Natural history of tracheostomy-dependent idiopathic congenital bilateral vocal fold paralysis

OBJECTIVE: To identify the age at which spontaneous improvement in vocal fold function occurs that will allow decannulation to be performed in tracheostomy-dependent children with isolated idiopathic congenital bilateral vocal fold paralysis (BVFP). STUDY DESIGN AND SETTING: Retrospective chart review in tertiary pediatric center. RESULTS: Three children were identified who underwent tracheostomy between 13 and 45 days old. Two patients have been decannulated at age 5 years 11 months and 7 years 1 month, but both have persistent symptoms of upper airway obstruction. One patient remains tracheostomy-dependent at 4 years of age with only minimal vocal cord abduction. CONCLUSIONS: Spontaneous improvement in vocal fold function sufficient to allow decannulation appears to occur during the second quinquennium of life. SIGNIFICANCE: Conservative treatment could be considered as an alternative to surgery in severe idiopathic congenital BVFP. (C) 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.