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Pediatric Vocal Fold Paralysis/Immobility

Division of Otolaryngology/Head and Neck Surgery, Primary Children's Medical Center, Voice Disorders Center at University Hospital, University of Utah School of Medicine
Salt Lake City, UT

Cara Sauder

Department of Speech-Language Pathology, University of New Mexico Hospitals, University of New Mexico
Albuquerque, NM

The pediatric otolaryngologist is frequently asked to see children with stridor and hoarseness. A very commonly seen cause of these problems is impaired vocal fold mobility. The use of the fiberoptic laryngoscope has made this diagnosis fairly straightforward. Speech-language pathologists routinely use the fiberoptic laryngoscope to evaluate swallowing and voice in adults and are more frequently working with otolaryngologists to provide multi-disciplinary assessment of voice and swallowing in infants and pediatric patients. Once the diagnosis of vocal fold paralysis is established, it is important to determine the cause of the impaired mobility and provide treatment options. The airway is of pre-eminent concern in infants. When airway is adequate, surgical intervention and/or therapy is considered, with the age of the patient influencing decision-making considerably more than in adults. The purpose of this article is to review the causes and treatment for vocal fold paralysis, or impaired vocal fold mobility as it is descriptively labeled, in the pediatric population. Factors that influence decision-making such as unilateral vs. bilateral condition, age of the patient, airway status, feeding, and voice are discussed. Finally, new options for management of these problems are outlined.