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George Kuruvilla, MS(ENT); Shirley Perry, APN; Beverly Wilson, MD; Hamdy El-Hakim, FRCS(Ed), FRCS(ORL)

Arch Otolaryngol Head Neck Surg. 2009;135(1):101-105.

Objective  To outline the natural history of vincristine-induced laryngeal paralysis (VLP) in children.

Design  Retrospective case series and review of reported cases in the English-language literature.

Setting  Tertiary pediatric center.

Patients  The study included all children with a confirmed diagnosis of VLP by inspection and with complete clinical information. The sources for patient identification were a prospectively kept database and a review of the English-language literature, conducted on PubMed since 1966, as well as a bibliography search.

Main Outcome Measures  Charts and literature were reviewed for demographics, primary diagnosis, other diagnoses, and duration and method of treatment. The prevalence of VLP, locally, was also calculated.

Results  Four children (3 boys and 1 girl) were identified in our database over a 5-year period, and 10 children (1 girl, 8 boys, and 1 with sex omitted) were described in the English-language literature. Four children had unilateral vocal fold paralysis only, all left-sided. The median age was 2.6 years. Acute lymphoblastic leukemia was the underlying diagnosis in 8 patients. Two patients had Down syndrome, and 1 patient had Charcot-Marie-Tooth disease, type 1. Only 2 patients required tracheotomies, and 1 patient was treated temporarily with bilevel positive-pressure ventilation. The median duration of paralysis was 6.8 weeks. The prevalence of VLP was 1.36%.

Conclusions  The data suggest that VLP is probably underreported and possibly underdiagnosed. Endoscopic inspection is a must in all patients with airway symptoms who are receiving vicristine therapy. Early recognition of VLP is mandatory, as it is reversible, has a good prognosis, and usually needs only interruption of vincristine therapy and conservative treatment.

Author Affiliations: Pediatric Otolaryngology Service, Division of Pediatric Surgery (Drs Kuruvilla and El-Hakim), Division of Otolaryngology (Drs Kuruvilla and El-Hakim), Department of Pediatrics (Drs Kuruvilla, Wilson, and El-Hakim and Ms Perry), and Division of Hematology and Oncology (Ms Perry and Dr Wilson), The Stollery Children's Hospitol, Edmonton, Alberta, Canada.

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