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Vocal fold paralysis in infants twelve months of age and younger
1Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1078, USA.
Insights
Infants with vocal fold paralysis often recover, especially those with idiopathic or CNS-related conditions. Post-thoracic surgery paralysis may not improve, but overall morbidity is minimal.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Medicine
- Thoracic Surgery
Background:
- Vocal fold paralysis (VFP) in infants can result from various causes.
- Understanding the incidence and prognosis of VFP is crucial for neonatal care.
Purpose of the Study:
- To investigate the causes, incidence, and outcomes of unilateral or bilateral vocal fold paralysis in infants.
- To assess the prognosis and morbidity associated with different etiologies of infant VFP.
Main Methods:
- Retrospective review of 17 infant cases diagnosed between 1991-1994.
- Analysis of patient history, focusing on prior thoracic surgery and central nervous system pathology.
- Evaluation of recovery rates and need for intervention based on VFP cause.
Main Results:
- 47% of left VFP cases were linked to prior thoracic surgery (7.4% incidence post-patent ductus arteriosus ligation).
- 41% of cases were idiopathic, and 12% were due to central nervous system pathology.
- Prognosis varied: no improvement with post-surgical VFP, rapid recovery in idiopathic cases, and functional return after CNS treatment.
Conclusions:
- Infant vocal fold paralysis has diverse causes with varying prognoses.
- While post-thoracic surgery VFP may be persistent, overall morbidity is low, and tracheotomy is typically unnecessary.
- Careful airway monitoring is essential for all infants diagnosed with vocal fold paralysis.
Abstract:
Seventeen cases of unilateral or bilateral vocal fold paralysis were diagnosed in infants younger than 12 months from 1991 to 1994 at the University of Iowa Hospitals and Clinics. Eight (47%) children with left vocal fold paralysis had a history of prior thoracic surgery--two to repair complex congenital anomalies and six to ligate a patent ductus arteriosus. During the study period, a total of 81 patent ductus arteriosus ligations were performed, yielding a 7.4% postoperative incidence of vocal fold paralysis. Seven (41%) children had idiopathic vocal fold paralysis (3 right, 1 left, 3 bilateral). Two (12%) children had VFP caused by central nervous system pathology (1 right, 1 bilateral). Tracheotomy was not required in any case. Prognosis for vocal fold paralysis varied with cause. With left vocal fold paralysis caused by thoracic surgery, no improvement was noted after an average follow-up of 6 months; with idiopathic vocal fold paralysis infants improved within an average of 6 weeks of diagnosis; with vocal fold paralysis caused by central nervous system pathology, treatment of the underlying condition was followed by return of vocal cord function. Irrespective of cause, the morbidity associated with vocal fold paralysis is minimal. Although tracheotomy is not required, careful airway observation is important. Differences and similarities of these results with other studies are discussed.