8.3 Bilateral Vocal Fold Paralysis
Key Features
Bilateral vocal fold paralysis is the second most common cause of infantile stridor.
It typically requires a tracheotomy for maintenance of airway until vocal fold mobility returns or definitive airway surgery is performed.
Acquired causes are most common, even in infants.
Bilateral vocal fold paralysis (BVFP) is a potentially lethal problem requiring aggressive management, typically tracheotomy, at least in the short term. Depending on the cause, spontaneous recovery can occur. Recovery, however, is generally a slow process, taking up to a year. A variety of surgical approaches to widen the airway have been described. Usually, however, the voice quality is degraded when there is an intervention to enlarge/improve the laryngeal airway.
Epidemiology
Twenty-five percent of BVFP is congenital. Most of the remaining cases are late presentations of central lesions. Acquired cases are most likely to occur as a result of surgery in the chest or from forceps delivery or infections.
Clinical
Signs
Vocal fold immobility can be seen using flexible laryngoscopy in the clinic. Stridor is a sign of BVFP.
Symptoms
Stridor
Typically a normal voice, episodic respiratory distress (e.g., with upper respiratory tract infections)
Weak cough; aspiration if underlying cause is a neural lesion above the nodose ganglion (inferior ganglion of vagus nerve)
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