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Vocal cord paralysis as mentioned previously can be bilateral or unilateral and the causes of this in the bilateral case may be due to birth trauma, intracranial disease or a condition such as an Arnold Chiari Malformation.  The unilateral vocal cord paralysis causes that may be related to cardiac surgery, neurologic conditions, vascular conditions, obstetrical trauma or unknown causes, is more common on the left and the child has a weak cry and sometimes has stridor on exertion.  This can be diagnosed by flexible fibreoptic endoscopy of the larynx and can be managed conservatively or occasionally surgically.

Recurrent respiratory papillomatosis or warts on the vocal cord and larynx is on the increase but is not particularly common.  This causes increasing hoarseness and stridor and treatment may involve interferon or laser surgery to remove the warts which are obstructing the breathing passage.  This is a serious condition which often requires surgical management.  HPV vaccination may reduce the incidence of this condition.

Vocal cord nodes are a common cause of hoarseness due to vocal abuse or chronic cough and often improve with speech therapy (or this condition often resolves spontaneously in teenage years when the child acquires the maturity not to abuse their voice) but occasionally we need to remove the vocal nodules if there is failed speech therapy or the child is handicapped socially with the condition.

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