Vocal Fold Paralysis
in Children
Learn about unilateral and
bilateral vocal fold paralysis
Learn about unilateral and bilateral vocal fold paralysis in children. Understand symptoms, causes, and advanced treatments to improve breathing and voice.
What is Vocal Fold Paralysis?
Vocal fold paralysis occurs when one or both vocal cords (also called vocal folds) do not move properly. This can affect a child’s voice, breathing, and ability to protect the airway during swallowing.
- Unilateral Vocal Fold Paralysis (UVFP): One vocal fold doesn’t move
- Bilateral Vocal Fold Paralysis (BVFP): Both vocal folds are immobile
Vocal fold paralysis is one of the most common causes of pediatric voice disorders and a leading cause of congenital airway obstruction.
Causes of Vocal Fold Paralysis
Congenital Causes
- Brainstem malformations
- Arnold-Chiari malformation
- Idiopathic (no known cause)
Acquired Causes
- Birth trauma or difficult delivery
- Cardiac surgery (especially PDA ligation or aortic arch repair)
- Neck or chest surgery
- Prolonged intubation
- Tumors, neurologic conditions, or vocal cord trauma
Symptoms of Vocal Fold Paralysis
The symptoms vary depending on whether one or both vocal folds are affected:
Unilateral Vocal Fold Paralysis (UVFP)
- Weak, breathy cry or voice
- Difficulty feeding or frequent choking/coughing
- Risk of aspiration (food entering the airway)
- Recurrent pneumonia or respiratory infections
Bilateral Vocal Fold Paralysis (BVFP)
- Stridor (high-pitched noisy breathing)
- Respiratory distress or retractions
- Cyanosis (blue lips) with crying or feeding
- May require tracheostomy in severe cases
How is Vocal Fold Paralysis Diagnosed?
Diagnosis is performed by a pediatric ENT specialist using:
- Flexible Fiberoptic Laryngoscopy
A small camera inserted through the nose to visualize vocal cord movement - Direct Laryngoscopy (in the OR)
Provides a more detailed view of the larynx under anesthesia - Neurologic & Imaging Evaluation
– MRI or CT scan to rule out brainstem or nerve compression
– Swallow studies (FEES or Modified Barium Swallow) to assess aspiration
Treatment Options for Vocal Fold Paralysis
Treatment is based on the child’s symptoms, age, and severity of airway or voice issues.
Observation & Therapy
- Voice therapy with a pediatric speech-language pathologist
- Swallowing therapy if aspiration is present
- Regular follow-up with ENT and feeding team
Injection Laryngoplasty
- Temporary filler injected into the paralyzed vocal fold to help it meet the functioning fold
- Improves voice and reduces aspiration
- Minimally invasive, often done in the operating room
Medialization or Reinnervation Surgery
- Used if paralysis persists and causes significant problems
- Medialization: Moves the vocal fold closer to the midline
- Reinnervation: Restores nerve input to the vocal fold
For Bilateral Vocal Fold Paralysis (BVFP)
Because both vocal folds are immobile, the main concern is airway obstruction.
Initial Airway Stabilization
- Tracheostomy may be required to secure the airway in severe cases
- Close monitoring in a pediatric ICU setting
Surgical Options
Depending on severity and feeding/swallowing ability:
- Posterior cordotomy or arytenoidectomy: Widens the airway by removing part of the vocal cord or cartilage
- Suture lateralization: Temporarily or permanently holds one vocal fold open
- Endoscopic CO₂ laser procedures: Minimally invasive airway widening
- Open reconstruction in complex or revision cases
Long-Term Outcomes
- Many children with UVFP compensate well with therapy
- Children with BVFP may eventually outgrow the condition or improve neurologically
- Airway and voice outcomes are best when managed by a multidisciplinary team
- We focus on safe breathing, preserving voice, and protecting the ability to swallow safely
Why Choose Us for Pediatric Vocal Fold Paralysis Care
Dr. Sohit Kanotra and the pediatric ENT team at UCLA specialize in complex airway, swallowing, and voice disorders. We offer:
- Advanced diagnostics (FEES, laryngoscopy, MRI)
- In-office and OR-based vocal cord procedures
- Expertise in airway surgery and pediatric tracheostomy
- Coordinated care with speech-language pathology, pulmonology, and neurology