National trends in pediatric laryngeal reinnervation

Over the last decade, many pediatric otolaryngologists have come to regard non-selective laryngeal reinnervation (NSLR) from ansa cervicalis to the recurrent laryngeal nerve as the preferred definitive treatment for unilateral vocal fold paralysis. The purpose of this study is to review national trends in NSLR.

Retrospective cohort study using the Pediatric Health Information System (PHIS), 2004 to 2022. Linear regression to identify trends in the incidence of reinnervation and vocal fold paralysis.

198 NSLRs were identified. Mean patient age was 8.2 years old (95 % confidence interval 7.50-8.97). The first documented NSLR in the study period was in 2008. In 2021, 49 NSLRs were performed. On linear regression, the number of reinnervations increased by 3.2 per year (95 % CI 3.01-3.47, R² = 0.76). Hospitals were broken into groups by their volumes over the study period (low volume, 1st to 50th percentile/0-5 reinnervations over the study period; medium volume, 51st to 75th/5-9 reinnervations; high volume, 76th to 99th/greater than 9 reinnervations). The increase in reinnervation held across groups but was strongest among the high volume centers (low volume, 0.35 more reinnervations per year, 95 % CI 0.24-0.45, R² = 0.47; medium volume, 0.89, 95 % CI 0.63-1.14, R² = 0.84; high volume, 1.69, 95 % CI 1.62-1.76, R² = 0.76).

NSLR is an increasingly popular surgery, but much of its growth is focused at high-volume centers. Given the incidence of unilateral vocal fold paralysis in children, there are likely other children nationwide who may benefit from this surgery.