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Vocal Fold Paralysis in Paediatric Patients With Arnold-Chiari Malformations: A Systematic Review and Meta-Analysis

Jad Hosri1, Vanessa Helou2, Jonathan Abou Chaar1

  • 1Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
|October 30, 2025
PubMed

Insights

Age at vocal fold paralysis (VFP) onset is critical for pediatric patients with Arnold-Chiari malformations (ACM). Younger VFP onset is associated with poorer recovery and survival outcomes in these ACM patients.

Area of Science:

  • Neurology
  • Pediatric Medicine
  • Genetics

Background:

  • Arnold-Chiari malformations (ACM) are congenital conditions affecting the cerebellum and brainstem.
  • Vocal fold paralysis (VFP) is a significant complication in pediatric ACM patients, impacting airway and feeding.
  • Understanding risk factors for VFP outcomes in ACM is crucial for patient management.

Purpose of the Study:

  • To identify and analyze risk factors influencing vocal fold paralysis (VFP) outcomes in patients diagnosed with Arnold-Chiari malformations (ACM).
  • To determine the association between the age of VFP onset and patient recovery and survival rates within the ACM cohort.

Main Methods:

  • A systematic review adhering to the 2020 PRISMA checklist was performed.
  • Comprehensive literature searches were conducted across multiple databases for studies on ACM and VFP.
  • Meta-analysis, including Chi-squared tests and binary logistic regression, was employed to assess variable associations.

Main Results:

  • The review included 33 studies with 165 pediatric patients (mean age 15.31 months); Chiari type 2 was predominant (120 cases).
  • Bilateral VFP occurred in 103 patients; common treatments included ventriculoperitoneal shunt (65.45%) and posterior fossa decompression (52.12%).
  • A significant association was found between VFP onset age and recovery/survival rates in the overall and ACM II cohorts.

Conclusions:

  • Age at onset of vocal fold paralysis (VFP) is a critical prognostic factor in pediatric ACM patients.
  • Younger age at VFP onset correlates with incomplete symptom resolution and reduced survival rates.
  • Early identification of VFP and its timing are essential for optimizing outcomes in ACM.
Abstract

Keywords:
airwayarnold‐chiaripaediatric otolaryngologyvocal fold paralysis

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