Vocal Fold Immobility

Children with vocal fold immobility (VFI) can have immobility of either one or both vocal cords. Symptoms of vocal fold immobility include hoarseness, breathing issues and/or aspiration (a condition in which either saliva or liquid or solid food contents inadvertently go down the air pipe, rather than the food pipe).

Diagnosis and Testing

Vocal fold immobility can occur for a variety of reasons, and the surgeon must seek to understand why one or both vocal folds are not working properly. Some questions they may consider:

  • Was the child born with this condition?
  • Was it the result of a necessary surgery, during which the nerve that enervates the vocal fold was injured?
  • Is there a mass or growth pressing on the nerve?
  • Is the nerve functional, but the joint that allows the vocal fold to move may be somehow stuck (perhaps due to local trauma or a prior intubation)?

To answer these questions, the physician may need to perform a laryngoscopy, perhaps an imaging study of the child’s head, neck and chest (such as an MRI) or other testing to fully understand the cause of the immobility.


Some cases of VFI resolve over time (see articles for more information), but this often takes up to one year. In the meantime, children with unilateral (one-sided) VFI may experience marked hoarseness or aspiration (or both).

If these symptoms are severe, a short-term solution may be vocal fold injections to improve voice and to prevent aspiration. Patients that need a more long-term solution are candidates for either thyroplasty or nerve reinnervation procedures.

Children with bilateral (both sides) VFI may have significant trouble breathing and may require a tracheostomy for a short time. If neither vocal fold regains function after one year, then these children are candidates for procedures such as vocal cordotomies, artenoid lateralization procedures, and airway reconstruction with rib grafts to allow these children to breathe better and to remove their tracheostomies.

Please see the articles in this section for further descriptions of these procedures and the videos as well. Please speak with your doctor for specific questions.