Prognosis of Dysphagia in Pediatric Patients With Vocal Fold Immobility.

Abstract

This study aims to determine the incidence and prognosis of dysphagia in pediatric patients with true vocal fold (TVF) immobility or hypomobility. A single-center retrospective chart review. A single-institution tertiary-care center. A total of 89 pediatric patients diagnosed with vocal fold hypo/immobility with a modified barium swallow (MBS) performed were examined. Patient demographic information and etiology of vocal fold immobility as well as laterality were reviewed. Changes in MBS findings over time were assessed. A total of 89 pediatric patients were identified with a mean follow-up of 35.4 months. The most common etiology of TVF hypo/immobility was cardiothoracic surgery (58.4%).Immobility was observed in 80.6% of patients. Patients with unilateral disease were more likely to present with dysphonia than bilateral disease (40.3% vs 9.1%, odds ratio [OR] 6.75, 95% confidence interval [CI] 1.77-44.5, P = .01). MBS results did not vary statistically with respect to laterality, hypomobility versus immobility, or etiology. Of the 33 children who demonstrated aspiration on their initial MBS, 48.5% demonstrated complete resolution over median of 10.5 weeks. Rates of recovery differed only with respect to hypomobility versus immobility (87.5% vs 33.3%, OR 14.0, 95% CI 2.01-286, P = .0133). Based on the study results, about half of pediatric patients with vocal fold hypo/immobility will have resolution of dysphagia at about 10.5 weeks. This may helpful when deciding on when to obtain follow up imaging/exam on pediatric patients with dysphagia. The only factor that confers improved prognosis is hypomobility when compared to complete immobility.