Vocal Cord Palsy in Children: Symptoms, Causes, Diagnosis & Treatment in Patna, Bihar, India

What is Vocal Cord Palsy in Children?

Vocal cord palsy, also called vocal cord paralysis, involves problems with the nerve pathways and the muscles to the voice box (larynx), and is a situation where one or both vocal cords are not able to move properly as they are weakened or paralyzed due to an issue with the nerve pathway that supplies the muscles for the voice box (larynx). As such, they control breathing, talking, and swallowing, and protect the airway during the swallowing of food and drink. When the movement of one or both voice cords is impaired, the child may experience breathing difficulties, an inability to cry effectively (a soft or weak cry), feeding problems, and/or inspiratory stridor (a high-pitched sound on breathing).

In a child, the condition may be present at birth (congenital) or acquired (develops at a later stage) due to trauma, nerve damage, infections, neurological conditions, or post-surgery to an adjacent anatomical structure that is closely associated with nerve pathways which are responsible for supplying muscles of the voice box (larynx), brain, and spinal cord, etc. The child would display different signs and symptoms depending on whether one vocal cord or both vocal cords are paralyzed.

Prompt diagnosis is crucial for treatment, as it has long-term implications for a child’s feeding, voice, growth, and airway function. Timely ENT evaluation for airway examination and evaluation of swallowing problems during feeding will prompt the initiation of appropriate treatment, thereby improving voice and airway function.

What Causes Vocal Cord Palsy in Children?

Vocal cord palsy happens when the nerve pathways controlling the muscles used for movement in the vocal cords are weak or damaged.

Some of the commonly seen causes in children include:

• Birth nerve injury
• Congenital nerve pathway defect and nervous system diseases
• Viral nerve infections
• Surgery involving the neck/chest or head.
• Head, neck, or chest injuries
• Brain, spinal cord, and neurological disorders
• Prematurity complications
• Idiopathic cases without a clear cause

In some cases, nerve pathway recovery will improve, and the child may show natural improvement with treatment.

Symptoms of Vocal Cord Palsy in Children

Depending on which vocal cords are impacted, the symptoms can vary in intensity.

The common signs and symptoms in the child include:

• Low/weak cry in a newborn
• Brittle voice and Hoarseness of voice
• Inspiratory wheezing sound or stridor when the child breathes
• Eating difficulties
• Coughing or choking on swallowing
• Chest infection recurring frequently due to aspiration
• Shortness of breath when active or at sleep
• Failure to thrive when the symptoms are severe
• Weak speech volume in older children

When both vocal cords are paralyzed, there is a risk of severe breathing difficulties from airway obstruction.

Types of Vocal Cord Palsy in Children

Types depend on whether one or more vocal cords are involved:

• Unilateral Vocal Chord Paralysis: Only one vocal cord is involved. Hoarseness is the most common sign associated with this condition. Nevertheless, there is a chance of feeding difficulties, but not as severe as those associated with the other type.
• Bilateral Vocal Cord Palsy: Both vocal cords are paralyzed, resulting in significant airway obstruction and difficulty breathing.
• Congenital Vocal Chord Palsy: Occurs from birth, and the cause of the nerve pathway defects leading to the paralyzed vocal cord is associated with developmental or neurological causes.
• Acquired Vocal Chord Palsy:
  • Occurs in a child after birth due to surgical procedures done close to the associated nerve pathways or other causes mentioned above in the section on causes.
  • Understanding the type is necessary for managing both the airway and voice aspects.

Diagnosis of Vocal Cord Palsy in Children

Accurate diagnosis is important for assessing vocal cord movement, vocal cord palsy, and, importantly, airway safety.

Methods of Diagnosis include:

• Clinical History & Physical Examination
• Flexible laryngoscopy: assessment of vocal cord movement with a scope attached to a camera, a flexible, thin tube that is placed into the airways and visually inspected
• Airway assessment & breathing evaluation
• Swallowing & Feeding Assessment
• Investigations like MRI or CT scan: this may be performed for selected cases for assessing the path of the nerve pathways that serve the vocal cord or associated structures, or other associated brain or nervous system conditions
• Neurological assessment when indicated

These assessments help the ENT specialist evaluate the extent and cause of the problem for appropriate management.

Treatment of Vocal Cord Palsy in Children

Treatment depends on the nature and severity of the symptoms, particularly those involving the airway and swallowing.

Observation & Monitoring

Some less severe cases recover over time, with improvement in nerve function, and are therefore followed up closely.

Medical & Supportive Management

• Feeding modification or tube feeding is instituted when the child has severe swallowing issues.
• Feeding therapy is often used to improve efficient feeding and prevent aspiration.
• Airway monitoring and oxygen saturation checks.

Other comorbidities associated with vocal cord palsy should be treated effectively. Reflux treatment, prevention, and treatment of chest infection are common and important treatments.

Speech & Voice Therapy

Improves voice quality and verbal communication and helps teach effective swallowing strategies.

Surgical Treatment

Surgery is necessary when the child has significant airway compromise or recurrent aspiration, which affects their health and development due to feeding issues.

The procedures performed are to widen the airway or position the vocal cords towards midline to achieve adequate and efficient airway closure during feeding and talking. These can include:

• Airway widening procedures, such as surgical opening of the posterior cricoid cartilage (posterior cricoidotomy) or tracheostomy in the case of profound airway obstruction.
• Vocal cord medialisation procedures such as Teflon injection or surgical repositioning of vocal cords with techniques such as suture medialization or arytenoid adduction.
• Endoscopic airway surgery to address and correct the airway abnormalities with minimally invasive techniques, thus preventing any need for more invasive open procedures.

Complications of Untreated Vocal Cord Palsy in Children

If timely treatment is not sought for the condition, there may be respiratory problems, as well as those involving eating. The complications that can arise are:

• Persistent breathing difficulty
• Recurrent aspirations and the resulting chest infections will prolong hospital admissions.
• Feeding-related problems that could lead to poor weight gain.
• Delayed speech and language development
• Sleep disorders
• Reduced oxygen level.

Early intervention provides optimal improvement in both airway safety and the child’s developmental outcomes.

How Vocal Cord Palsy Prevented in Children?

Vocal cord palsy may not always be preventable, especially when present at birth. Nevertheless, early intervention can significantly reduce symptom severity. Measures that may help to reduce the risks of developing vocal cord Palsy in some children are:

• Early consultations for noisy breathing or feeble cries
• Regular checkups to keep track of the feeding habits of the infant
• Early medical assistance should be sought when there is suspicion of any respiratory infection in an infant.
• Regular ENT follow-ups to examine the airways and monitor breathing.

Timely diagnosis is very important for preventing long-term complications of the airway, voice, and speech.

Living with Vocal Cord Palsy

Children diagnosed with Vocal Cord Palsy often require consistent medical care and support from medical professionals as well as their parents and family. The Key things to take away for parents are to:

• Ensure that the child’s feeding and airway monitoring are regular and accurate.
• Regular follow-ups with ENTs & Speech Therapists
• Take appropriate care to monitor the infant’s feeding, sleeping, and breathing patterns to effectively report any issues, such as choking and recurring chest infections.
• Encourage communication and voice activities to promote speech and language development.
• Ensure proper adherence and follow-up of the recommended diet and rehabilitation program as advised by the speech and feeding therapist.

Many children will eventually regain control of their voice and airway with appropriate management and rehabilitation.

Why choose LIKITA ENT Hospital for Vocal Cord Palsy Treatment in Children in Patna, Bihar, India?

Likita ENT Hospital offers safe and effective Vocal Cord Palsy Treatment in Children in Patna, Bihar, India, at an affordable cost. Our team of experienced Pediatric ENT specialists provides accurate voice and airway examination and diagnostic assessment to identify vocal cord movement problems and evaluate their effect on the child’s voice, breathing, and swallowing. Treatment is tailored according to the cause, severity, number of affected vocal cords, duration of symptoms, age of the child, and individual needs. When required, our Pediatric ENT specialists can manage associated hoarseness, weak or breathy voice, noisy breathing, stridor, difficulty swallowing, choking, aspiration, or breathing difficulties and recommend suitable observation, voice therapy, vocal cord procedures, or surgical treatment when appropriate. With advanced ENT diagnostic facilities, experienced specialists, and a child-focused approach, Likita ENT Hospital is committed to providing safe, precise, and comfortable Vocal Cord Palsy Treatment in Children in Patna, Bihar, India.

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