1
|
Siu JM, Amin SN, Colyer J, Horner C, Bhat A, Bohuta L, Chan T, Dahl JP, Fridgen J, Johnson K, Yip C, Parikh SR. Injection Medialization in Infants with Vocal Fold Immobility Improves Dysphagia. Laryngoscope 2024. [PMID: 38676424 DOI: 10.1002/lary.31462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Unilateral vocal fold immobility (VFI) is a known cause of morbidity amongst children following congenital heart surgery. Injection medialization (IM) provides medial distraction and improves glottic closure. Limited objective data is available for the effect of IM in young children (<2 years-old) with VFI. METHODS Retrospective case series of infants <2 who underwent IM for VFI after congenital cardiac surgery. Primary outcome was objective reduced risk of aspiration based on Dysphagia and Outcome Severity Scores (DOSS) on Video swallow study (VFSS) performed prior to and within 4 weeks following IM. Secondary analysis included perioperative complications and number of children who were able to avoid NG or G tube placement. RESULTS 17 children <2 years of age had unilateral VFI after congenital cardiac surgery and underwent IM. The median age at time of initial cardiac surgery was 6 days (IQR 3-7). There was no intraoperative or postoperative stridor or associated complications. All 17 patients had preoperative aspiration noted on VFSS. Average swallowing outcomes on VFSS improved after IM with an increase in DOSS score (preop score 3 (IQR 2-4) to postop score 6.5 (IQR 5-7) [P = 0.001]). At 2 months following IM, of the patients who had improvement in swallowing function, 50% (n = 6) were able to feed completely orally, 25% (n = 3) were fed orally with an NG wean, and 3 (25%) had a G tube placed. CONCLUSION Initial results suggest that IM is safe and improves early objective swallowing outcomes in children <2 years old with VFI after congenital cardiac surgery. LEVEL OF EVIDENCE IV Laryngoscope, 2024.
Collapse
Affiliation(s)
- Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaunak N Amin
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jessica Colyer
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Cassie Horner
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Aarti Bhat
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Lyubomyr Bohuta
- Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Titus Chan
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - John P Dahl
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jennifer Fridgen
- Division of Physical Therapy, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Kaalan Johnson
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Caitlin Yip
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Sanjay R Parikh
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| |
Collapse
|
2
|
Sheen D, Houser TK, Olsson SE, Dabbous H, Kou Y, Johnson RF, Chorney SR. Injection Laryngoplasty for Children with Dysphagia after Cardiac Surgery. OTO Open 2024; 8:e142. [PMID: 38689853 PMCID: PMC11058695 DOI: 10.1002/oto2.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/16/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
Objective To determine whether injection laryngoplasty (IL) resolves thin liquid aspiration among children with unilateral vocal cord paralysis (UVCP) after cardiac surgery. Study Design Retrospective case-control. Setting Tertiary children's hospital. Methods Consecutive children (<5 years) between 2012 and 2022 with UVCP after cardiac surgery were included. Resolution of thin liquid aspiration after IL versus observation was determined for children obtaining videofluoroscopic swallow studies (VFSS). Results A total of 32 children with left UVCP after cardiac surgery met inclusion. Initial surgeries were N = 9 (28%) patent ductus arteriosus ligations, N = 7 (22%) aortic arch surgeries, N = 9 (28%) surgeries for hypoplastic left heart syndrome, and N = 7 (22%) other cardiac surgeries. The mean age at initial surgery was 1.8 months (SD: 3.7). All children had a VFSS obtained after surgery that confirmed aspiration. There were 17 children that obtained an IL at 33.6 months (SD: 20.9) after cardiac surgery and 15 children observed without IL procedure. No surgical complications after IL were noted. The rate of aspiration resolution based on postoperative VFSS was N = 14 (82%) for the IL group and N = 9 (60%) for the control group P = .24. Documented VFSS aspiration resolution after cardiac surgery occurred by 9.6 months (SD: 10.0) in the observation group and 47.4 months (SD: 24.1) in the IL group (P < .001). Conclusion IL can help treat aspiration in children with UVCP after cardiac surgery but the benefit beyond observation remains unclear. Future studies should continue to explore the utility for IL in managing dysphagia in this pediatric population.
Collapse
Affiliation(s)
- Derek Sheen
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Thomas K. Houser
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Sofia E. Olsson
- Burnett School of Medicine at Texas Christian UniversityFort WorthTexasUSA
| | - Helene Dabbous
- Department of Otolaryngology–Head and Neck SurgeryWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Yann‐Fuu Kou
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's HealthDallasTexasUSA
| | - Romaine F. Johnson
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's HealthDallasTexasUSA
| | - Stephen R. Chorney
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's HealthDallasTexasUSA
| |
Collapse
|
3
|
Ayoub N, Balakrishnan K, Meister K, Grimm D, Johnson A, Maida K, Sidell DR. Safety and effectiveness of vocal fold injection laryngoplasty in infants less than one year of age. Int J Pediatr Otorhinolaryngol 2023; 168:111542. [PMID: 37058865 DOI: 10.1016/j.ijporl.2023.111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Injection laryngoplasty (IL) is commonly performed for unilateral vocal fold immobility (UVFI). However, the safety and efficacy in patients <1 year of age are not widely recognized. This study analyzes the safety and swallow outcomes in a cohort of patients <1 year who underwent IL. METHODS This retrospective analysis evaluated patients at a tertiary children's institution between 2015 and 2022. Patients were eligible if they underwent IL for UVFI and were <1 year at time of injection. Baseline characteristics, perioperative data, oral diet tolerance, and preoperative and postoperative swallow data were collected. RESULTS 49 patients were included, 12 (24%) of whom were premature. The average age at injection was 3.9 months (SD 3.8), time from UVFI onset to injection 1.3 months (2.0), and weight at injection 4.8 kg (2.1). The baseline American Association of Anesthesiologists physical status classification scores were 2 (14%), 3 (61%), and 4 (24%). 89% of patients had improvements in objective swallow function postoperatively. Of the 35 patients who were preoperatively enterally-dependent and did not have medical circumstances precluding advancement to oral feeds, 32 (n = 91%) tolerated an oral diet postoperatively. There were no long-term sequelae. Two patients had intraoperative laryngospasm, one intraoperative bronchospasm, and one with subglottic and posterior glottic stenosis was intubated for <12 h for increased work of breathing. CONCLUSIONS IL is a safe and effective intervention that can reduce aspiration and improve diet in patients <1 year old. This procedure can be considered at institutions with the appropriate personnel, resources, and infrastructure.
Collapse
Affiliation(s)
- Noel Ayoub
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA.
| | - Karthik Balakrishnan
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
| | - Kara Meister
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
| | - David Grimm
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA
| | - April Johnson
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA; Lucile Packard Children's Hospital Rehabilitation Services, USA
| | - Kelli Maida
- Lucile Packard Children's Hospital Rehabilitation Services, USA
| | - Douglas Ryan Sidell
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
| |
Collapse
|
4
|
Smatanová K, Burián A, Dršata J, Krtičková J, Kőnig-Péter A, Mejzlík J, Chrobok V. Comparison of Short and Long-Term Results after Injection Laryngoplasty with Radiesse® Voice and Thyroplasty Type I in Unilateral Vocal Fold Palsy. ACTA MEDICA (HRADEC KRALOVE) 2023; 66:107-111. [PMID: 38511420 DOI: 10.14712/18059694.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Unilateral vocal fold palsy independently of etiology results in glottic insufficiency leading to unfavorable short or long-term impact on voice quality. Our aim was to evaluate the effect of injection laryngoplasty using Radiesse® Voice and thyroplasty type I on glottic closure, voice quality and aerodynamics by comparing preoperative, short- and long-term results. MATERIALS AND METHODS Data of 32 consent patients were reviewed between 2012 and 2023. All patients underwent either injection laryngoplasty (14 patients) or thyroplasty type I (18 patients) under local anesthesia. Maximum phonation time, glottic closure based on videolaryngostroboscopy, VHI-30 values and GRBAS scale were recorded prior, short-term (3 month) and long-term (12 months) after procedures for statistical comparison. Friedman test, Mann-Whitney test and Wilcoxon signed rank tests were used for statistical analysis. RESULTS In injection laryngoplasty group, we found significant improvement in maximum phonation time (p = 0.002), grade of hoarseness (p = 0.002) and breathiness (p = 0.000) when comparing results before and short-term after procedure. In thyroplasty type I group we saw significant improvement of maximum phonation time (p = 0.000), glottic insufficiency (p = 0.000), all three VHI-30 components (p = 0.000), as well as grade of hoarseness, breathiness (both p = 0.000) and roughness (p = 0.011) of GRBAS scale when comparing voice outcome before and short-term after procedure. There was no significant difference in voice outcome results neither between short and long-term results nor between the two groups in any parameter. CONCLUSION These results demonstrate both short and long-term efficiency of injection laryngoplasty and thyroplasty type I in the improvement of voice quality and glottic closure.
Collapse
Affiliation(s)
- Katarína Smatanová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic.
- Department of Paediatric Otolaryngology, University of Pécs, Clinical Centre, Hungary.
| | - András Burián
- Department of Otolaryngology and Head and Neck Surgery, University of Pécs, Clinical Centre, Hungary
| | - Jakub Dršata
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | - Jana Krtičková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | - Anikó Kőnig-Péter
- University of Pécs, Faculty of Medicine, Department of Bioanalysis, Hungary
| | - Jan Mejzlík
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | - Viktor Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| |
Collapse
|
5
|
Bishop R, Mousset M, Althubaiti A, Gerwig A, Kern C, Onwuka A, Sethia R, Chiang T, Elmaraghy C. Effect of injection laryngoplasty material on outcomes in pediatric vocal fold paralysis. Transl Pediatr 2022; 11:1114-1121. [PMID: 35957995 PMCID: PMC9360818 DOI: 10.21037/tp-21-361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/15/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND While injection laryngoplasty is becoming increasingly common in children, there has not been clearly established guidelines for the choice of injection material. This study evaluates for variability in post-surgical outcomes between different materials used for injection laryngoplasty in the treatment of pediatric unilateral vocal cord paralysis. METHODS In this cohort study, a retrospective chart review was performed for all patients undergoing injection laryngoplasty for unilateral vocal cord paralysis at our tertiary-care children's hospital between January 2010 and December 2019. Patients with vocal cord paresis or bilateral vocal cord paralysis were excluded from this study. Demographics, pre- and post-injection clinic visits, and operative reports were reviewed to compare outcomes between injection materials, including the number of injections required, inter-surgical interval, and rate of vocal improvement. RESULTS Forty-four patients were included in the analysis. Half of the patients were female, and half were male. A total of 97 injections were observed, with 32 patients receiving multiple injections. The mean age at first injection was 7 years. The most common causes of vocal fold paralysis were iatrogenic (n=21, 48%) and idiopathic (n=9, 20%). Thirty-nine percent (n=17) had a history of cardiac surgery. Forty-five percent of injections used Radiesse® voice/Prolaryn® plus, 35% used Radiesse®/Prolaryn® voice Gel, and 20% used Cymetra™. The material used was not associated with a difference in post-operative outcomes, including number of injections, (P=0.10; 0.29), inter-surgical interval (P=0.27; 0.29), or rate of voice improvement (P=0.86; 0.36). CONCLUSIONS Neither material choice nor demographic factors were associated with a difference in outcomes following injection laryngoplasty or a change in the inter-surgical interval. Further research is needed to develop standardized protocols for injection laryngoplasty in this population.
Collapse
Affiliation(s)
- Ryan Bishop
- The Ohio State University, Columbus, OH, USA
| | - Marike Mousset
- Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Abdulrahman Althubaiti
- Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Charlemagne Kern
- Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rishabh Sethia
- Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tendy Chiang
- Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
6
|
Barr JM, Bowman K, Deshpande M, Dewey EN, Milczuk HA, Vo J, Shen I, Muralidaran A. Incidence and Recovery of Vocal Fold Immobility Following Pediatric Cardiac Operations. World J Pediatr Congenit Heart Surg 2021; 12:535-541. [PMID: 34278856 DOI: 10.1177/21501351211015922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Loss of laryngeal function after congenital cardiac surgery causes morbidity and prolongs hospitalization. Early diagnosis of vocal fold immobility (VFI) and referral to pediatric otolaryngology (pOTO) aids in laryngeal rehabilitation. Understanding the incidence and recovery rates of VFI enables counseling for families of infants undergoing high-risk surgery. METHODS A retrospective chart review from November 2014 to July 2019 of infants postcardiac surgery where the aortic arch or surrounding structures were manipulated and were screened via flexible fiberoptic laryngoscopy (FFL) at a single institution was performed. Patients were divided into five surgical categories: Norwood procedure, aortic arch augmentation via median sternotomy, arterial switch operation, coarctation repair via lateral thoracotomy, and cardiac surgeries including ligation of a patent ductus arteriosus (PDA). Patients undergoing isolated PDA ligation were excluded. RESULTS One hundred ninety-nine qualifying operations occurred during this period; 28 patients did not undergo FFL before discharge and were excluded from the analysis. Immediately following cardiac surgery, 34% (58 of 171 patients) had VFI. Follow-up was completed by 38 of 58 patients with VFI. Complete recovery was demonstrated in 63% (24 of 38) of patients by 6 months and in 86% (33 of 38) within 18 months. The highest risk occurred with the Norwood procedure and arch augmentation via median sternotomy. CONCLUSIONS Infants undergoing surgery involving the aortic arch and surrounding structures have high rates of VFI. Follow-up by pOTO is recommended to optimize laryngeal rehabilitation. Most patients have spontaneous recovery within 18 months of cardiac surgery.
Collapse
Affiliation(s)
- Jennifer M Barr
- Section of Pediatric and Congenital Cardiac Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Kandice Bowman
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Monica Deshpande
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth N Dewey
- Department of Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Henry A Milczuk
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Johnson Vo
- Division of Gastroenterology, Department of Medicine, 6684Oregon Health & Science University, Portland, OR, USA
| | - Irving Shen
- Section of Pediatric and Congenital Cardiac Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Ashok Muralidaran
- Section of Pediatric and Congenital Cardiac Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
7
|
Aires MM, Marinho CB, Vasconcelos SJD. Surgical interventions for pediatric unilateral vocal fold paralysis: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2021; 141:110553. [PMID: 33333340 DOI: 10.1016/j.ijporl.2020.110553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate outcomes of injection laryngoplasty (IL) and laryngeal reinnervation for the treatment of pediatric Unilateral Vocal Fold Paralysis (UVFP), especially on swallowing and quality of voice. METHODS A literature review was performed in Medline/PubMed and Cochrane Library, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish about surgical treatment for UVFP on the pediatric population (0-21 years) that documented outcomes for one of the following techniques: IL or laryngeal reinnervation. Study characteristics, patient demographics, technical aspects of each procedure, complications, and outcomes for voice and swallowing were extracted. A meta-analysis with inverse variance, random-effects model was performed. RESULTS The PRISMA approach yielded 22 studies, totaling 267 patients. Seven reinnervation articles were included in meta-analysis for maximum phonation time (MPT) and quality of voice measured by Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Cardiac surgery had caused UVFP in 62.8% (142/226) of the cases. The main indication for IL was aspiration and for reinnervation was dysphonia. For IL, there was an improvement of 84.5% (confidence interval [CI] 82.6-88.4%) in swallowing and 81.4% (CI 74.6-88.1%) in voice. For reinnervation, there was an improvement of 91.6% (CI 88.2-94.9%) in swallowing and 96.8% (CI 95.5-98.0%) in voice. We found an increase of 6.19 s (CI 1.00 to 11.38) in MPT and a mean difference in GRBAS sum of -3.53 points (CI -6.15 to -0.91) after reinnervation. CONCLUSION Retrospective cohort studies suggest that injection laryngoplasty and reinnervation are both effective in improving swallowing and voice in children with UVFP. There was clinical evidence of improvement in the MPT and GRBAS scale meta-analysis in patients undergoing reinnervation.
Collapse
Affiliation(s)
- Mateus Morais Aires
- Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
| | - Camila Barbosa Marinho
- Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Silvio José de Vasconcelos
- Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| |
Collapse
|
8
|
Abstract
Vocal fold paralysis (VFP) is an important cause of respiratory and feeding compromise in infants. The causes of neonatal VFP are varied and include central nervous system disorders, birth-related trauma, mediastinal masses, iatrogenic injuries, and idiopathic cases. Bilateral VFP often presents with stridor or respiratory distress and can require rapid intervention to stabilize an adequate airway. Unilateral VFP presents more subtly with a weak cry, swallowing dysfunction, and less frequently respiratory distress. The etiology and type of VFP is important for management. Evaluation involves direct visualization of the vocal folds, with additional imaging and testing in select cases. Swallowing dysfunction, also known as dysphagia, is very common in infants with VFP. A clinical assessment of swallowing function is necessary in all cases of VFP, with some patients also requiring an instrumental swallow assessment. Modification of feeding techniques and enteral access for feedings may be necessary. Airway management can vary from close monitoring to noninvasive ventilation, tracheostomy, and laryngeal surgery. Long-term follow-up with otolaryngology and speech-language pathology service is necessary for all children with VFP to ensure adequate breathing, swallowing, and phonation. The short- and long-term health and quality-of-life consequences of VFP can be substantial, especially if not managed early.
Collapse
|