Jan. 19, 2021
Vocal cord paresis or paralysis in children is an uncommon disorder. It can be associated with birth trauma, neurological conditions, infections or recent cardiac surgery, or it can be idiopathic. Multidisciplinary specialists in pediatric otolaryngology, pulmonology, speech and language pathology, and neurology at Mayo Clinic Children's Center in Rochester, Minnesota, work together to address vocal cord paralysis in children.
Signs and symptoms of vocal cord paralysis may include:
- A breathy quality to the voice
- Hoarseness
- Noisy breathing
- Loss of vocal pitch
- Choking or coughing while swallowing food, drink or saliva
- The need to take frequent breaths while speaking
- Inability to speak loudly
- Loss of gag reflex
- Ineffective coughing
- Frequent throat clearing
Up to 80% of children can be symptomatic in the form of dysphonia, respiratory difficulties, or dysphagia and aspiration. Traditional medical interventions include cordectomy or tracheostomy for respiratory issues. For those with dysphonia or aspiration, injection medialization procedures have gained traction, although results last only a couple of months.
"Research reveals that only 25% to 30% of paretic vocal cords spontaneously resolve, taking anywhere from months to years," says Joshua P. Wiedermann, M.D., pediatric otolaryngology head and neck surgeon at Mayo Clinic in Rochester, Minnesota. "Patients can benefit from an evaluation that will help identify the cause of their symptoms in addition to identification of reinnervation treatment options that work toward eliminating symptoms."
Specialized surgeries and emerging treatments
The first evaluation involves a flexible laryngoscopy followed by a visit to the operating room to analyze the innervation of the vocal cord with electromyography (EMG). At the time of the EMG, a vocal cord injection is performed, with a temporary filler material, to test the effect of a potential reinnervation procedure. The effect of the injection usually lasts a couple of months. If the EMG confirms vocal cord paralysis and the injection test is successful in relieving symptoms, reinnervation surgery is offered.
For single cord immobility leading to aspiration or dysphonia, surgeons offer vocal cord reinnervation with a donator branch from the ansa cervicalis. For bilateral vocal cord immobility leading to respiratory distress, Mayo Clinic pediatric otolaryngologists offer bilateral abductor reinnervation with branches from the phrenic nerve.
These procedures have been shown to result in long-lasting improvements in phonation and aspiration compared with injection techniques alone and to help avoid the need for tracheostomy. For those already with a tracheostomy, it may be a critical first step to decannulation," says Dr. Wiedermann.
Coordinated care with emphasis on working with local care teams
Mayo Clinic Children's Center coordinates care across many specialties and subspecialties. Aerodigestive Clinic team members discuss treatment plans with local care teams for pediatric aerodigestive disorders including vocal cord paralysis, airway reconstruction, tumors, secondary obstructive sleep, lymphovascular malformations and pediatric cleft lip and palate surgery. Options also exist for telemedicine evaluation and follow-up that focus on interventions through local support structures.
For more information
Mayo Clinic Children's Center. Mayo Clinic.
Mayo Clinic Children's Center: Aerodigestive Clinic. Mayo Clinic.