title: Factors associated with tracheotomy and decannulation in pediatric bilateral vocal fold immobility.
abstract: OBJECTIVE
  Describe the natural history of all-cause bilateral vocal fold immobility (BVFI) in pediatric patients and analyze factors associated with tracheotomy and subsequent decannulation.
  
  
  METHODS
  This is a retrospective review of all patients diagnosed with complete or partial BVFI at a metropolitan private pediatric otolaryngology practice between 2001 and 2012. Records were reviewed for data on demographics, etiologies, vocal fold position, and BVFI resolution. Patients requiring tracheotomy were further investigated for tracheotomy duration and associated complications and procedures.
  
  
  RESULTS
  One hundred two patients were included, with a median (range) follow-up of 32.9 (0.3-124.2) months. Of these, 68.6% required tracheotomy. Tracheotomies were more likely in those with concomitant airway disease (p = 0.005) and paramedian vocal fold position compared to lateral position (p = 0.02). Among patients requiring tracheotomy, 64.3% underwent decannulation during follow up. Decannulation was more likely in those who demonstrated VFI resolution (p = 0.002) and those with idiopathic compared to neurogenic etiologies (p = 0.003). Median duration of cannulation was 30.6 (0.5-297.3) months. The most common tracheotomy-related complication requiring medical attention was tracheal and stomal granuloma formation (77.1%), while the most frequent associated procedures included granuloma excision (47.1%) and airway reconstruction (31.4%). Of those who avoided tracheotomy, 40.6% did not demonstrate BVFI resolution during median follow up of 13.4 (0.6-44.4) months.
  
  
  CONCLUSIONS
  Most pediatric BVFI patients require tracheotomy, with the majority of those undergoing eventual decannulation. A better understanding of the factors associated with tracheotomy and subsequent decannulation improves the otolaryngologist's ability to counsel parents and caregivers of children with BVFI.
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Funk
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Jad
authors.initials: J
authors.lastname: Jabbour
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, WI, USA. Electronic address: trobey@mcw.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Robey
mesh_terms: D000293:Adolescent; D057785:Catheters; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014133:Tracheal Diseases / Q000209:etiology*; D014139:Tracheostomy / Q000009:adverse effects; D014140:Tracheotomy / Q000009:adverse effects; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D014827:Vocal Cords / Q000033:anatomy & histology; D055815:Young Adult
keywords: Bilateral vocal fold immobility; Decannulation; Pediatric vocal cord paralysis; Pediatric vocal fold immobility; Tracheostomy; Tracheotomy