Etiologies and clinical outcomes in pediatric vocal cord dysfunction: A single-center retrospective review

Vocal cord dysfunction (VCD) encompasses diverse etiologies in pediatric patients, causing various symptoms that can even be life-threatening. Although existing literature often categorizes VCD by side of involvement, exploring underlying etiologies may offer a more comprehensive understanding of the disorder.

A total of 65 pediatric patients diagnosed with VCD via flexible bronchoscopy between January 2018 and December 2022 were enrolled, with follow-up extending from diagnosis until December 2022. Characteristics including demographic data, precursor events, clinical and imaging presentations, along with interventions and prognostic outcomes, were analyzed and compared across various potential etiology groups of VCD.

Patients were classified into four groups based on potential etiologies of VCD. Patients with central nervous system (CNS) comorbidities (n = 11), mainly hypoxic-ischemic encephalopathy (HIE) (n = 8), had the highest rate of tracheostomy (72.7 %). In contrast, most with peripheral nervous system (PNS) conditions (n = 27), including iatrogenic events and cardiovocal syndrome, were managed conservatively (70.4 %). Those with local events (n = 17), such as intubation history and granulations, had significantly higher rates of undergoing surgical interventions and achieving clinical recovery (both P < 0.05). Among idiopathic cases, sedation medication was considered a potential contributing factor in half (n = 5 out of 10) of the patients. Mortality rates did not differ significantly among the groups.

Etiology-based clinical evaluation and management are essential for promoting long-term outcomes in these patients. Conservative treatment is recommended in patients with consistent respiratory health.