Vocal cord paralysis appears to be an acquired lesion in children with repaired esophageal atresia/tracheoesophageal fistula

Background: reports suggest that congenital esophageal atresia/tracheoesophageal fistula (EA/TEF) is associated with a number of upper airway anomalies [1,2]. Aims: it remains unclear whether vocal cord paresis or paralysis (VCP) is usually a primary anomaly, or is secondary to EA/TEF repair. Methods: a retrospective study was carried out in 105 patients with EA/TEF referred to the Department of Pediatric Medicine, Bambino Gesu Children’s Hospital (BGCH) for multidisciplinary follow-up following EA/TEF repair, between 2010 and 2015. Results: 64 of the 105 patients included in the study underwent EA/TEF repair and had pre-operative bronchoscopy in BGCH; the remaining patients had their initial surgery elsewhere. No patient included in the study had VCP detected pre-operatively. Six patients were diagnosed with VCP during the follow-up period (6/105, 5.7%), of whom 4 were surgically managed at the BGCH, and two were managed elsewhere. Four children with bilateral VCP initially required tracheostomy. The other two patients were treated with posterior cordotomy by CO2 laser, and one received a tracheostomy. Conclusion: we did not observe VCP in pre-operative bronchoscopy in patients undergoing EA/TEF repair, but observed VCP in 5.7% of patients during a post-operative re-evaluation, suggesting that VCP is an acquired lesion in TEF patients. Future studies are needed to determine whether VCP is present in some patients prior to EA/TEF repair, and if so, what the prevalence is. References: 1. Ann Otol Rhinol Laryngol. 2015; 124: 808-13. 2. Laryngoscope. 2015; 125: 469-74.