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UPSC-CMS 2010 — ENT

Q: What is the most common indication of tracheostomy in a child?

Vocal cord paralysis. ***Vocal cord paralysis*** - Among the options listed, **vocal cord paralysis** is the most appropriate answer as it remains a relevant pediatric indication for tracheostomy in current practice. - **Bilateral vocal cord paralysis** can cause significant airway obstruction requiring tracheostomy, especially in congenital cases or after cardiac surgery. - Note: In modern pediatric practice, the overall most common indications are **prolonged mechanical ventilation** and **congenital airway anomalies**, but among the specific causes listed here, vocal cord paralysis is the best answer. *Laryngeal diphtheria* - While **laryngeal diphtheria** historically was a common cause of pediatric tracheostomy due to pseudomembrane formation causing severe airway obstruction, its incidence has drastically decreased with **widespread immunization programs**. - In the pre-vaccination era, this was indeed a leading indication, but it is now rare in countries with effective vaccination coverage. *Poliomyelitis* - **Poliomyelitis** can affect respiratory muscles leading to ventilatory failure requiring tracheostomy, but with **global eradication efforts and vaccination**, it is now extremely rare. - This was a significant historical indication but is no longer relevant in most parts of the world. *Carcinoma of larynx* - **Laryngeal carcinoma** is predominantly an adult malignancy with peak incidence in the 6th-7th decades, associated with smoking and alcohol use. - It is **extremely rare in the pediatric population**, making it the least likely indication for tracheostomy in children among all the options listed. [Practice more ENT PYQs on OnCourse]

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What is the most common indication of tracheostomy in a child?