Exercise-Induced Dyspnea as an Indication for Non-Selective Laryngeal Reinnervation in Adolescents With Vocal Cord Paralysis

Introduction: Non-selective laryngeal reinnervation (NSLR) is the gold standard for treatment in long standing vocal fold paralysis, typically indicated for dysphonia or in some cases aspiration. We introduce dyspnea as an additional indication, with excellent patient-reported and clinician-observed outcomes.

Methods: This study included patients under the age of 26 who received NSLR at Children’s National Hospital from 2014-2023. Patient charts were analyzed for pre and postoperative patient symptomology, work-up, and treatment. The primary endpoint tracked in this study was symptom resolution. Secondary endpoints included voice outcomes, laryngoscopy findings, and patient/parent reported outcomes.

Results: In total, 24 patients underwent NSLR, and 5 patients were found to have the primary indication for NSLR of EID. The median age of the overall cohort was 5 (range 2-21), whereas the median age at treatment was 11 (range 10-17) in the EID patients. The primary cause of VFP in the overall cohort was PDA ligation (71%), though this made up only 20% of the EID cohort, with other patients having history of coarctation, lymphoma, and birth trauma as the cause of VFP in this group. All 100% (n=5) of patient’s demonstrated stridor alongside their EID, but only 60% (n=3) also reported a weak voice. In all cases, EID/stridor resolved immediately following NSLR and voice function was noted to be similar or improved by 6 months following NSLR. No patient had recurrent EID symptoms at follow-up (range 6 months-6 years).

Conclusions: Our study highlights NSLR as a potential key intervention for adolescents with VFP experiencing EID. We postulate the symptoms of EID in VFP are related to type III synkinesis. NSLR acts to denervate and reinnervate and seems to alter the input to the larynx leading to significantly improve exercise tolerance while maintaining functional closure for voice. Further investigation is needed to consolidate these preliminary results and to explore predictive factors for successful outcomes post-NSLR, aiming to establish NSLR as a standard therapy for EID due to VCP in the adolescent population.