Prognosis of congenital idiopathic abductor laryngeal paralysis with laryngeal electromyography

Abstract

Objective To assess if laryngeal electromyography could provide additional information in the prognosis of congenital bilateral idiopathic abductor vocal cord paralysis (abCBILP). Methods We performed a retrospective review over a 23‐year period (1995–2018) of all children younger than 13 years old in the Medical University of Innsbruck. Results We identified five infants with abCBILP. Fiberoptic laryngeal endoscopy revealed bilateral vocal cord immobility in adduction without accompanying laryngeal findings. Tracheostomy rate was 100%. Tracheostomy was performed after minimum 3 weeks of non‐improvement with continuous positive airway pressure treatment or intubation. In all patients, repeated laryngeal electromyography revealed volitional activity. All patients showed excellent full late recovery in the second quinquennium of life. Conclusion Presence of volitional activity in laryngeal electromyography could identify patients with excellent prognosis. Prospective laryngeal electromyography studies are required in more patients with abCBILP in order to document laryngeal electromyography findings also by patients with poor late recovery. Patients with poor prognosis could be selected for early laryngeal intervention to avoid tracheostomy‐dependent issues. Level of Evidence 4 Laryngoscope, 130:E252–E257, 2020

Aktive und passive Bioimplantate bei Stimmlippenlähmung

“…Aus Langzeitbeobachtungen ist bekannt, dass angeborene beidseitige Stimmlippenmotilitätsstörungen, deren Ätiologie 138 139 und Zuordnung zu einer Schädigung des ersten oder zweiten Motoneurons noch unklar sind, sich noch bis zum 10. Lebensjahr erholen können 140 141 . Daher ist der Krikoidsplit zur Dekanülierung eine sinnvolle Option mit Erhalt der Chance auf spätere Motilitätserholung einer oder beider Seiten.…”

“…In the context of thorough maneuvers, also the IA muscles may be mostly preserved. Long-term observations show that congenital bilateral vocal fold motility disorders with unclear etiology [138,139] or assignment to a damage of the first or second motoneuron may recover up to the 10 th year of life [140,141]. Therefore, the cricoid split for decanulation is a useful option with maintenance of the chance of later motility recovery of one or both sides.…”

Evaluation of the pediatric airway: a review

“…Bilateral vocal fold paralysis is usually present at birth, whereas unilateral vocal fold paralysis is an acquired condition that occurs as a result of injury to the recurrent laryngeal nerve. 47 Due to the longer length and course of the left recurrent laryngeal nerve, this is more likely to be injured than the right recurrent laryngeal nerve. So, acquired paralysis often affects the left vocal fold.…”

“…The congenital vocal fold paralysis is usually idiopathic and seen in central nervous system pathology like hydrocephalus and Chiari malformation of the brainstem. 47 Most of the children with bilateral vocal fold paralysis present with airway compromise, though with an excellent voice. These children do not aspirate.…”