title: Swallowing function in pediatric patients with bilateral vocal fold immobility.
abstract: BACKGROUND
  Infants with bilateral vocal fold immobility (BVFI) often have poor swallow function in addition to potential airway compromise. While there are several reports on BVFI and its effect on patients' airway status, little is known about long term swallow function.
  
  
  OBJECTIVE
  We aim to characterize the swallowing function over time in pediatric patients with bilateral vocal fold immobility.
  
  
  METHODS
  A retrospective review of medical records of infants diagnosed with BVFI at a tertiary care children's hospital between 2005 and 2014 was conducted. Patient demographics, nature and etiology of immobility, laryngoscopy findings, comorbidities, and swallow outcomes at diagnosis and follow-up were recorded. Swallowing outcomes as measured by presence or absence of a gastrostomy tube were compared by etiology, vocal fold status, and normal or developmentally delay using the Fisher's exact test.
  
  
  RESULTS
  110 patients with a diagnosis of vocal fold immobility were identified. Twenty-nine (26%) had BVFI and twenty-three had complete medical records. Etiologies of vocal fold immobility include cardiac related in 13% (3/23), idiopathic in 30% (7/23) prolonged intubation in 26% (6/23) central neurologic in 22% (5/23), trauma in 4% (1/23), and infection in 4% (1/23). Average follow-up time was 44 months (range 5-94 months). Ten patients (56.5%) required a gastrostomy tube at time of diagnosis. Of this cohort who received gastrostomy tubes, three (30%) ultimately transitioned to complete oral feeds. Return of vocal fold mobility did not correlate with swallow function. In those with non-neurologic etiologies, the need for gastrostomy tube at end of follow up was unlikely. There was a statistically significant difference in the percentage of gastrostomy tube-free children at most recent follow up in patients who were normally developed (86%) versus those who were developmentally delayed (33%) (p = 0.02).
  
  
  CONCLUSIONS
  We characterized the swallowing function of 23 pediatric patients with BVFI. Comorbidities are significant predictors of long term swallow function in patients with BVFI while return of vocal fold function is not.
authors.affiliation: Montefiore Medical Center Albert Einstein College of Medicine, Department of Otorhinolaryngology, Bronx, NY, United States. Electronic address: jeffreyvhsu@gmail.com.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Montefiore Medical Center Albert Einstein College of Medicine, Department of Otorhinolaryngology, Bronx, NY, United States.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Tibbetts
authors.affiliation: Montefiore Medical Center Albert Einstein College of Medicine, Department of Otorhinolaryngology, Bronx, NY, United States.
authors.forename: Derek
authors.initials: D
authors.lastname: Wu
authors.affiliation: Montefiore Medical Center Albert Einstein College of Medicine, Department of Otorhinolaryngology, Bronx, NY, United States.
authors.forename: Michel
authors.initials: M
authors.lastname: Nassar
authors.affiliation: Montefiore Medical Center Albert Einstein College of Medicine, Department of Otorhinolaryngology, Bronx, NY, United States.
authors.forename: Melin
authors.initials: M
authors.lastname: Tan
mesh_terms: D002648:Child; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007828:Laryngoscopy; D008297:Male; D012189:Retrospective Studies; D014826:Vocal Cord Paralysis / Q000503:physiopathology*; D014827:Vocal Cords / Q000503:physiopathology*
keywords: Aspiration; Bilateral vocal fold immobility; Dysphagia; Feeding; Gastrostomy tube; Pediatric; Swallow function; Vocal fold paralysis