Pediatric unilateral vocal fold immobility

Unilateral vocal fold immobility (VFI) is a rare entity in the pediatric age group. Initial evaluation should include a thorough history and physical examination, particularly assessing for associated central nervous system and cardiovascular anomalies. Modalities of investigation include fiberoptic examination, electromyography in the older child, diagnostic imaging, and rigid endoscopy. Controversy exists about the relevance of "growth centers" in the developing larynx, although recent studies dispute their existence. Recovery in idiopathic or congenital cases can occur up to 11 years later, which supports some observation between onset of paralysis and surgical intervention. In cases where the etiology is clear and recovery is not anticipated, a few reported series have demonstrated success with endoscopic injection and thyroplasty techniques. Unlike the case in adults, careful identification of the vocal fold level should be performed in children before implant placement. Further research is necessary to prove prospectively that surgical intervention in the pediatric larynx does not affect subsequent growth. Until this occurs, the otolaryngologist will continue to be challenged with decisions regarding the timing and choice of technique for correction of unilateral VFI immobility in neonates and children.