JAMA Otolaryngol Head Neck Surg. 2014 May;140(5):428-33. doi: 10.1001/jamaoto.2014.81.
IMPORTANCE The clinical course and outcomes of pediatric vocal fold immobility (VFI) vary widely in the literature, and follow-up in these patients varies accordingly. A better understanding of the natural history of pediatric VFI is crucial to improved management. OBJECTIVE To characterize the natural history of pediatric VFI, including symptoms and rates of resolution and surgical intervention. DESIGN, SETTING, AND PARTICIPANTS Retrospective review at an academically affiliated private pediatric otolaryngology practice in a metropolitan area of all patients seen between July 15, 2001, and September 1, 2012, with a diagnosis of complete or partial VFI. After elimination of 92 incomplete or duplicate files, 404 patient records were reviewed for demographic characteristics, etiologies, symptoms, follow-up, resolution, and interventions. Follow-up records were available for 362 patients (89.6%). MAIN OUTCOMES AND MEASURES Resolution of VFI confirmed by repeated laryngoscopy, length of follow-up, and surgical intervention rates. RESULTS Among the 404 patients, left VFI was present in 66.8%, right VFI in 7.9%, and bilateral VFI in 25.3%. Median (range) age at presentation was 2.9 (0-528.1) months. Major etiological categories included cardiac surgery in 68.8%, idiopathic immobility in 21.0%, and neurologic disease in 7.4%. At presentation, 61.4%experienced dysphonia, 54.0%respiratory symptoms, and 49.5%dysphagia. Tracheotomy was performed in 25.7%and gastrostomy in 40.8%. Median (range) duration of follow-up among the 89.6%of patients with follow-up was 17.2 (0.2-173.5) months. Resolution evidenced by laryngoscopy was found in 28.0%, with a median (range) time to resolution of 4.3 (0.4-38.7) months. In patients without laryngoscopic resolution, median follow-up was 26.0 months, and 28.9% reported symptomatic resolution. CONCLUSIONS AND RELEVANCE The natural history of pediatric VFI involves substantial morbidity, with lasting symptoms and considerable rates of surgical intervention. In this large database, the majority of patients did not experience resolution. This suggests a need for more regimented follow-up in these patients, a recommendation for which is proposed here.
儿科声带固定（VFI）的临床病程和结局在文献中差异很大，这些患者的随访也相应不同。更好地了解儿科 VFI 的自然病史对于改善管理至关重要。
描述儿科 VFI 的自然病史，包括症状、缓解率和手术干预率。
设计、地点和参与者：对一家大都市地区学术附属私立儿科耳鼻喉科实践中，2001 年 7 月 15 日至 2012 年 9 月 1 日期间，所有被诊断为完全或部分 VFI 的患者进行回顾性回顾。在排除 92 例不完整或重复的文件后，对 404 名患者的病历进行了人口统计学特征、病因、症状、随访、缓解和干预的回顾。362 名患者（89.6%）的随访记录可用。
通过重复喉镜检查确认的 VFI 缓解、随访时间和手术干预率。
在 404 名患者中，左侧 VFI 占 66.8%，右侧 VFI 占 7.9%，双侧 VFI 占 25.3%。发病时的中位（范围）年龄为 2.9（0-528.1）个月。主要病因类别包括心脏手术占 68.8%、特发性不动占 21.0%和神经疾病占 7.4%。就诊时，61.4%的患者出现声音嘶哑，54.0%的患者出现呼吸症状，49.5%的患者出现吞咽困难。25.7%的患者行气管切开术，40.8%的患者行胃造口术。在 89.6%有随访记录的患者中，中位随访时间为 17.2（0.2-173.5）个月。通过喉镜检查发现 28.0%的患者缓解，缓解的中位（范围）时间为 4.3（0.4-38.7）个月。在没有喉镜缓解的患者中，中位随访时间为 26.0 个月，28.9%的患者报告症状缓解。
儿科 VFI 的自然病史涉及到相当大的发病率，包括持续的症状和相当高的手术干预率。在这个大型数据库中，大多数患者没有经历缓解。这表明这些患者需要更规范的随访，这里提出了这一建议。
