Vocal cord immobility is the second most common abnormality of the larynx in the paediatric population. The team from New York aimed to characterise the long-term swallowing function in a cohort of patients with bilateral vocal cord immobility over a nine-year period. They conducted a retrospective review, and had complete data on 23 patients, which they followed up for a mean of 44 months. Data was collected regarding etiology, co-morbidities, and clinical examination findings. Nine children were considered developmentally delayed, with 14 children being of normal development. Surprisingly the mean age at diagnosis was 14 months. All children had follow-up flexible laryngoscopy and 48% were found to have return of vocal cord function. At diagnosis 60% of children were feeding orally, however despite half the children regaining function of the cords, the percentage of children feeding orally at follow-up was only 70%. They found there was no statistical correlation between VF mobility and swallowing function, but did find that co-morbidities are a significant predictor of long-term swallowing function. Of the nine patients with developmental delay, five (55%) required a gastrostomy tube at the time of presentation and six (67%) maintained a gastrostomy tube at most recent follow-up. Five of 14 patients with normal development (35%) required feeding tubes at the time of diagnosis while only two (14%) required a feeding tube at follow-up. Not surprisingly, neurologic deficit is a poor prognosis for return to oral intake. Paediatric patients with non-neurologic causes of BVFI are more likely to ultimately regain ability to feed orally and this information may benefit clinicians when advising parents on likely outcomes.
Long-term swallowing function in bilateral vocal cord immobility
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