Which statement about vocal cord paralysis in pediatric patients is accurate?

• A. It is always caused by viral infection
• B. It never coexists with heart conditions
• C. Most lesions are bilateral
• D. Most lesions are unilateral

Answer: (D)

In pediatric vocal cord paralysis, unilateral involvement is far more common than bilateral. This is typically due to injury to one recurrent laryngeal nerve, often from birth trauma or perioperative factors, which leaves one vocal cord paralyzed while the other functions normally. The result is a hoarse or weak cry with relatively preserved airway. Bilateral paralysis, while possible, is less common and tends to cause more significant airway obstruction, sometimes requiring immediate airway management.

So the statement that most lesions are unilateral best fits the typical clinical pattern. The idea that it’s always caused by a viral infection isn’t accurate, since viral etiologies are not the primary or defining cause. It can also occur with other congenital conditions, including heart defects, so it isn’t true that it never coexists with heart conditions. And the notion that most lesions are bilateral contradicts the common clinical presentation.