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Pediatric Vocal Fold Paralysis.

Patrick Kiessling1, Douglas Sidell2

  • 1Department of Otolaryngology-Head & Neck Surgery, Stanford Health Care, Stanford, CA, USA.

Otolaryngologic Clinics of North America
|April 21, 2026
PubMed
Summary
This summary is machine-generated.

Pediatric vocal fold paralysis (VFP) diagnosis and management are challenging. This condition, often caused by surgery, requires specific treatments for unilateral and bilateral cases to improve breathing and voice.

Keywords:
Pediatric airwayVocal foldVocal fold paralysis

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Area of Science:

  • Otolaryngology
  • Pediatric Surgery
  • Speech Pathology

Background:

  • Pediatric vocal fold paralysis (VFP) presents diagnostic and management challenges.
  • Iatrogenic VFP, commonly linked to cardiac procedures, is the most frequent type.
  • Symptoms vary from dysphonia and stridor in unilateral VFP to severe respiratory distress in bilateral VFP.

Purpose of the Study:

  • To review the diagnostic and management strategies for pediatric vocal fold paralysis.
  • To highlight the differences in presentation and treatment between unilateral and bilateral VFP.
  • To discuss current and emerging treatment options for pediatric VFP.

Main Methods:

  • Review of current literature on pediatric vocal fold paralysis.
  • Analysis of diagnostic modalities including flexible laryngoscopy and vocal fold ultrasound.
  • Evaluation of treatment outcomes for injection laryngoplasty, nerve reinnervation, and surgical interventions for bilateral VFP.

Main Results:

  • Flexible laryngoscopy is the gold standard for diagnosing pediatric VFP.
  • Vocal fold ultrasound serves as a viable alternative diagnostic tool.
  • Unilateral VFP can be managed with short-term injection laryngoplasty or long-term nerve reinnervation.
  • Bilateral VFP management often involves tracheostomy, but surgical options exist to avoid or facilitate decannulation.

Conclusions:

  • Effective diagnosis of pediatric VFP relies on flexible laryngoscopy or ultrasound.
  • Treatment strategies for pediatric VFP are tailored to unilateral versus bilateral presentation.
  • Surgical interventions offer promising alternatives to tracheostomy in managing bilateral VFP.