Aspiration and Feeding Outcomes in Pediatric Patients with Bilateral Vocal Fold Immobility

Monday, October 19, 2026

10:00 AM - 10:06 AM PT

Location: 409AB

Presenting Author(s)

LK

Lauren Kwa, MD

Resident Physician
Boston University Medical Center
Boston, Massachusetts, United States

Co-Author(s)

EP

Eshan Patel, BS

Clinical Research Assistant
Boston Children's Hospital
Simpsonville, South Carolina, United States
HK

Hae-Young Kim, DrPH

Senior Biostatistician / Assistant Professor
Boston Children's Hospital
Boston, MA, United States
KH

Kayla Hernandez, CCC-SLP

Speech-Language Pathologist
Boston Children's Hospital, United States
KD

Kathryn Davidson, MS, CCC-SLP, BCS-S, CLC

Speech-Language Pathologist
Boston Children's Hospital
Boston, Massachusetts, United States
Reza Rahbar, MD

Professor; Associate Otolaryngologist-in-Chief
Boston Children's Hospital, United States

Senior Author(s)

Anne Hseu, MD

Assistant Professor
Boston Children's Hospital
Boston, Massachusetts, United States

Introduction: Vocal fold immobility is a common laryngeal abnormality in pediatric populations. This study aims to characterize swallowing abnormalities in children with bilateral vocal fold immobility (BVFI) utilizing modified barium swallow (MBS) and report the impact of these abnormalities on feeding and respiratory outcomes.

Methods: A retrospective review was conducted on all patients 0-18 years with diagnosis of BVFI at a tertiary referral children’s hospital from 2014-2024. Patients were included if they had undergone at least one MBS within a 4-month period of their BVFI diagnosis. Outcomes included Penetration-Aspiration Scale (PAS) scores at initial MBS and follow-up MBS, diet recommendations, need for tracheostomy, need for enteral access, and vocal fold mobility at most recent follow-up.

Results: 100 patients were included. Mean (SD) age was 2.71 (3.60) years. Iatrogenic injury was the most common etiology (n=63) of BVFI. 18% of patients had feeding difficulties on presentation. 92 patients underwent initial MBS testing with thin liquids; 29.4% (n=27) were found to silently aspirate and only 16% were recommended for an unrestricted/regular diet. Children with comorbid cardiac disease were more likely to have silent aspiration on initial MBS than children without (39% vs 21.6%, p=0.002). 41% required nasogastric tube and 47% gastrostomy tube placement for adequate nutrition. Median follow-up was 13.8 months, at which time 31% of patients had normal vocal fold motion bilaterally.

Conclusions: A minority of children with BVFI had feeding difficulties on presentation, but about one third were found to have silent aspiration and the majority were deemed unsafe for a regular diet. Increased vigilance for feeding issues is required, especially in children with cardiac comorbidities.