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Purpose: Bilateral vocal fold paralysis (BVFP) is a critical condition in newborns, which may present with significant airway distress necessitating tracheostomy. The purpose of this study is to report the safety and effectiveness of endoscopic percutaneous suture lateralization (EPSL) for newborns with BVFP, and evaluated the long‐term results and the stability of the lateralization. Methods: A review of patients undergoing EPSL for BVFP at our institutions was performed between October 2018 and June 2023. Preoperative and postoperative clinical information was collected. The functional outcomes of the surgery in terms of breathing, voice, and swallowing were evaluated and recorded. Results: Twenty seven patients were included, with a median age at diagnosis of 12 days (range, 1–33 days). The maximum follow‐up is for 5 years. EPSL was successful in 77.8% of cases, effectively avoiding the need for tracheostomy. Dyspnea was relieved within a month after surgery, enabling patients to tolerate oral feeds within 2 months after surgery. Notably, some patients experienced a return of vocal fold function, particularly in successful EPSL cases, underlining the procedure's efficacy. Minor complications, including granulation tissue and wound infection, were observed but were manageable. Major complications were notably absent. The results are durable and stable at long‐term follow‐up. Conclusion: EPSL for BVFP is a relatively simple, minimally invasive, non‐destructive, safe, and effective procedure in newborns, which may avoid the need for a tracheostomy, preserves the laryngeal framework, and does not affect the natural recovery of vocal cords. Level of Evidence: 3: retrospective case series Laryngoscope, 135:429–437, 2025 [ABSTRACT FROM AUTHOR]

Introduction: Type 4 posterior glottic stenosis and bilateral vocal fold paralysis are clinically challenging causes of bilateral vocal fold immobility (BVFI) that result in glottic airway obstruction. Established procedures for BVFI typically worsen dysphonia. We hypothesize the use of thyroarytenoid myomectomy (TAM) in the setting of BVFI will improve dyspnea with decreased detriment to voice. Methods: Eleven unilateral TAM procedures were performed between April 2021 and June 2023 at a single institution. Pre‐ and postoperative patient reported outcomes were compared. Representative images of maximal glottic opening were analyzed in ImageJ to calculate ipsilateral bowing index (BI), total BI, maximum glottic surface area (MGSA), and maximum opening angle (MOA). Statistical comparisons were performed with paired t‐tests when normality was confirmed with Shapiro–Wilk test and otherwise with Wilcoxon signed‐rank tests, with threshold for significance of α = 0.05. Interrater reliability for objective glottal measures was compared with intraclass correlation coefficient (ICC). Results: Dyspnea Index improved from mean (standard error) of 24.1 (3.8) to 9.1 (3.3), p = 0.004. Voice Handicap Index‐10 improved from 20.0 (4) to 10.3 (3.8), p = 0.011. Glottal Function Index improved from 9.6 (1.4) to 6.3 (1.3), p = 0.017. There was no significant difference in ipsilateral BI, total BI, MOA, and median MGSA. There was good to excellent ICCs for all comparisons (0.83–0.95). Conclusions: TAM demonstrated significant improvement in symptoms from BVFI while not significantly altering glottal structure. These data suggest TAM improves dyspnea in patients with BVFI without significantly impairing voice. Level of Evidence: 4 Laryngoscope, 134:4307–4312, 2024 [ABSTRACT FROM AUTHOR]

Background: Bilateral vocal cord palsy (BVCP) continues to be a challenge for laryngologists. The cause varies from idiopathic to trauma. At present, there are many static surgical treatments available for BVCP, which improve airway at the expense of voice. More than 75% of nerve fibers goes to adductors. Bilateral adductor involvement is rare in BVCP. For improving the airway without compromising the voice a dynamic procedure is needed. Two such procedures at experimental stages are total selective reinnervation and posterior crico arytenoid (PCA) pacemaker. Here, we are analyzing our experience with eight such cases of total selective reinnervation. Aim: To assess the efficacy of total selective reinnervation in cases of BVCP. Objectives: (1) To assess the improvement in airway post total selective reinnervation; (2) To assess the improvement in voice post total selective reinnervation; (3) To assess the involvement of swallowing function in total selective reinnervation. Methodology: This is a prospective study of 8 cases of BVCP who had undergone total selective reinnervation during a period of 9 years. Among the eight cases, two cases had idiopathic BVCP and six cases were post total thyroidectomy. All patients had a minimum follow-up period of 12 months except the last case which was in 7th postoperative month. Patient selection: all cases were seen within 2 years of their complaint except the child with congenital bilateral vocal cord palsy which was done at 4 years. Examination under anesthesia was done in all cases to rule out cricoarytenoid joint fixity. Electromyography (EMG) was not done. Pre-op assessment of quality of voice in each of these patients was done with Voice Handicap Index (VHI-10). Glottic space assessment was done with dyspnoea index score and flexible endoscopy. None of the patients had swallowing dysfunction at presentation. A repeat assessment was done at 6 and 12 months post-op and the results were compared. Results: In the immediate post-op period, all the patient had worsened voice quality. However, voice improved by 4 months and by 12 months all patients had better voice and lower VHI. Regarding airway: six patients were decannulated in 2 weeks, one patient was decannulated after 4 months and the youngest one after 1 year. By 6 months all patients had improved their dyspnea index by 1. However, between 8 and 12 months four patients had worsening dyspnea index requiring static procedures. Out of the four patients who did not require static procedures, one has completed only 6 months. The immediate swallowing dysfunction following the procedure improved within a period of 2 weeks. Conclusion: Total selective reinnervation improved the voice in all cases and it did not have any adverse effect on swallowing; however, the long-term effect in improving the airway was only in 50% of patients. The best results were obtained in younger patients. This is in sharp contrast with nonselective reinnervation for unilateral vocal cord palsy, whose success rate is as high as as 95%. This suggests that total selective reinnervation is to be taken up only in selected patients and that too only after detailed discussion about the final outcome and possible need for further surgical procedures. [ABSTRACT FROM AUTHOR]

Abstract Background The study was performed to evaluate the changing trends in etiology and presenting features of vocal cord paralysis (VCP) from March 1998 to March 2020. Methods Patient’s record collected from hospital database and divided into two groups, from March 1998 to March 2009 and from April 2009 to March 2020, to evaluate the changing trends in etiology and presenting features. Results Total of 711 VCP patients, 80.3% with unilateral (UVCP) and 19.7% with bilateral vocal cord paralysis (BVCP) included. The commonest etiology was non-surgical (57.1%) for UVCP and surgical (55.7%) for BVCP. The commonest surgical etiology was thyroid and parathyroid surgery for both UVCP (16.6%) and BVCP (38.5%). The commonest non-surgical etiology was idiopathic for UVCP (23.1%) and malignancies for BVCP (13.6%). There was increase in surgical etiology for both UVCP (39.3 to 45.3%) and BVCP (51.2 to 57.7%), and decrease in non-surgical etiology for both UVCP (60.7 to 54.6%) and BVCP (48.8 to 42.3%). The change in voice was most common presenting features for both UVCP (69.2%) and BVCP (92.8%). The frequency of the presenting features was comparable, with decrease in the duration of symptom onset over the time period. Conclusion The most common etiology for UVCP was idiopathic, and for BVCP was thyroid and parathyroid surgery. For both, UVCP and BVCP there was increasing trend for surgical and decreasing trend for non-surgical etiology. The change in voice was the most common presenting complain, with decrease in duration of symptom onset over time period.

Obstructive sleep apnoea (OSA) is typically caused by multilevel obstruction of the upper airway. Laryngeal obstruction from bilateral vocal cord paralysis (BVCP) is a rare cause of OSA. The predominance of nocturnal symptoms is likely due to decreased tone and activity of the laryngeal muscles during sleep, therefore reducing the glottic calibre and limiting airflow through the glottis.While BVCP is a rare cause of OSA, it is a well-recognized and significant complication of thyroid surgery due to the proximity of the recurrent laryngeal nerve to the thyroid gland. However, patients classically develop acute stridor in the immediate post-operative period, rather than a delayed presentation of “snoring”.In this article, we describe a series of two rare cases of non-obese patients with BVCP, presenting with “snoring” to the ENT Sleep Clinic, some months to years after their thyroid surgery. One patient decided on expectant management, the other underwent a tracheostomy with relief of her symptoms.This case series illustrates the importance of performing a flexible nasoendoscopy to evaluate the upper airway tract, especially the vocal cords, in a patient who has a history of thyroid surgery and/or thyroid pathology who presents to the Sleep Clinic with seemingly benign “snoring”.

This systematic review and meta-analysis evaluated the efficacy of various glottic widening procedures (GWPs) in avoiding tracheostomy in infants with bilateral vocal cord paralysis (BVCP). A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to July 2023, without any timeframe limitations. Studies reporting GWPs (Endoscopic anterior-posterior cricoid split, Botox injection, suture lateralization, and other procedures including laser posterior cordotomy/arytenoidectomy) in infants with BVCP were included. Meta-analysis was performed to assess tracheostomy avoidance and secondary outcomes including voice, swallowing, and resolution of airway symptoms. Thirteen studies with 100 patients were included. The mean age was 51.6 days. The etiology of BVCP was idiopathic (83 %), neurologic (10 %), and acquired (7 %). The GWP interventions were successful in 88 % of patients, with only 12 % requiring tracheostomy after surgery. The pooled proportion for avoiding tracheostomy was 0.88 (95 % CI 0.82–0.94) across interventions, with no significant differences between techniques. Among patients who avoided tracheostomy, 64 % had normal voice, 86 % tolerated oral feeding, 77 % had airway symptom resolution, and 70 % had recovery of vocal cord mobility. GWPs prevent a majority of infants with BVCP from undergoing tracheostomy, without permanent alterations to laryngeal function. All interventions were comparable in efficacy. Further research with larger sample sizes is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Kashima operation, also known as endoscopic laser cordotomy is used for the treatment of bilateral abductor vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any strider. Materials and Methods: This Clinical Trial Was Performed On 12 Patients[1] with Bilateral Abductor Vocal Cord Paralysis. All Patients Underwent Kashimas Procedure and Post-Operative Voice, Respiratory and Deglutition Function Were Evaluated. Results: 75% of patients were females and the mean age of patients was 40.9 ±9.13 years. In our patients, the most common etiology of bilateral vocal cord palsy was thyroid surgery (n=10, 83.33%).There was a significant improvement in breathing after surgery (P=0.001). After the procedure, 70% of patient had mild voice handicap score, and MPT was in normal range in 91.6% of cases. Conclusion: Kashimas procedure is a satisfactory surgical treatment for treating bilateral vocal cord palsy in regards to strider. No aspiration was seen in any of the patients post-surgery and voice outcome of these patients was also satisfactory.

The related research of nerve repair for bilateral vocal cord paralysis（BVCP） can be traced back to a century ago. There is still no standardized surgical therapeutic schedule and the evaluation of curative effect, due to the variability and complexity of laryngeal nerve innervation. Otolaryngologists have been constantly weighing and improving the surgical plan in relieving airway obstruction, maintaining vocal function and reducing cough to protect the normal physiological function of the larynx. Different medical institutions have great differences in the treatment methods. Many studies and literatures were published on the treatment of BVCP, yet have few related works on the application of it's nerve repair technology presently. The research progress of nerve repair technology for BVCP were described, along with its developing trend, aiming to lay the foundation for the future technical exploration and development., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Bilateral vocal cord paralysis poses life-threatening risks to patients who do not undergo prompt diagnostic intervention and airway management. Although developing bilateral vocal cord paralysis is extremely rare, if injury does occur, it is more frequently due to surgical resection sequelae in the neck. This case is particularly unique as we present a patient with a history of stage III laryngeal carcinoma status post chemotherapy in remission, who developed respiratory distress three days following an upper endoscopy procedure for an esophageal stricture at the level of the cricopharyngeus muscle, where he received a botulinum injection. This manuscript discusses the anatomy, clinical practices of botulinum toxin, nerve innervation, and mechanisms of injury for patients who develop bilateral recurrent laryngeal nerve injury. In addition, this manuscript details vocal cord positioning and how the positioning of the cords during laryngoscopy investigation can lead to diagnostic confirmation. With few reported cases of bilateral recurrent laryngeal nerve injury secondary to botulinum toxin particularly at the cricopharyngeus level, this report should serve as a guide for future clinicians regarding the risks of using this toxin, the risks of local spread, and management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Potesta et al.)

Multiple myeloma is B-cell neoplastic disease occurring as a result of monoclonal expansion of plasma cells. This lymphoproliferative disease may involve bone marrow and extramedullary soft tissues. It has been treated successfully over the years with chemotherapy. Novel chemotherapeutic agents may result in devastating unknown complication. Herein, we would like to report a case of bilateral vocal cord palsy following Bortezumib in an elderly gentleman with multiple myeloma. [ABSTRACT FROM AUTHOR]

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Miller Fisher syndrome (MFS) typically presents with acute development of ataxia, ophthalmoplegia, and areflexia. Bilateral vocal cord palsy (BVCP) is a rare manifestation of MFS. We present a case of a 66-year-old male diagnosed with MFS complicated by an unusually delayed onset of BVCP while undergoing inpatient rehabilitation. We also describe the inpatient rehabilitation course, including the use of a patient-guided suspension system (PGSS) as a therapeutic adjunct to aid gait training, resulting in significant functional improvement in ambulation and activities of daily living. Given the rarity of BVCP in MFS, this case highlights the importance of healthcare professionals being aware of this phenomenon so that prompt treatment can be initiated to reduce significant morbidity. Innovative treatment approaches such as the use of a PGSS may also prove beneficial in the rehabilitation of patients with MFS with significant ataxia., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chen et al.)

Abstract Background Congenital bilateral vocal cord paralysis is a rare occurrence. Approximately half the cases are associated with a major comorbidity, usually neurological, neuromuscular or malformative. Case presentation In a male newborn, respiratory distress syndrome and stridor were observed immediately following birth. The cause was bilateral vocal cord paralysis in the adducted position. Neuroradiological investigation revealed a unilateral discontinuity between the upper pons and the right medulla oblongata. Hypoplasia of the right posterior hemiarches of C1-C2 and the right exo-occipital bone was observed, as was a small clivus. MR angiography showed the absence of the distal right vertebral artery, with hypoplasia and parietal irregularities of the proximal segments. Respiratory autonomy was not obtained despite endoscopic laser cordotomy, corticosteroid therapy and nasal continuous positive airway pressure. The infant died at the age of 4 weeks after treatment was limited to comfort care. Conclusions A medullary lesion is an exceptional cause of congenital bilateral vocal cord paralysis. The strictly unilateral neurological and vascular defect and the absence of associated intracranial or extracranial malformation make this clinical case unique and suggest a disruptive mechanism. This case also highlights the help provided by advanced neuroimaging techniques, i.e. fibre tracking using diffusion tensor imaging, in the decision-making process.

Introduction: Kashima operation, also known as endoscopic laser cordotomy is used for the treatment of bilateral abductor vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any strider. Materials and Methods: This Clinical Trial Was Performed On 12 Patients2 with Bilateral Abductor Vocal Cord Paralysis. All Patients Underwent Kashimas Procedure and Post-Operative Voice, Respiratory and Deglutition Function Were Evaluated. Results: 75% of patients were females and the mean age of patients was 40.9 ±9.13 years. In our patients, the most common etiology of bilateral vocal cord palsy was thyroid surgery (n=10, 83.33%).There was a significant improvement in breathing after surgery (P=0.001). After the procedure, 70% of patient had mild voice handicap score, and MPT was in normal range in 91.6% of cases. Conclusion: Kashimas procedure is a satisfactory surgical treatment for treating bilateral vocal cord palsy in regards to strider. No aspiration was seen in any of the patients post-surgery and voice outcome of these patients was also satisfactory. [ABSTRACT FROM AUTHOR]

Introduction: The presentation, course, and management of a rare laryngeal manifestation of neurosarcoidosis due to central nervous system (as opposed to peripheral nervous system) injury are described. Methods: The authors present 3 cases of vocal cord paralysis as the initial symptom of isolated neurosarcoidosis at a tertiary care laryngology clinic. Results: Laryngoscopy diagnosed unilateral vocal cord paralysis. Laryngeal electromyography revealed high vagal injury, prompting workup on brain magnetic resonance imaging. On magnetic resonance imaging, 2 cases showed basilar leptomeningeal inflammation and 1 case showed a brainstem mass. Patients were found at follow-up to have severe, progressive vagal injury, with patients developing severe quality of life impairments and medical complications. Conclusions: Neurosarcoidosis is not usually considered in the differential diagnosis of vocal cord paralysis. At initial presentation, all patients lacked other cranial neuropathies and systemic sarcoidosis manifestations, making diagnosis difficult. Otolaryngologists should be aware of this rare presentation, as prompt diagnosis by brain magnetic resonance imaging with or without central nervous system biopsy, as opposed to traditional chest radiography or computed tomography for the workup of peripheral nerve injury, is necessary. Serial laryngeal examinations are recommended for close monitoring of progressive disease and recommending treatment. Injection or medialization laryngoplasty can provide improvements in voicing but not swallow. [ABSTRACT FROM AUTHOR]

The article discusses a study focusing on the use of botulinum toxin in managing laryngeal synkinesis, a movement disorder, in patients with unilateral and bilateral vocal fold paralysis. Topics discussed include the treatments for dyspnea and stridor caused by laryngeal synkinesis, the use of laryngeal electromyography (LEMG) in the study, and the lack of effectiveness of botulinum toxin therapy.

Introduction Bilateral vocal cord paralysis in adducted position (BVCPAd) is a severe cause of airway obstruction and usually debuts with stridor and airway distress necessitating immediate intervention. Tracheostomy has long been the gold standard for treating this condition, but has significant associated morbidity and mortality in pediatric patients. New conservative procedures have emerged to treat this condition thus avoiding tracheostomy, like endoscopic anterior and posterior cricoid split (EAPCS). The objective of this paper was to review our experience with EAPCS in newborns and infants. Methods Prospective study involving patients undergoing endoscopic EAPCS for symptomatic BVCPAd. The primary outcomes were tracheostomy avoidance and resolution of airway symptoms. Results Three patients underwent EAPCS between January 2016 and December 2016. All patients stayed at least 7 days in the Intensive Care Unit (ICU) intubated. All patients presented complete resolution of their symptoms due to airway obstruction, without the need for tracheostomy. Conclusion EAPCS is a novel and effective alternative to treat BVCPAd in patients under 1 year old. Our study is an initial experience; more cases are required to identify the real impact and benefits of this technique and to determine the proper selection of patients. [ABSTRACT FROM AUTHOR]

We describe a patient with acute respiratory insufficiency and difficult ventilator weaning in the ICU ward, leading to diagnosis of small cell lung cancer with superior vena cava superior syndrome. Bilateral vocal cord paralysis caused his respiratory distress and weaning difficulties. Thyroidectomy and neurological problems (such as Parkinson disease and Guillain Barré syndrome) are more common causes of bilateral vocal cord paralysis. Lung cancer patients are also at risk due to mediastinal invasion. The left recurrent laryngeal nerve is more prone to paralysis because of the typical anatomy. In contrary, bilateral vocal cord paralysis is rare and doesn't result in speech problems but rather breathing difficulties. Tracheostomy is the classic therapy, but laser cordectomy and Botulinum toxin injection in the laryngeal muscles are alternatives.

Bilateral vocal cord paralysis is a potentially life-threatening condition, depending on the position in which the vocal cords are paralyzed. When the vocal cords are fixed in adduction, patients develop respiratory distress, inspiratory stridor, aspiration, and minimal phonation deficits. This condition can result from acute injuries to the right and left recurrent laryngeal nerves, or from chronic bilateral recurrent laryngeal nerve palsy. The clinical presentation is variable with such nerve injuries. Traumatic injuries to the cervical spine are an uncommon cause of this condition. In this report, we describe a patient who developed progressive respiratory distress, inspiratory stridor, and dysphagia to liquids several weeks after suffering major trauma to the head and neck. Laryngoscopy revealed immobile bilateral vocal cords fixed in the paramedian position, resulting in severe airway obstruction that warranted an emergency tracheostomy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ehret et al.)

Conclusion: This method is an easy, non-expensive, and effective technique in bilateral vocal cord paralysis to improve glottic airway and clinical performance. Objective: To evaluate the effectiveness of 'suture arytenoid laterofixation' surgery in bilateral vocal cord paralysis. Materials and methods: A retrospective analysis of patients' medical history undergoing 'suture arytenoid laterofixation' surgery for bilateral vocal cord paralysis. This technique was applied under general anesthesia with both microlaryngoscopy and video-monitoring. Two 16 g needles and one 1/0 nylon thread were used for the procedure with 1 cm skin incision; no tracheotomy or tissue excision was required. Pre-post-operative photographs of the glottic region were taken from the endoscopic records, and the areas of rima glottis openings were calculated with the Image-J programme. Results: Forty-seven patients were analyzed. The mean pre-post-operative rima glottis areas were 1.11 ± 0.56 and 2.24 ± 0.93 mm2, respectively ( p < 0.001). Five patients with previous tracheotomy were decannulated within a few days after the operation. In three patients, mild complications developed in the early post-operative period (two laryngeal edemas, one submucosal hematoma). Tracheotomy was performed to only one pregnant patient in the post-operative first day. None of the patients had granulation formation or synechia. [ABSTRACT FROM AUTHOR]

To compare the functional results between posterior cordotomy, cordoplasty and external procedure in managing bilateral vocal cord paralysis in one of the largest published study group. Retrospective and comparative study. 54 patients with bilateral vocal cord paralysis who underwent posterior cordotomy (Group-I), cordoplasty (Group-II) and external procedure (Group-III) from 2001 to 2013 were compared for functional outcomes. Successful decannulation was achieved more in Group-I and II than in Group-III. Voice outcome was better in Group-II patients compared to other groups. Outcomes of cordoplasty was better than posterior cordotomy and external procedures, with acceptable airway and good quality of voice. Posterior cordotomy is preferred in patients without tracheostomy and in pediatric patients. In patients with tracheostomy or who accept temporary tracheostomy, a cordoplasty is preferred for favorable voice. External procedure is preferred for patients not fit for general anesthesia. [ABSTRACT FROM AUTHOR]