Recovery of Vocal Cord Motion Among Pediatric Patients

Abstract

Objectives: Patients with vocal cord paralysis can experience feeding, respiratory, and vocal problems leading to disability and decreased quality of life. Current evidence suggests waiting a period of 12 months for spontaneous recovery before permanent interventions. This study aims to determine the time to recover spontaneously and vocal cord movement in a pediatric population and create a model for evidence-based patient counseling. Study Design: Retrospective longitudinal cohort study. Methods: The report is a single institution longitudinal study on vocal cord paralysis recovery. Patients were categorized based on spontaneous recovery with vocal cord movement or no recovery. Recovery rates were determined using the Kaplan-Meier method. Results: Of 158 cases of vocal cord paralysis over a 4-year period, 36 had spontaneous recovery with symptom improvement and motion return. The average recovery was 8.8 months for those who recovered, and 78% recovered within 9 months. Two groups emerged from the data: an early recovery group with spontaneous recovery before 12 months and a late recovery group after 12 months. Children with dysphonia and paralysis due to cardiac surgery were less likely to recover, and children with aspiration were more likely to recover. Children with gastrointestinal comorbidities were less likely to recover; however, those who did recover were more likely to have recovered after 12 months. Based on our model, there is about a 3% chance of recovery between 9 and 12 months. Conclusions: Patients should be counseled about earlier interventions. Waiting the conventional 12 months for only a 3% chance of spontaneous recovery without intervention or laryngeal EMG may not be the preferred option for some patients and their families.

Characterizing Pediatric Bilateral Vocal Fold Dysfunction: Analysis with the Pediatric Health Information System Database

“…A recent study linked gastrointestinal comorbidities to delayed recovery and no recovery of vocal fold motion compared to patients without gastrointestinal comorbidities. 22 Another consideration in this cohort is the overall inpatient mortality rate of 2.9%. Due to the data reporting restraints of PHIS, no conclusion can be made whether mortality is directly a result of BVFD, the associated complex condition, or both.…”

“…The importance between feeding and vocal fold paralysis is well‐established, however, the specific relationship between gastrointestinal comorbidities and BVFD is limited. A recent study linked gastrointestinal comorbidities to delayed recovery and no recovery of vocal fold motion compared to patients without gastrointestinal comorbidities 22 …”

Is Laryngeal Reinnervation Recommended for Pediatric Unilateral Vocal Fold Paralysis?

“…4 pUVFP due to cardiac surgery or those with dysphonia alone are less likely to recover, whereas congenital cases and those associated with aspiration are more likely to recover. 4 Prestwood et al reported that among 36 patients who recovered spontaneously, 80.6% had early recovery (within 12 months) and 19.4% had late recovery. Within the early recovery group, most recovered within 9 months, with only a 3% chance of recovery between 9 and 12 months.…”

“…The recommendations for the management of pUVFP are predominantly based on Level 4 evidence. [2][3][4][5] One systematic review and meta-analysis with Level 2 evidence are presented. 1…”

“…Up to 60% of idiopathic pUVFP may recover spontaneously 3 . When including all etiologies of vocal fold paralysis, 23% recover spontaneously 4 . pUVFP due to cardiac surgery or those with dysphonia alone are less likely to recover, whereas congenital cases and those associated with aspiration are more likely to recover 4 .…”