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Natural history of tracheostomy-dependent idiopathic congenital bilateral vocal fold paralysis

Robert G Berkowitz1

  • 1Department of Otolaryngology, Royal Children's Hospital, Australia. robert.berkowitz@rch.org.au

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|April 10, 2007
PubMed

Insights

Children with congenital bilateral vocal fold paralysis (BVFP) may regain vocal fold function for decannulation around age 5-7 years. Conservative management is a viable option for severe BVFP cases.

Area of Science:

  • Pediatric Otolaryngology
  • Neurology
  • Genetics

Background:

  • Idiopathic congenital bilateral vocal fold paralysis (BVFP) is a rare condition causing significant airway obstruction in infants.
  • Tracheostomy is often required to manage airway compromise, but decannulation depends on the spontaneous recovery of vocal fold function.

Purpose of the Study:

  • To determine the typical age of spontaneous vocal fold function improvement allowing decannulation in children with isolated idiopathic congenital BVFP.
  • To evaluate the long-term outcomes and potential for conservative management in these patients.

Main Methods:

  • A retrospective chart review was conducted at a tertiary pediatric center.
  • The study included children diagnosed with isolated idiopathic congenital BVFP who underwent tracheostomy.

Main Results:

  • Three tracheostomy-dependent children with BVFP were identified, with tracheostomy performed between 13 and 45 days of age.
  • Two patients were decannulated at ages 5 years 11 months and 7 years 1 month, respectively, though both experienced persistent upper airway obstruction symptoms.
  • One patient remained tracheostomy-dependent at 4 years old with minimal vocal cord abduction.

Conclusions:

  • Spontaneous improvement in vocal fold function sufficient for decannulation in BVFP typically occurs during the second quinquennium (ages 5-10 years).
  • Conservative treatment strategies may be a suitable alternative to surgical intervention for severe cases of idiopathic congenital BVFP.
Abstract

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