Paediatric vocal fold paralysis
Reviewed by Sangeeta Maini and Bhaskar Ram

This paper takes a relatively complex paediatric airway problem and provides a structured approach from terminology and anatomy through to aetiology, assessment, investigation and management. I found it particularly clinically relevant because it provides a framework that can be applied directly when assessing a child with suspected vocal fold paralysis. The paper clearly explains the terminology surrounding vocal fold paralysis (VFP) and vocal fold immobility, which is particularly helpful given that these terms are sometimes used interchangeably. The causes of paediatric VFP are presented systematically, including traumatic, central neurological, peripheral neurological, congenital, iatrogenic and idiopathic. I particularly liked the detailed discussion of the clinical presentation of unilateral versus bilateral VFP and the structured approach to history-taking. It highlights important questions regarding birth history, congenital abnormalities, previous intubation, surgical history and neurological symptoms, as well as when to involve specialties such as neurology, genetics and pulmonology. The paper reinforces flexible laryngoscopy as the gold standard for assessing vocal fold mobility and discusses the importance of appropriately investigating the underlying cause. It also discusses the role of ultrasound as a non-invasive alternative in appropriate circumstances. I found the management section particularly useful because it gives a good overview of treatment options for unilateral VFP, including injection laryngoplasty and recurrent laryngeal nerve reinnervation, while also discussing the different priorities in bilateral VFP, particularly management of the airway.

Pediatric Vocal Fold Paralysis.
Kiessling P, Sidell D.
OTOLARYNGOL CLIN NORTH AM
2026;(5)945–55.