Vocal cord paralysis is the second most common congenital anomaly of the voice box (larynx) and is characterised by loss of movement of the cords in the voice box (vocal cords). This paralysis may affect one or both of the vocal cords.

While in most children the case may not be ascertained, such paralysis may occur due to conditions identified at the level of the brain and nervous system due to birth defects, bleeding, low oxygen, injury, tumours etc.

A child with vocal cord paralysis may have a hoarse, breathy cry that is aggravated by agitation. Often there may be severe respiratory distress with stridor (noisy breathing). Feeding difficulties and aspiration resulting in chest infections may also occur.

The paediatric ENT surgeon will need to carry out an endoscopy to confirm the diagnosis and to assess the airway for other anomalies. A CT scan is done to look for possible causes.

Many children will need urgent treatment to provide a safe airway. This can be achieved by endotracheal intubation or a tracheostomy. As some children may recover spontaneously in a few years, it may be necessary to retain the tracheostomy for that period. In case recovery does not occur, microlaryngeal surgery may be considered to improve the airway.