title: Left vocal cord paralysis after extreme preterm birth, a new clinical scenario in adults.
abstract: OBJECTIVE
  The goal was to study the incidence and long-term consequences of left vocal cord paralysis (LVCP) after neonatal surgical treatment of patent ductus arteriosus (PDA) in a population-based cohort of adults who were born at gestational ages of ≤28 weeks or with birth weights of ≤1000 g in western Norway.
  
  
  METHODS
  Subjects with a history of neonatal PDA surgery were examined with transnasal flexible laryngoscopy, and those with LVCP were examined with continuous laryngoscopy during maximal treadmill exercise (continuous laryngoscopy exercise testing). All subjects underwent lung function testing, ergospirometry, and pulmonary high-resolution computed tomography. Symptoms were recorded with a questionnaire.
  
  
  RESULTS
  Forty-four (86%) of 51 eligible preterm infants participated in the study, 13 (26%) had a history of PDA surgery and 7 (54%) had LVCP, with the laryngeal appearances varying slightly. As a group, subjects with LVCP had significant airway obstruction, no decreases in aerobic capacity, and no obvious evidence of longstanding aspiration on high-resolution computed tomography scans. The continuous laryngoscopy exercise tests revealed increasing respiratory symptoms in parallel with increasing anteromedial collapse of the left aryepiglottic folds as the exercise load increased. Hoarseness and voice-related symptoms were the most typical complaints. Symptoms were attributed erroneously to other diseases for at least 2 subjects.
  
  
  CONCLUSIONS
  LVCP is not uncommon in young adults exposed to PDA surgery as preterm infants. The condition may be overlooked easily, and symptoms may be confused with those of other diseases. Laryngoscopy should be offered on the basis of liberal indications after PDA ligation.
authors.affiliation: Haukeland University Hospital, Department of Paediatrics, N-5021 Bergen, Norway.
authors.forename: Ola Drange
authors.initials: OD
authors.lastname: Røksund
authors.forename: Hege
authors.initials: H
authors.lastname: Clemm
authors.forename: John Helge
authors.initials: JH
authors.lastname: Heimdal
authors.forename: Stein Magnus
authors.initials: SM
authors.lastname: Aukland
authors.forename: Lorentz
authors.initials: L
authors.lastname: Sandvik
authors.forename: Trond
authors.initials: T
authors.lastname: Markestad
authors.forename: Thomas
authors.initials: T
authors.lastname: Halvorsen
mesh_terms: D000328:Adult; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007828:Laryngoscopy; D008026:Ligation / Q000009:adverse effects; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D014827:Vocal Cords / Q000293:injuries*; D055815:Young Adult