Paediatric vocal fold paralysis

Laryngeal electromyography, a useful tool in difficult cases of pediatric laryngeal mobility disorders

INTRODUCTION

Pediatric laryngeal mobility disorders constitute a challenge in terms of diagnosis and treatment, especially in small children and those complex patients with prior history of prolonged intubation or surgery. Laryngeal electromyography (L-EMG) may help to distinguish vocal fold paralysis from fixation.

MATERIAL AND METHODS

Ten children with laryngeal mobility disorders (including bilateral vocal fold immobility (BVFI) or unilateral vocal fold immobility (UVFI) with contralateral hypomobility) underwent suspension laryngoscopy and L-EMG between July 2019 and March 2021. The EMG data were acquired simultaneously in both thyroarytenoid muscles. Anesthesia was lightened until volitional activity appeared like cough, cry or spontaneous Valsalva maneuver.

RESULTS

We found secondary airway lesions in 2 patients and 3 vocal fold fixation. L-EMG recordings were pathologic in 4 patients (3 moderate and 1 severe nerve lesion). No recurrent laryngeal nerve injury was found in congenital BVFI cases. The data from both suspension laryngoscopy and L-EMG recordings influenced clinical decision-making.

CONCLUSIONS

L-EMG adds value to suspension laryngoscopy in the management of pediatric patients with laryngeal mobility disorders. Selected cases such as patients with iatrogenic BVFI, UVFI with associated contralateral hypomobility or patients with combined pathologies may obtain the greatest benefit.

Neonatal Stridor in Familial Congenital Laryngeal Paralysis (Plott Syndrome): A Case Study in an Omani Family

Stridor presenting soon after birth due to bilateral abductor vocal cord paralysis (VCP) is rare. We report a family with bilateral VCP affecting four male members in two generations and hence suggesting X-linked recessive inheritance. Severe stridor in the neonatal period requires meticulous airway evaluation, and tracheostomy in 35-70% cases. The current trend is towards conservative management and tracheostomy is avoided unless respiratory distress is severe or life-threatening. Neonatal VCP can be an isolated finding, or it can be familial with or without syndromic features. There are very few reports of non-syndromic familial cases. Unlike the cases reported previously, none of our patients required prolonged intubation or tracheostomy suggesting an excellent prognosis in such cases. This is the first case study of congenital familial non-syndromic VCP reported from the Middle East.

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

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 surgical management of inspiratory stridor in newborns and infants

OBJECTIVE

Compare the incidence of endoscopic surgical treatment of patients with laryngomalacia to other aerodigestive pathology who may present with similar symptoms.

METHODS

Consecutive case series with chart review of endoscopic surgical intervention in infants, aged 12 months or less, presenting with inspiratory stridor, in the absence of syndromic condition or prior history of intubation.

RESULTS

A total of 30 patients were identified. The average age at the time of surgical intervention was 2.7 months. Endoscopic surgical management was directed at laryngomalacia (70%), vallecular cysts (23.3%), and anterior glottic webs (6.7%). All patients had nearly immediate resolution of the stridor and feeding difficulties. None required revision surgery, modified diets, or alternative means of enteric nutrition.

CONCLUSIONS

Laryngomalacia was the most commonly encountered surgical indication for stridulous newborns and infants with severe symptoms. Like most previous descriptions, patients responded well to supraglottoplasty. Vallecular cysts accounted for about one-quarter of the infants treated. Clinicians should carefully consider the presence of other airway pathology, which may mimic laryngomalacia, in non-syndromic infants without a previous history of intubation. Endoscopic surgical management may be safe and effective.