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Stridor: intracranial pathology causing postextubation vocal cord paralysis.
F C Chaten1, S E Lucking, E S Young
1Division of Pediatric Critical Care Medicine, Children's Medical Center, Medical College of Virginia, Richmond.
Pediatrics
|January 1, 1991
Summary
Pediatric vocal cord paralysis, often causing stridor after extubation, can result from nerve injury or intracranial pressure. Early laryngeal evaluation is crucial for affected children.
Area of Science:
- Pediatric critical care medicine
- Otolaryngology
- Pediatric neurology
Background:
- Vocal cord paralysis is a serious complication in pediatric intensive care.
- Stridor upon extubation can indicate vocal cord dysfunction.
Purpose of the Study:
- To identify the incidence and causes of vocal cord paralysis in pediatric intensive care patients.
- To evaluate the outcomes of vocal cord paralysis in this population.
Main Methods:
- Flexible bronchoscopy was used to diagnose vocal cord paralysis in nine pediatric patients over 18 months.
- Patient data including age, paralysis type, cause, and treatment outcomes were collected.
Main Results:
- Nine pediatric patients (17 days to 5.5 years) presented with vocal cord paralysis and stridor post-extubation.
- Bilateral abductor paralysis (7 patients) frequently required tracheostomy (6/7), while unilateral paralysis (2 patients) did not.
- Neurologic disorders with increased intracranial pressure were the likely cause in most cases (7/9).
- Recovery of cord mobility occurred in 4/7 bilateral cases within 4 months; unilateral cases resolved within 1 year.
Conclusions:
- Increased intracranial pressure may cause vagal nerve compression leading to vocal cord paralysis.
- Early laryngeal visualization is recommended for extubated children with stridor, particularly those with a history of thoracic procedures or neurological conditions associated with intracranial hypertension.