Bilateral vocal fold paralysis in infants: tracheostomy or not?

Tracheostomy has, in the past, been performed in the majority of children under one year with bilateral vocal fold paralysis. We present our experience of 11 cases over a ten-year period during which tracheostomy was avoided whenever possible. Ten cases were managed conservatively but in the youngest a tracheostomy was required. Full bilateral vocal fold mobility developed in all cases at a mean age of 11.5 months (range 5-26 months). Our experience suggests that the airway can commonly be managed expectantly without a tracheostomy.