Comorbidities and Airway Prosthesis Dependence in Bilateral Vocal Fold Immobility

Bilateral vocal fold immobility (BVFI) results from posterior glottic stenosis (PGS) or bilateral vocal fold paralysis (BVFP). In the context of prolonged intubation, PGS often presents with additional airway stenosis (PGS⁺). There is a paucity of literature comparing isolated PGS (iPGS), PGS⁺, and isolated BVFP (iBVFP). The objective of this study is to analyze demographics, airway prosthesis (AP) dependence, and risk factors for failed decannulation within these cohorts.

Retrospective case series of patients with BVFI managed at a tertiary academic institution between 2011 and 2021. Univariate analysis determined factors associated with decannulation rates and AP dependence at last contact.

118 patients were identified: 39 iPGS, 54 PGS⁺, 25 iBVFP. PGS⁺ patients were younger than iPGS or iBVFP (P = .009). iPGS, PGS⁺, and iBVFP were less common in men than women (P = 0.838). The mean number of airway operations per year was higher in PGS⁺ versus iPGS or iBVFP patients (P = .001). Decannulation rate was similar in iPGS, PGS+, and iBVFP (P = 0.739). The AP dependence rate was 39% in the PGS⁺ cohort and 26% and 24% in patients with isolated glottic pathology (iPGS, iBVFP respectively, P = 0.105). Active smoking was associated with a higher rate of AP dependence in the iPGS group only (P = .020). PGS⁺ and a history of head and neck radiation both had higher observed rates of AP dependence without achieving statistical significance (P = .092, P = .073).

58% of PGS patients had additional stenosis beyond the glottis. These patients were younger and received more airway surgeries than iPGS or iBVFP patients, however there was no statistically significant difference in AP dependence or decannulation rate between the groups. Independent analysis of iPGS and PGS⁺ elucidates the relative complexity of treating PGS patients with additional airway stenosis.