Dysphagia in pediatric unilateral vocal fold immobility after aortic arch surgery

Unilateral vocal fold immobility (UVFI) after pediatric cardiac surgery is prevalent; however, the burden of swallowing symptoms is unclear.

We hypothesize that swallowing dysfunction is more prevalent in UVFI patients compared to non-UVFI patients, and that perioperative factors may influence swallowing symptom burden.

This was a retrospective cohort study of pediatric patients who underwent aortic arch surgery between 2013 and 2024 at the Stollery Children's Hospital. Exclusion criteria included bilateral vocal fold paralysis, genetic, or neurological comorbidities that could affect nerve function. Swallowing data from clinical and instrumental swallowing assessments were collected via chart review. Abnormal findings were compared between UVFI and non-UVFI patients. Associations between variables and aspiration on instrumental swallow assessments in UVFI patients were calculated through univariate analysis using a significance level of p < 005.

234 patients of 1047 included in the study were diagnosed with UVFI. The mean gestational age was 37.0 (±4.7) weeks. There were 623 males and 424 females. UVFI patients were significantly more likely to undergo clinical and instrumental swallowing assessments compared to non-UVFI patients (p < 0.001, p < 0.001). Univariate analysis showed aortic coarctation (p = 0.012, OR = 0.07, CI = 0.01-0.56) was negatively associated with penetration or aspiration on instrumental swallowing assessments.

Swallowing dysfunction is more common in patients who develop UVFI after cardiac surgery than those who do not. Patients who underwent aortic coarctation repair were less likely to have penetration or aspiration post-operatively. However, there were no other clear predictors or perioperative factors associated with a higher likelihood of swallowing dysfunction.