Children with recurrent laryngeal nerve injury and other causes of vocal cord weakness and paralysis need care from a team of experts with experience diagnosing and treating these complex conditions. The Esophageal and Airway Treatment Program at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, is one of the few programs in the country with expertise in diagnosing the various types of vocal cord immobility and identifying when it is due to recurrent laryngeal nerve injuries so that patients receive optimal care.

Recurrent laryngeal nerve injury occurs when the nerve branch that controls the muscles of the voice box (called the larynx) is damaged. This results in vocal cord weakness or paralysis (loss of movement) in one or both vocal cords. The recurrent laryngeal nerve also controls sensation to the vocal cords and the larynx below the vocal cords, so injury also can cause a loss of sensation of the voice box.

Recurrent laryngeal nerve injury and vocal cord paralysis can have several causes, including:

• Congenital, meaning it is present at birth
• Trauma during birth
• Injury from manipulation of the airway, such as if a baby requires intubation. Subglottic stenosis, or narrowing of the airway just below the vocal cords, is often associated with this cause.
• Prior surgery, such as surgery to the esophagus, airway, neck or other heart/cardiac surgeries
• Inflammatory or autoimmune conditions

Why Choose Johns Hopkins All Children’s

Experienced Team

Our multidisciplinary team includes pediatric thoracic and airway surgeons experienced in treating this condition, as well as pediatric anesthesiologists with expertise in meeting the unique anesthesia needs of children needing surgery for airway conditions. The hospital’s radiology specialists also provide additional expertise in caring for our patients. Learn more about our team.

Advanced Diagnostic Techniques

Recurrent laryngeal nerve injury and vocal cord paralysis can be a complex condition with several possible underlying causes and associated conditions. Patients have often been misdiagnosed before they come to us for care. Our team has specialized expertise in airway assessment so that our patients receive an accurate diagnosis and comprehensive treatment that addresses all their needs.

Using various methods, we examine the structure and function of the vocal cords, larynx (or voice box), trachea and esophagus to establish a complete picture of your child’s condition. This thorough testing allows us to carefully plan your child’s treatment. We are also one of few programs that uses ultrasound imaging to examine the movement of the vocal cords.

Conditions We Treat

• Vocal cord hypomobility, in which one vocal cord does not move normally
• Vocal cord immobility, in which one vocal cord does not move at all
• Vocal cord paralysis, in which a vocal cord lacks motor control or moves in the wrong direction
• Bilateral vocal cord paralysis, impacting both vocal cords
• Recurrent laryngeal nerve injury

We also treat aspiration (the accidental inhaling of food, liquid or saliva into the lungs) which is typically associated with these conditions.

Our Approach to Treatment

Proper treatment depends on complete and accurate diagnosis and understanding of the child’s condition. We perform a complete evaluation of your child to assess their vocal cord mobility.

Testing includes:

Flexible laryngoscopy: A thin, flexible camera is used to examine the nasal passages, throat, and vocal cords, allowing us to look at the structure of the vocal cords and how they work when your child is breathing normally and when coughing collapses the airway.

Bronchoscopy: Done with anesthesia under the close care of our expert anesthesia team, a thin tube with a camera is used to examine the trachea, bronchi (the passages between the trachea and the lungs), and smaller airways, to examine the anatomy or the trachea.

Ultrasound: An ultrasound is done while your child is awake to examine how their vocal cords move.

We may also recommend a CT or MRI scan to examine the anatomy of the neck and how it may be impacting the vocal cords, especially if your child’s vocal cord condition is due to a prior trauma or surgical procedure.

Once we understand the full scope of your child’s condition, we design a surgical plan to meet their individual needs. We work closely with specialists throughout the hospital as needed, such as pediatric plastic surgeons with expertise in microsurgery or cardiothoracic surgeons.

What to Expect

We follow all our patients long-term after surgery. Typically, we’ll have a phone or video chat follow up with you about a week after your child’s discharge home, and then they will have an appointment with us in our clinic about a month after the surgery. We understand that travel is often difficult for our patients from other states and other countries, and we will do our best to work with you. We’ll determine appropriate follow up from there depending on your child’s condition.