Neurophysiological Assessment in Children with Vocal Fold Paralysis: A Tertiary Center Experience

Objective The aim of this study is to report on experience acquired during the laryngeal electrophysiological assessment with Co‐MEP and L‐EMG in pediatric patients with acquired, congenital, and syndromic vocal fold paralysis (VFP), and correlate our findings with patients' characteristics, their comorbidities, and VFP etiology. Methods Pediatric patients with suspected or previously diagnosed unilateral or bilateral VFP underwent electrophysiological records under general anesthesia; corticobulbar motor‐evoked potentials (Co‐MEPs) and laryngeal electromyography (L‐EMG) of thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles were recorded. Results Statistical analysis revealed a statistically significant correlation between early gestational age at childbirth and TA muscle intensity ( p = 0.002) and PCA muscle intensity ( p = 0.002); tracheostomy presence and TA muscle intensity ( p = 0.002) and PCA muscle intensity ( p = 0.002); presence of genetic anomalies with intensity and latency for TA muscle and latency for PCA muscle (TA latency p = 0.015, TA intensity p = 0.021, PCA latency p = 0.035); congenital presentation of VFP and an increased intensity for TA muscle ( p = 0.04); latency and intensity for TA muscle ( p = 0.024); TA muscle intensity and PCA intensity ( p = 0.005). Conclusion Intraoperative Co‐MEPs and L‐EMG are two complementary tools for evaluating the functional integrity of the structures involved in conveying signals from the motor cortex to TA and PCA muscles in children with vocal fold paralysis. Further studies are needed to establish their ability to predict the recovery of VF mobility, which could potentially lead to decannulation. Level of Evidence 4 Laryngoscope , 135:935–941, 2025