Pediatric Airway Disorders

Vocal Fold Paralysis

Vocal fold paralysis is a condition in which the vocal cords cannot move. It may affect one side (unilateral) or both sides (bilateral).

What causes vocal cord paralysis?

Scarring from cardiac surgery is often the cause of one-sided vocal cord paralysis, but many times the cause is unknown. Two-sided vocal cord paralysis is often associated with birth trauma and central nervous system abnormalities (such as Chiari malformations or increased intracranial pressure). However, often a cause is not identified, and we say that the condition has an idiopathic etiology (unknown cause).

How common is vocal cord paralysis?

Vocal cord paralysis is the second most common congenital defect of the larynx (voice box). About 10 to 15 percent of congenital laryngeal disorders are vocal cord paralysis.

What are the symptoms of vocal cord paralysis?

Symptoms of vocal cord paralysis often show up by 2 months of age. Symptoms vary by the seriousness of the condition and may include:

Unilateral (one-sided) paralysis

Bilateral (two-sided) paralysis

How is vocal cord paralysis treated?

In most circumstances, no immediate treatment is needed for one-sided vocal cord paralysis. Treatment is needed when your child is having trouble breathing or is aspirating fluid into the lungs.

Treatment for unilateral (one-sided) vocal cord paralysis

If the only effect your child is experiencing from unilateral vocal cord paralysis is a weak, breathy, hoarse voice, we can perform procedures to make your child’s voice louder. At The Children's Hospital of Philadelphia, surgeons use two treatment approaches for single-sided paralysis:

Treatment for bilateral (two-sided) vocal cord paralysis


CO2 laser cordotomy performed for bilateral vocal
cord paralysis.
Airway surgeons manage two-sided (bilateral) vocal cord paralysis by observation unless your child is having trouble breathing. When the airway is compromised, surgical options include:

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