Vocal fold paralysis in infants with tracheoesophageal fistula.
OBJECTIVE
We describe the clinical characteristics and management of vocal fold paralysis in infants who were born with a tracheoesophageal fistula (TEF).


METHODS
This retrospective case series included all infants born with TEFs who presented to our pediatric otolaryngology unit and intensive care unit because of dyspnea or aphonia in the years 2005 and 2006, and who were found to have vocal fold paralysis.


RESULTS
Five boys and 1 girl were studied. One infant had stridor before TEF repair, and 5 after it. All children underwent flexible laryngotracheobronchoscopy and were treated in the pediatric intensive care unit before diagnosis of the vocal fold paralysis (5 bilaterally and 1 unilaterally) was made. The ages at diagnosis of paralysis ranged between 14 days and 14 months. Five infants required tracheostomy.


CONCLUSIONS
Vocal fold paresis in infants is difficult to diagnose. The risk for recurrent laryngeal nerve injury associated with TEF and TEF repair should be emphasized in these children. We recommend that all newborns with TEF should be examined by an otolaryngologist before operation to confirm the mobility of the vocal folds and to rule out other associated airway malformations, and examined after operation if respiratory difficulties develop.
Oestreicher-Kedem
Yael
Y
Pediatric Otolaryngology Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. dkyo@013.net
DeRowe
Ari
A
Nagar
Hagit
H
Fishman
Gad
G
Ben-Ari
Josef
J
D001044:Aphonia / Q000209:etiology; D001999:Bronchoscopy; D055154:Dysphonia / Q000209:etiology; D004933:Esophageal Atresia / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000150:complications / Q000151:congenital; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000150:complications / Q000151:congenital; D008297:Male; D011184:Postoperative Period; D011300:Preoperative Care; D012135:Respiratory Sounds / Q000209:etiology; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000151:congenital* / Q000601:surgery*; D055090:Tracheomalacia / Q000150:complications / Q000151:congenital; D014139:Tracheostomy; D014826:Vocal Cord Paralysis / Q000150:complications / Q000175:diagnosis*