Paralyzed Vocal Cords
Written by Anna
I finally got to meet Linus on Sunday, March 10. After being discharged from UW, my parents took me straight to Seattle Children’s to meet my son. During that first day with Linus, a few things stood out to me:
He was hands down the sweetest and cutest baby I had ever seen.
His “rather large omphalocele” had been replaced by a tiny bandaid that guarded the surgical site.
He squeaked when he breathed.
Every hiccup, every sneeze, and every inhale sounded like someone squeezed a squeaky dog toy. At first doctors said that it was likely a result of him being intubated and that it would resolve without intervention in likely a few days. Intubation can be hard on structures in the airway, and sometimes that can temporarily alter breathing. I thought about my C-section. I was intubated at the same time Linus was, and I was breathing just as I have always been. I didn’t even have a sore throat from it. Yes, Linus had a breathing tube for much longer than me, but his less than 24 hours was still a relatively short period of time. Something about that explanation did not sit right with me.
My concerns were validated the following day when our new occupational therapist OT came by to meet Linus and do a feeding evaluation. She quickly pointed out his retractions, or the sucking in of the skin and muscle beneath the trachea (called a trach-tug) and ribs with each breath. It shows that an individual is working hard to breathe. Our OT joined our team at rounds the following morning to discuss her concerns and request that an Otolaryngologist (or ENT) come by to take a look. Between the squeaky breathing (called stridor) and the retractions, she was concerned that Linus had some kind of airway anomaly.
One of the ENTs came by our NICU room that afternoon prepared to do an nasoendoscopy to see what was happening in Linus’s airway. This procedure is done by inserting a thin scope up the nose and down the throat. Zach and our OT held Linus still while the ENT worked to visualize some key structures and Linus stressfully squeaked his way through the procedure. I was fascinated yet clueless as I watched the screen showcasing the camera’s footage. After a couple minutes, the camera was removed and the doctor replayed the video while discussing what they noticed.
We were informed that Linus has vocal cord paralysis. Instead of moving in and out like a pair of scissors, his vocal cords are frozen in a very narrow position that makes it difficult for air to pass through. This explained the retractions and stridor that we saw with every breath. Zach and I were overflowing with questions. What caused this? Can it be fixed? How will this affect speech? How can we tell if Linus is working too hard to breathe?
Soon after this procedure, Linus was dismissed from the NICU and moved to a PCU room under the care of our craniofacial team. Together, we spent the next couple of weeks investigating Linus’s vocal cords and figuring out how to ensure that he can breath well enough to go home. Our son’s congenital vocal cord paralysis was deemed idiopathic- meaning that there is no known cause for it. God simply just made him this way. Doctors reassured us by saying that his breathing would improve as he and his airway grew, and that sometimes the vocal cords can remobilize on their own. We were told to keep him in positions that allowed him to breathe with as little stridor as possible- for Linus, this was positioning him on his side or stomach. As long as he is able to gain weight and his stridor and retractions don’t get noticeably worse, things should be okay. This seemed easy enough to manage on our own, and we began to eagerly await discharge from the hospital.