol Relat Spec. 1987;49:35–41.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  22. Carneiro-Pla D, Miller BS, Wilhelm SM, Milas M, Gauger PG, Cohen MS, et al. Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: a multi-institutional experience. Surgery. 2014;156(6):1597–602.

    Article  Google Scholar 

  23. Parangi S. Editorial: Translaryngeal vocal cord ultrasound: ready for prime time. Surgery. 2016;159:67–9.

    Article  Google Scholar 

  24. Berkowitz RG. Laryngeal electromyography findings in idiopathic congenital bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol. 1996;105:207–12.

    Article  CAS  Google Scholar 

  25. Wohl DL, Kilpatrick JK, Leshner RT, Shaia WT. Intraoperative pediatric laryngeal electromyography: experience and caveats with monopolar electrodes. Ann Otol Rhinol Laryngol. 2001;110:524–31.

    Article  CAS  Google Scholar 

  26. Holinger PC, Holinger LD, Reichert TJ, Holinger PH. Respiratory obstruction and apnea in infants with bilateral abductor vocal cord paralysis, meningomyelocele, hydrocephalus, and Arnold Chiari malformation. J Pediatr. 1978;92:368–73.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  28. Cohen SR, Geller KA, Birns JW, Thompson JW. Laryngeal paralysis in children: a long-term retrospective study. Ann Otol Rhinol Laryngol. 1982;91:417–24.

    Article  CAS  Google Scholar 

  29. De Gaudemar I, Roudaire M, Francois M, Narcy P. Outcome of laryngeal paralysis in neonates: a long term retrospective study of 113 cases. Int J Pediatr Otorhinolaryngol. 1996;34:101–10.

    Article  Google Scholar 

  30. Daya H, Hosni A, Bejar-Solar I, Evans JN, Bailey CM. Pediatric vocal fold paralysis. Arch Otolaryngol Head Neck Surg. 2000;126:21–5.

    Article  CAS  Google Scholar 

  31. Andropoulos DG, Greene MF. Anesthesia and developing brains-implications of the FDA warning. N Engl J Med. 2017;376(10):905–7.

    Article  Google Scholar 

  32. Nichols BG, Jabbour J, Hehir DA, Ghanayem NS, Beste D, Martin T, et al. Recovery of vocal fold immobility following isolated patent ductus arteriosus ligation. Int J Pediatr Otorhinolaryngol. 2014;78(8):1316–9.

    Article  Google Scholar 

  33. Jang YY, Lee SJ, Lee SJ, Jeon JY, Lee SJ. Analysis of video fluoroscopic swallowing study in patients with vocal cord paralysis. Dysphagia. 2012;27(2):185–90.

    Article  Google Scholar 

  34. Swift AC, Rogers J. Vocal cord paralysis in children. J Laryngol Otol. 1987;101:169–71.

    Article  CAS  Google Scholar 

  35. Hollinger PH, Brown WT. Congenital webs, cysts, laryngoceles, and other anomalies of the larynx. Ann Otol Rhinol Laryngol. 1967;76:744–52.

    Article  Google Scholar 

  36. Murty GE, Shinkwin C, Gibbin KP. Bilatearl vocal fold paralysis in infants: tracheostomy or not? J Laryngol Otol. 1994;108:329–31.

    Article  CAS  Google Scholar 

  37. Berkowitz RG. Natural history of tracheostomy-dependent idiopathic congenital bilateral vocal fold paralysis. Otolaryngol Head Neck Surg. 2007;136:649–52.

    Article  Google Scholar 

  38. Funk RT, Jabbour J, Robey T. Factors associated with tracheotomy and decannulation in pediatric bilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol. 2015;79(6):895–9.

    Article  Google Scholar 

  39. Woodman DG. A modification of the extralaryngeal approach to arytenoidectomy for bilateral abductor paralysis. Arch Otolaryngol. 1946;43:63–5.

    Article  CAS  Google Scholar 

  40. Woodson G. Arytenoid abduction: indications and limitations. Ann Otol Rhinol Laryngol. 2010;119:742–8.

    PubMed  Google Scholar 

  41. Thakkar K, Gerber ME. Endoscopic posterior costal cartilage graft placement for acute management of pediatric bilateral vocal fold paralysis without tracheostomy. Int J Pediatr Otorhinolaryngol. 2008;72:1555–8.

    Article  Google Scholar 

  42. Bigenzahn W, Hoefler H. Minimally invasive laser surgery for the treatment of bilateral vocal cord paralysis. Laryngoscope. 1996;106:791–3.

    Article  CAS  Google Scholar 

  43. Eckel HE, Thumfart M, Wassermann K, Vossing M, Thumfart WF. Cordectomy versus arytenoidectomy in the management of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol. 1994;103:852–7.

    Article  CAS  Google Scholar 

  44. Ossoff RH, Duncavage JA, Shapshay SM, Krespi YP, Sisson GA. Endoscopic laser arytenoidectomy revisited. Ann Otol Rhinol Laryngol. 1990;99:764–71.

    Article  CAS  Google Scholar 

  45. Marina MB, Marie JP, Birchall MA. Laryngeal reinnervation for bilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg. 2011;19:434–8.

    Article  Google Scholar 

  46. Smith ME, Park AH, Muntz HR, Gray SD. Airway augmentation and maintenance through laryngeal chemodenervation in children with impaired vocal fold mobility. Arch Otolaryngol Head Neck Surg. 2007;133:610–2.

    Article  Google Scholar 

  47. Schindler A, Bottero A, Capaccio P, Ginocchio D, Adorni F, Ottaviani F. Vocal improvement after voice therapy in unilateral vocal fold paralysis. J Voice. 2008;22:113–8.

    Article  Google Scholar 

  48. Tucker HM. Vocal cord paralysis in small children: principles of management. Ann Otol Rhinol Laryngol. 1986;95:618–21.

    Article  CAS  Google Scholar 

  49. Butskiy O, Mistry B, Chadha NK. Surgical interventions for pediatric unilateral vocal cord paralysis: a systematic review. JAMA Otolaryngol Head Neck Surg. 2015;14(7):654–60.

    Article  Google Scholar 

  50. Misono S, Merati AL. Evidence-based practice: evaluation and management of unilateral vocal fold paralysis. Otolaryngol Clin North Am. 2012;45(5):1083–108.

    Article  Google Scholar 

  51. DeFatta RA, Chowdhury FR, Sataloff RT. Complications of injection laryngoplasty using calcium hydroxylapatite. J Voice. 2012;26(5):614–8.

    Article  Google Scholar 

  52. Sipp JA, Kerschner JE, Braune N, Hartnick CJ. Vocal fold medicalization in children: injection laryngoplasty, thyroplasty, or nerve reinnervation? Arch Otolaryngol Head Neck Surg. 2007;133(8):767–71.

    Article  Google Scholar 

  53. Tucker HM. Vocal cord paralysis in small children: principles in management. Ann Otol Rhinol Laryngol. 1986;95(6, pt 1):618–21.

    Article  CAS  Google Scholar 

  54. Levine BA, Jacobs IN, Wetmore RF, Handler SD. Vocal cord injection in children with unilateral vocal cord paralysis. Arch Otolaryngol Head Neck Surg. 1995;121(1):116–9.

    Article  CAS  Google Scholar 

  55. Patel NJ, Kerschner JE, Merati AL. The use of injectable collage in the management of pediatric vocal unilateral fold paralysis. Int J Pediatr Otorhinolaryngol. 2003;67(12):1355–60.

    Article  Google Scholar 

  56. Cohen MS, Mehta DK, Maguire RC, Simons JP. Injection medicalization laryngoplasty in children. Arch Otolaryngol Head Neck Surg. 2011;137(3):264–8.

    Article  Google Scholar 

  57. Yung KC, Likhterov I, Courey MS. Effect of temporary vocal fold injection medialization on the rate of permanent medialization laryngoplasty in unilateral vocal fold paralysis patients. Laryngoscope. 2011;121(10):2191–4.

    Article  Google Scholar 

  58. Friedman AD, Burns JA, Heaton JT, Zeitels SM. Early versus late injection medialization for unilateral vocal cord paralysis. Laryngoscope. 2010;120(10):2042–6.

    Article  Google Scholar 

  59. Link DT, Rutter MJ, Liu JH, Willging JP, Myer CM, Cotton RT. Pediatric type I thyroplasty: an evolving procedure. Ann Otol Rhinol Laryngol. 1999;108:1105–10.

    Article  CAS  Google Scholar 

  60. Gardner GM, Altman JS, Balakrishnan G. Pediatric vocal fold medialization with silastic implant: intraoperative airway management. Int J Pediatr Otorhinolaryngol. 2000;52:37–44.

    Article  CAS  Google Scholar 

  61. Isaacson G. Extraluminal arytenoid reconstruction: laryngeal framework surgery applied to a pediatric problem. Ann Otol Rhinol Laryngol. 1990;99(8):616–20.

    Article  CAS  Google Scholar 

  62. Paniello RC, Edgar JD, Kallogjeri D, Piccirillo JF. Medialization versus reinnervation for unilateral vocal fold paralysis: a multicenter randomized clinical trial. Laryngoscope. 2011;121(10):2172–9.

    Article  Google Scholar 

  63. Smith ME, Roy N, Houtz D. Laryngeal reinnervation for paralytic dysphonia in children younger than 10 years. Arch Otolaryngol Head Neck Surg. 2012;138:1161–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Children’s Hospital at Vanderbilt, Nashville, TN, USA

    Ryan Belcher

  2. Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Nikhila Raol

Authors
  1. Ryan Belcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikhila Raol
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan Belcher .

Editor information

Editors and Affiliations

  1. Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA

    Julina Ongkasuwan

  2. Pediatric Gastroenterology and Nutrition, Baylor College of Medicine, Houston, TX, USA

    Eric H. Chiou

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Belcher, R., Raol, N. (2018). Vocal Fold Paralysis and Dysphagia: Challenges and Controversies. In: Ongkasuwan, J., Chiou, E. (eds) Pediatric Dysphagia. Springer, Cham. https://doi.org/10.1007/978-3-319-97025-7_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-97025-7_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97024-0

  • Online ISBN: 978-3-319-97025-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation