Our Summary

This research paper focuses on a condition in children where both vocal cords are immobile (BVCI), which can be life-threatening as it often makes it difficult to breathe. The study looks at a fairly new, safe surgical technique called endoscopic arytenoid lateral abduction (EALA) and how it impacts breathing, voice quality, and swallowing abilities.

Twenty-one kids with BVCI were involved in the study. Eleven of them had a tracheostomy, a surgical procedure to create an airway in the throat, at the time of surgery. The researchers examined the patients before and after surgery by looking at the vocal cords, measuring how long they could speak in one breath, using a voice assessment for kids (pVHI), a scale for grading voice disorders (GIRBAS Scale), and a feeding scale from Montreal Children’s Hospital. In kids without a tracheostomy, they also measured the peak of the inhale during normal breathing (PIF) and how often oxygen levels dipped each hour (ODI/h).

After surgery, all patients showed better airway function when looking at the vocal cords. On average, it took about 4.6 weeks to remove the tracheostomy tube. One patient has not had their tube removed yet. No major complications happened. In the kids without a tracheostomy, there were significant improvements in both ODI/h and PIF after the surgery. However, the voice and feeding assessments and the GIRBAS score got worse one month after surgery. But a year after surgery, all these measures went back to their pre-surgery levels, except for two parameters on the GIRBAS score.

In conclusion, the EALA surgery seems to be a simple, safe, and effective solution for children with BVCI. It avoids the need for a tracheostomy, allows for early removal of the tracheostomy tube if already present, preserves swallowing function, and maintains a good voice quality.

FAQs

  1. What is Endoscopic Arytenoid Lateral Abduction (EALA) and how does it help in treating pediatric bilateral vocal cord immobility (BVCI)?
  2. What improvements were observed in patients who underwent EALA surgery?
  3. Were there any complications or negative side effects experienced by patients who underwent EALA surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about vocal cord surgery is to follow postoperative care instructions carefully, including voice rest and avoiding activities that strain the vocal cords. It is also important to attend follow-up appointments with your doctor to monitor healing and vocal function. Additionally, practicing good vocal hygiene, such as staying hydrated and avoiding irritants like smoking, can help promote healing and prevent complications.

Suitable For

Patients with pediatric bilateral vocal cord immobility (BVCI) who are experiencing severe dyspnea are typically recommended vocal cord surgery. This surgery, specifically endoscopic arytenoid lateral abduction (EALA), is a relatively new, secure, minimal-invasive surgical technique that has been shown to be effective in improving respiratory function, voice quality, and swallowing capabilities in pediatric patients with BVCI. This surgery may be recommended for patients who have not responded to other treatments and are at risk of life-threatening complications due to their vocal cord immobility.

Timeline

Before vocal cord surgery:

  • Patient presents with symptoms of severe dyspnea
  • Endoscopic evaluation confirms bilateral vocal cord immobility
  • Preoperative assessments include maximum phonation time, pediatric Voice Handicap Index, GIRBAS Scale criteria, and Montreal Children’s Hospital Feeding scale
  • Some patients may have tracheostomy at the time of surgery

After vocal cord surgery:

  • Endoscopic evaluation shows improvement in glottic airway
  • Average time for decannulation is 4.6 weeks
  • No major complications occur
  • Patients without tracheostomy show significant improvement in peak tidal inspiratory flow and number of desaturations/hour
  • Voice quality, swallowing capabilities, and respiratory function may worsen initially post-surgery but improve over time
  • EALA is seen as a simple, safe, and effective solution in pediatric patients with bilateral vocal cord immobility
  • Early decannulation is possible, swallowing function is preserved, and good quality voice is maintained

Overall, vocal cord surgery leads to improved airway function and quality of life for pediatric patients with bilateral vocal cord immobility.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with EALA surgery for pediatric bilateral vocal cord immobility?

  2. How long is the recovery period after EALA surgery and when can the patient expect to see improvements in their respiratory function, voice quality, and swallowing capabilities?

  3. Will the patient require a tracheostomy before or after the surgery, and if so, for how long?

  4. What are the success rates of EALA surgery in pediatric patients with bilateral vocal cord immobility?

  5. What postoperative care and follow-up appointments will be necessary for the patient to ensure optimal outcomes?

  6. How will the patient’s voice quality be affected by the surgery, and are there any potential long-term effects on their voice?

  7. What alternative treatment options are available for pediatric bilateral vocal cord immobility, and how does EALA compare to these alternatives in terms of effectiveness and safety?

  8. How soon after the surgery can the patient resume normal activities and return to school or work?

  9. Are there any lifestyle changes or restrictions that the patient should follow after EALA surgery to optimize their recovery and long-term outcomes?

  10. Is there a possibility of the vocal cord immobility recurring after EALA surgery, and if so, how can it be prevented or managed?

Reference

Authors: Trozzi M, Torsello M, Meucci D, Micardi M, Tropiano ML, Balduzzi S, Ossandon Avetikian A, Salvati A, Bottero S. Journal: Laryngoscope. 2023 Sep;133(9):2325-2332. doi: 10.1002/lary.30535. Epub 2022 Dec 29. PMID: 36579686