Clinical and Electromyographic Characteristics of Pediatric Laryngeal Dyskinesia

Objective: To report the clinical and laryngeal electromyographic (LEMG) parameters of children with laryngeal dyskinesia (LD) and its prevalence among laryngeal mobility disorder (LMD) requiring full airway examination.

Study design: Retrospective uncontrolled study.

Setting: Tertiary pediatric center.

Methods: Eligible children (<17 years old) were stridulous patients suspected of LMD (16 years period). We included those diagnosed with LD according to previously described criteria by Denoyelle et al, followed up for at least 3 months, who were assessed endoscopically and LEMG.

Primary outcome: LEMG scores, and the prevalence of LD in all LMD who required airway exam under anesthesia.

Secondary outcomes: clinical resolution, McGill scores, and instrumental swallowing test.

Results: A total of 44 patients (<17 years) were identified. Of these, 29 were included (25 boys; median age: 9.83 months [0.42-116.58]). LD constituted 18.58% of all patients during the study period. Asymmetry of movement and LEMG between the 2 sides was noted (the right side was more affected). Seventeen had swallowing difficulties (13 abnormal instrumental tests), and 27 snored (mean McGill score 3). The median follow up was 49.96 months (range: 5.25-243.25). Symptoms improved in all patients, but one, by the last follow-up date.

Conclusion: LD is prevalent among LMD and is mostly self-limiting. We noted asymmetry of LEMG grades between the 2 sides of the larynx, male predominance, and functional deficits in sleep and swallowing. The diagnosis requires a complete endoscopic exam with LEMG. Conflating this entity with bilateral laryngeal paralysis has likely impacted the documented epidemiology and natural history.