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Factors associated with tracheotomy and decannulation in pediatric bilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol 2015 Jun;79(6):895-899

Date

04/19/2015

Pubmed ID

25887134

DOI

10.1016/j.ijporl.2015.03.026

Scopus ID

2-s2.0-84929043732   20 Citations

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.

Author List

Funk RT, Jabbour J, Robey T

Author

Thomas C. Robey MD Professor in the Otolaryngology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Catheters
Catheters, Indwelling
Child
Child, Preschool
Device Removal
Female
Follow-Up Studies
Granuloma
Humans
Infant
Infant, Newborn
Male
Retrospective Studies
Time Factors
Tracheal Diseases
Tracheostomy
Tracheotomy
Vocal Cord Paralysis
Vocal Cords
Young Adult