Vocal Fold Immobility due to Birth Trauma: A Systematic Review and Pooled Analysis

Abstract

Objectives To describe the present understanding of birth trauma-related vocal fold immobility and quantitatively compare it with idiopathic congenital vocal fold immobility to explore whether it is a discrete entity. Data Sources PubMed, Ovid, and Cochrane databases. Review Methods English-language, observational, or experimental studies involving infants with idiopathic congenital or birth trauma-related vocal fold immobility were included. Data from these studies were pooled with our institution's vocal fold immobility database, with the resultant idiopathic congenital and birth trauma cohorts compared regarding patterns and outcomes of immobility. Results The search returned 288 articles, with 24 meeting inclusion criteria. Of studies reviewing all-cause immobility, 8 of 9 (88.9%) identified birth trauma as an etiology, although birth trauma definitions and proposed mechanisms of immobility varied. The study subjects, combined with our institution's database, yielded 188 idiopathic congenital and 113 birth trauma cases. Compared with idiopathic congenital cases, birth trauma cases had a higher proportion of unilateral immobility (72 of 113 [63.7%] vs 52 of 188 [27.7%], P < .001) and rate of resolution (41 of 51 [80.4%] vs 91 of 159 [57.2%], P = .003). Resolution occurred in 24 of 26 (91.3%) unilateral and 17 of 25 (68.0%) bilateral birth trauma cases and in 30 of 40 (75.0%) unilateral and 59 of 109 (54.1%) bilateral idiopathic congenital cases ( P = .11 and .20, respectively). Conclusion While the definition and mechanism of birth trauma-related vocal fold immobility warrant further investigation, these findings suggest that it is distinct from idiopathic congenital vocal fold immobility, with a unique presentation and potentially more favorable outcomes. This can inform counseling and management for infants with otherwise unexplained immobility but known birth trauma.

Endoscopic arytenoid abduction lateropexy for the treatment of neonatal bilateral vocal cord paralysis – Long-term results

“…6 unavoidable in 69% of cases [11,12]. Alternatives to tracheotomy in the vulnerable, confined neonatal airway are much more limited compared to those in adults.…”

Respiratory Morbidity in Children with Repaired Congenital Esophageal Atresia with or without Tracheoesophageal Fistula

“…In children with aero-digestive malformations, vocal cord paresis or paralysis, although uncommon, can occur after surgical repair [ 44 , 45 , 46 , 47 , 48 ]. Bilateral paralysis is a potentially life-threatening condition because it can lead to complete airway obstruction, requiring long-term tracheostomy placement, whereas the mildest cases may resolve spontaneously [ 44 , 45 , 46 , 47 , 48 ]. Moreover, vocal cord paralysis can also be lateralized and not lead to airway obstruction [ 44 , 45 , 46 , 47 , 48 ].…”

“…Bilateral paralysis is a potentially life-threatening condition because it can lead to complete airway obstruction, requiring long-term tracheostomy placement, whereas the mildest cases may resolve spontaneously [ 44 , 45 , 46 , 47 , 48 ]. Moreover, vocal cord paralysis can also be lateralized and not lead to airway obstruction [ 44 , 45 , 46 , 47 , 48 ]. However, all these children are at increased risk of swallowing dysfunction and aspiration [ 47 , 48 ].…”

“…The incidence of vocal cord dysfunction in patients who have undergone surgical repair varies significantly among studies and is reported in 3% to 30% of the cases according to the criteria used to evaluate the problem [ 44 , 45 , 46 ]. A recent Italian retrospective analysis documented that postoperative vocal cord paralysis is more common in patients with type B CEA (CEA, with a proximal TEF, or a TEF connecting between the upper pouch of the esophagus and the trachea) and E CEA (TEF connecting between the esophagus and the trachea, without CEA) [ 47 ].…”

“…However, it is likely that not all these cases are caused by the surgical repair due to prolonged intubation or recurrent laryngeal or vagus nerve injury during surgery. Many cases can be the result of a congenital malformation [ 44 ]. Differentiation between congenital and acquired cases is difficult because evaluation of vocal cord function via laryngoscopy is not routinely performed pre-operatively, although some authors suggest that the procedure be performed before CEA ± TEF repair [ 49 ].…”