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Neonatal vocal cord paralysis
B N Benjamin1, S D Gray, C M Bailey
1Department of Otolaryngology, William Bland Centre, Sydney, Australia.
Head & Neck
|March 1, 1993
Summary
Surgery is a common cause of neonatal unilateral vocal cord paralysis. Evaluation for cardiovascular or central nervous system anomalies is recommended when surgery is not the cause.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Neurology
Background:
- Unilateral vocal cord paralysis (UVCP) in neonates often stems from surgical procedures.
- In cases without a surgical history, potential underlying causes include cardiovascular or central nervous system anomalies.
Observation:
- Consultants debated diagnostic approaches for neonatal UVCP, with recommendations including endoscopy, assessment of cricoarytenoid mobility, and evaluation for congenital anomalies.
- Neurologic examination and observation of laryngeal dynamics were also suggested.
- Laryngeal electromyography (EMG) is not a standard infant diagnostic technique, though it is used in research.
Findings:
- There is no consensus on the relationship between laryngomalacia and vocal cord paralysis.
- Aspiration is generally considered unlikely but conservative management (thickened feedings, anti-reflux precautions) is advised if it occurs.
- Treatment options for severe cases range from injections and tracheotomy to Nissen fundoplication or tube feedings.
Implications:
- The prognosis for neonatal UVCP is typically good.
- Follow-up often involves serial laryngoscopic examinations.
- Surgical reinnervation procedures may be considered for persistent vocal weakness around age 3.