Nelson Textbook of Pediatrics 22nd Edition | Third most common congenital laryngeal anomaly. Unilateral vocal cord paralysis: often iatrogenic (PDA ligation, thyroid surgery, cardiac surgery) → weak breathy cry, aspiration, hoarseness. Bilateral vocal cord paralysis: often congenital (Chiari malformation, hydrocephalus, idiopathic) → stridor, aphonia, respiratory distress. Diagnosis: awake flexible laryngoscopy (immobile cord(s)). Treatment: unilateral often resolves spontaneously within 6-12 months; bilateral may require tracheostomy, later glottic widening procedures (arytenoidectomy, cordotomy).
🌐 paeds.online — Pakistan's Pediatric Platform| Type | Etiology | Clinical Features | Management |
|---|---|---|---|
| Unilateral VCP (acquired) | Iatrogenic (PDA ligation, cardiac/thyroid surgery), trauma, idiopathic, rarely congenital | Weak breathy cry, hoarseness, aspiration, choking with feeds | Observation (spontaneous recovery 6-12 mo), feeding therapy, vocal cord injection if persistent |
| Unilateral VCP (congenital) | Idiopathic, birth trauma | Same as above, may present at birth | Observation, feeding support, monitor for aspiration |
| Bilateral VCP (congenital) | Chiari malformation, hydrocephalus, brainstem anomalies, idiopathic | High-pitched inspiratory stridor, aphonia, respiratory distress, may present with acute airway compromise | Tracheostomy often required. Treat underlying Chiari (posterior fossa decompression). Later glottic widening (arytenoidectomy, cordotomy) |
| Bilateral VCP (acquired) | CNS injury, tumor | Same as congenital bilateral | Treat underlying cause, tracheostomy if needed |