Diagnosis and Treatment of Benign Pediatric Lesions

Efficacy and safety of acupuncture for vocal nodules: A systematic review and meta-analysis with trial sequential analysis

In this study, we aim to evaluate the efficacy and safety of acupuncture for vocal nodules, concerning qualitive overall efficacy and quantitative improvement on quality of voice. Four English and four Chinese databases were searched up to December 10th, 2022. Risk of bias among the included trials were evaluated by the Cochrane ROB tool. Systematic reviews and meta-analyses were conducted based on the Cochrane systematic review method by using RevMan 5.4 Software, and trial sequential analyses were performed by TSA 0.9. Meta-influence analyses, subgroup-analyses, meta-regression, and evaluation of publication bias were performed for exploration of heterogeneity by Stata V.14. Quality of the results was accessed through the GRADE-pro GDT. Cluster analyses and correlation coefficient were performed by R 4.1.3. Finally, 15 trials involving 1,888 participants were included. Results showed that compared with western medicine alone or Chinese herbal medicine alone, acupuncture alone yielded significantly (p<0.05) higher clinical effective rate and more improvement on scores of voice analyses. However, reduction on scores of grade, roughness, and breathiness and voice handicap index during follow-ups, and results of clinical effective rate suggested that acupuncture was inferior to voice training. In addition, meta-regression and sub-group analyses firstly revealed advanced efficacies of acupuncture when performed with local and remote acupoints, compared with local acupoints only. Acupuncture specified adverse event was denied in six trials while it was not mentioned in other nine trials. Results of cluster analyses and correlation coefficient showed that Kai yin yi hao and He gu (LI-4) were the most frequently applied matching-acupoints in trials. In conclusion, compared with western medicine (level of evidence: low ⨁⨁◯◯, GRADE C) and Chinese herbal medicine (level of evidence: moderate ⨁⨁⨁◯, GRADE B), acupuncture is safe and of better efficacy for patients with vocal nodules, while there is also need for RCTs with improvements on designing and interventions in experimental and controls.

Pediatric Voice Disorders from the Perspective of Rare Diseases

OBJECTIVE

This study aims to present rare pediatric voice disorders, which are usually reported as case reports in the literature, with their clinical features, treatment options, and prognosis, and to emphasize clinical findings that may be associated with rare diseases.

METHODS

The clinical records of the pediatric patients presented with dysphonia were reviewed between 2014 and 2019. The terminology "rare disease" is used to describe diseases where the average prevalence thresholds are between 40 to 50 cases/100,000 people. Age, gender, symptoms, laryngeal examination findings, histopathological results, treatment modalities and follow-up results of rare laryngeal pathologies were reviewed.

RESULTS

274 children were diagnosed with and treated for voice disorders at our institution. Seven patients were identified with rare laryngeal pathologies. Four patients diagnosed with lipoid proteinosis, two patients with neurofibroma and one patient with amyloidosis. One patient was known to have neurofibromatosis type-1, while the others did not have any previously diagnosed diseases, dysphonia was the initial clinical presentation.

CONCLUSION

There are some clues that bring to mind rare entities. Firstly, these patients generally present with various systemic manifestations. Secondly, if there is any discrepancy between voice quality and endoscopic laryngeal examination, the diagnosis should be reconsidered. Thirdly, in the case of the prolonged dysphonia recalcitrant to treatment, the clinician should reassess the treatment or the diagnosis.

Assessment of Subjective and Objective Voice Analysis According to Types of Sulcus Vocalis

INTRODUCTION

Sulcus vocalis (SV) subtypes are difficult to diagnose. Non-invasive techniques are sometimes not feasible in the diagnosis. The study aims to demonstrate the effectiveness and applicability of objective and subjective voice analysis combined with videolaryngostroboscopic examination (VLS) in the diagnosis of SV types.

MATERIAL AND METHODS

This is a retrospective study that includes patients who presented to Phoniatric outpatient clinic with complaints related to voice and diagnosed with SV on VLS examination between 2017-2020. The SV type was determined based on VLS findings and the patients were categorized into respective groups. Between- and within-group assessment of objective and subjective voice analysis of SV types was conducted.

RESULTS

47 patients were included in the study; Type I, Type II, Type III SV patients were 16, 17, and 14 in number, respectively. Fundamental frequency (F0) and Shimmer (%) values were significantly high in Type II and III SV cases, whereas the Maximum Phonation Time (MPT) was significantly low. GRBAS, Voice Handicap Index -10 (VHI-10), Reflux Symptom Index (RSI) scores were statistically significantly high in pathological SV and Voice Related Quality of Life (V-RQOL) scores were low. A moderate correlation between VHI-10 and V-RQOL and between RSI and V-RQOL was detected.

CONCLUSIONS

Objective and subjective voice analysis in Type II and III SV show a significant difference compared to Type I SV. The use of objective and subjective voice analysis combined with VLS examination can be helpful in the diagnosis of SV types.

Examining Therapy Duration in Adults With Voice Disorders

PURPOSE

This study examined the number of voice therapy sessions and the number of weeks in treatment to achieve desired voice outcomes in adults with voice disorders. Factors that may predict therapy duration were examined, as was the percentage of patients returning to the clinic for additional voice therapy after initial discharge.

METHOD

An observational cohort design was utilized. Data from 558 patients were extracted from the University of Wisconsin-Madison Voice and Swallow Outcomes Database. Patients diagnosed with muscle tension dysphonia, vocal fold paralysis, benign vocal fold lesions, laryngospasm/irritable larynx, and presbyphonia were examined. Patient demographics, auditory-perceptual assessments, acoustics, aerodynamics, videostroboscopy ratings, self-reported scales, and medical comorbidities were collected.

RESULTS

Patients required an average of 5.32 (SD = 3.43) sessions of voice therapy before voice outcomes were sufficiently improved for discharge. Average number of sessions ranged from 4.3 for presbyphonia to 6.7 for benign vocal fold lesions. Baseline overall Grade Roughness Breathiness Asthenia and Strain rating (p < .001), Dysphonia Severity Index (p < .001), Voice Handicap Index score (p < .01), age (p = .006), and occupational voice user status (p < .001) significantly predicted the number of therapy sessions required. Overall, 14.5% of patients returned for additional voice therapy following an initial discharge from treatment.

CONCLUSIONS

Findings inform our understanding of how many sessions patients with voice disorders require to achieve desired voice outcomes. Additional research is needed to optimize the efficacy of voice treatment and determine how recurrence of dysphonia might best be prevented.

Voice Therapy Improves Acoustic and Auditory-Perceptual Outcomes in Children

PURPOSE

This study employed acoustic measures as well as auditory-perceptual assessments to examine the effects of voice therapy in children presenting with benign vocal fold lesions.

METHODS

A retrospective, observational cohort design was employed. Sustained vowels produced by 129 children diagnosed with benign vocal fold lesions were analyzed, as well as connected speech samples produced by 47 children. Treatment outcome measures included Consensus of Auditory-Perceptual Evaluation of Voice (CAPE-V), jitter, shimmer, Noise-to-Harmonic Ratio (NHR), cepstral peak prominence (CPP), and Low-to-High Ratio (LHR) on sustained vowels, and CPP and LHR on connected speech.

RESULTS

Following voice therapy, significant improvements in CAPE-V ratings (p < 0.001) were observed. Additionally, jitter (p = 0.041), NHR (p = 0.019), and CPP (p < 0.01) on sustained vowels, and CPP (p = 0.002), and LHR (p = 0.008) on connected speech significantly improved following voice therapy. CPP increased with age in males but did not change in females. CAPE-V ratings and perturbation measures indicated that dysphonia was more severe in younger children pre and post-therapy.

CONCLUSIONS

Auditory-perceptual and acoustic measures demonstrated improved voice quality following voice therapy in children with dysphonia. CPP effectively quantified voice therapy gains and allowed for analysis of connected speech, in addition to sustained vowels. These findings demonstrate the value of CPP as a tool in assessing therapy outcomes and support the efficacy of voice therapy for children presenting with vocal fold lesions.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:977-983, 2023.

Voice outcomes following surgical treatment for pediatric vocal fold nodules: A systematic review and meta-analysis

OBJECTIVES

This study aimed to systematically review the literature to determine outcomes following surgical treatment of pediatric vocal fold nodules.

METHODS

Studies with patients ≤18 years with nodules who underwent surgery were reviewed for dysphonia improvement and recurrence in PubMed, EMBASE, Medline, CINAHL, Cochrane, Scopus, and Web of Science databases, searched from inception to November 1, 2022 using PRISMA guidelines. Non-English studies and case reports were excluded. Two evaluators independently reviewed each abstract and article. Heterogeneity and bias across studies were evaluated and meta-analysis was performed.

RESULTS

The literature search yielded 655 articles; 145 underwent full-text screening and eight were selected for systematic review and meta-analysis. There were 311 children with nodules, aged 2-18 years, with male-to-female ratio of 3.6:1. There were no surgical complications. Voice therapy was inconsistently reported. Follow-up time ranged from 1 month to 10 years. One study concluded that neither surgery nor voice therapy was effective, while five studies concluded that dysphonia improved with surgery. Voice grading by GRBAS, objective voice measures, and lesion size were improved following surgery, when reported. Meta-analysis of six studies demonstrated improvement in dysphonia in 90% of children post-operatively (95% CI: 74-99%). Meta-analysis of four studies showed that recurrence occurred in 19% of children (95% CI: 13-23%).

CONCLUSION

This systematic review suggests possible post-operative improvement in dysphonia for pediatric patients with vocal fold nodules; however, study measures, methods, and surgery utilized were heterogeneous and results should be interpreted cautiously. In order to better understand surgical outcomes, future studies should include standardized definition of nodules and objective measures of voice.

Assessment of Life Quality in Children with Dysphonia Using Modified Pediatric Voice-Related Quality of Life Questionnaire in Serbia

(1) Background: Hoarseness is not uncommon in children, especially at school age, as communication with peers is intensified. It is caused by improper use or overuse of the vocal apparatus. (2) Methods: The study included 85 hoarse children aged 6-12 (study group) and 240 healthy children (control group) of the same age. The study group underwent a detailed medical history, phoniatric examination, larynx fiber endoscopy, allergy treatment and the Pediatric Voice-Related Quality of Life questionnaire, modified by Jasmina Stojanovic. (3) Results: Our modified questionnaire revealed the significance of parental perception of a voice disorder in a child after organized activities. Using our modified questionnaire, we were able to determine the most frequent form of a voice disorder in children-speaking too loudly-is often neglected by the environment and can lead to an overall lower life quality. (4) Conclusions: As the presence of hoarseness impairs the quality of life in the pediatric population, awareness of a voice disorder must be recognized and treated on time to overcome the possible side effects on a child's psychological and emotional development.

Pediatric Voice Therapy: How Many Sessions to Discharge?

PURPOSE

Voice therapy is the primary treatment for children presenting with benign morphological vocal fold changes. This study examined the number of voice therapy sessions required to meet treatment goals and identified factors that predicted treatment length for pediatric voice patients.

METHOD

An observational cohort design was employed. Data were extracted from the University of Wisconsin-Madison Voice and Swallow Outcome Database. This study examined 62 children who completed a course of voice therapy with a speech-language pathologist (SLP) addressing dysphonia caused by benign vocal fold lesions. Extracted data included patient demographics, auditory-perceptual assessments, acoustic and aerodynamic voice measures, videostroboscopy ratings, and medical comorbidities. Linear regression was used to identify predictors of number of therapy sessions.

RESULTS

Patients received an average of 7.5 sessions of voice therapy prior to discharge. Baseline auditory-perceptual assessment of dysphonia (p = .032), phonation threshold pressure (PTP, p = .005), Glottal Function Index (GFI) score (p = .006), and glottic closure pattern (p = .023) were significant predictors of number of voice therapy sessions. These measures, as well as hourglass glottic closure, predicted longer intervention duration. The regression model had an overall r ² of .62.

CONCLUSIONS

Pediatric voice therapy addressing benign vocal fold lesions and/or laryngeal edema required an average of 7.54 sessions before voice outcomes were sufficiently improved for discharge. More severe overall SLP ratings of dysphonia, GFI scores, PTP, or hourglass glottic closure pattern significantly predicted increased number of therapy sessions prior to discharge. Future work should determine what other factors affect treatment duration and how the efficiency of pediatric voice therapy can be maximized.

Systematic review of pediatric postcricoid cushion and postcricoid lesions

OBJECTIVES

It is thought that many infants have a prominent venous plexus of the postcricoid area. In the past this entity had occasionally been reported as a postcricoid hemangioma or even a postcricoid mass. The term postcricoid cushion is now gaining acceptance to describe the prominent venous plexus of the posterior cricoid area. Although it rarely causes symptoms, it should be considered when patients present with symptoms of obstruction. Differentiating between normal variant postcricoid prominent venous plexuses, hemangiomas, and vascular malformations can be difficult and cannot be confirmed without immunohistochemistry. The objective of this systematic review is to describe current practices, clinical symptoms, management and outcomes of pediatric postcricoid lesions including postcricoid cushion.

METHODS

A systemic review of the literature was done using the PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analyses) guidelines to investigate postcricoid lesions. The following terms: Postcricoid, Postcricoid lesions, Postcricoid mass, Posterior cricoid, Pressure-dependent postcricoid mass, postcricoid prolapse, postcricoid hemangiomas, postcricoid vascular malformations, and postcricoid cushion were searched in PubMed and Google Scholar. Articles that were within the inclusion criteria were reviewed. Demographics, past medical and birth histories, clinical symptoms, evaluations, biopsy results, treatments, and outcomes were included. For the purposes of this review, postcricoid cushions, pressure-dependent postcricoid mass, and postcricoid prolapse will be group under normal variant postcricoid cushion.

RESULTS

15 articles with 42 distinct cases were included in this systemic review. 21/42 of the patients were female, the age ranged from 2 days to 18 years, the median age was 6.5 months, and 39/42 of patients were under the age of 2 years. 17/42 patients were diagnosed "hemangiomas" in the papers with only 1 case confirming the diagnosis of hemangioma with immunohistochemistry. 7/42 were diagnosed vascular malformations with 3 cases confirming the diagnosis of with immunohistochemistry. 17/42 of cases were normal variant postcricoid cushions. Most commonly, patients had a history of laryngomalacia (14/33) followed by no other medical history (9/33). The most common clinical symptoms were stridor, dysphonia, or weak cry in 30/42, dysphagia in 20/42, sleep disordered breathing in 9/42, and regurgitation or aspiration in 9/42.8/38 of patients diagnosed with postcricoid cushion did not have visualization of the lesion until a Valsalva maneuver was performed. The most common management for "hemangiomas" was observation (8/17), for "vascular malformations" was laser therapy (3/7), and for normal variant postcricoid cushions was observation (8/17). The most common outcome was complete resolution (14/30) followed by improvement of symptoms (9/30), and residual complications (4/30) The median time to follow-up was 12 months.

CONCLUSION

Due to the relatively new "discovery" of the normal variant postcricoid cushion, including postcricoid cushion, pressure-dependent postcricoid mass, and postcricoid prolapse, the majority of the literature are case reports. Although it is theorized that many children under the age of 2 have a prominent venous plexus, in some cases it could cause symptoms of obstruction. Because immunohistochemistry is rarely done and reported in the literature, many case reports may have misdiagnosed the postcricoid lesions. Also, in many cases visualizing the normal variant postcricoid cushion requires that the patients have increased intrathoracic pressure; therefore, if no postcricoid prominence is seen initially or when the patient is under general anesthesia and a postcricoid lesion is suspected, the patient should receive a Valsalva maneuver or be placed in Trendelenburg position. Most cases of normal variant postcricoid cushions can be managed with observation. Due to the rarity and novelty of the discovery, more research needs to be done on the management of symptomatic postcricoid lesions and differentiating between normal variants and pathological vascular lesions.

Effects of voice therapy in children with vocal fold nodules: A systematic review

BACKGROUND

Vocal fold nodules (VFNs) are the main cause of paediatric dysphonia. Voice therapy is recommended as the preferable treatment option for VFNs in children.

AIM

The aim of this systematic review is to provide an overview of the existing literature concerning the effects of voice therapy in children with VFNs.

METHODS & PROCEDURES

This systematic literature review was developed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed) and Embase were searched and the grey literature was checked. The search strategy was based on three concepts: VFNs, voice therapy and children. Two examiners independently determined article eligibility and extracted all relevant data from the included studies. The methodological quality of the included study was assessed using the QualSyst tool.

MAIN CONTRIBUTIONS

By identifying, evaluating and summarizing the results of all relevant studies about voice therapy in paediatric VFNs, this systematic review makes the available evidence more accessible to voice therapists, otolaryngologists and other relevant stakeholders.

CONCLUSIONS & IMPLICATIONS

24 studies were included in this systematic review. Eight studies (8/24) reported a significant improvement for at least one outcome parameter after voice therapy. However, five papers (5/24) could not demonstrate significant changes after voice therapy. All studies that did not test for significance (11/24) found improvements for one or more outcome parameters. The overall quality of the included studies is adequate (55%). In sum, there is some evidence that voice therapy is effective in children with VFNs, but further well-designed research, especially randomized controlled trials, is necessary to confirm these results.

WHAT THIS PAPER ADDS

What is already known on the subject Voice therapy is preferable in children with VFNs because of the phonotraumatic nature of the nodules and the associated high recurrence rate after phonosurgery. Most voice therapists in clinical practice offer an eclectic voice therapy programme, consisting of direct and indirect voice therapy techniques. What this study adds to existing knowledge This systematic review provides a clear overview of the available evidence concerning the effects of voice therapy in paediatric VFNs. There is some evidence that voice therapy is an effective treatment option in children with VFNs, but well-designed research is scarce on this subject. What are the potential or actual clinical implications of this work? This review shows that effectiveness studies with strong designs are very scarce in children with VFNs. Clinicians should be aware that few therapy techniques have been thoroughly investigated in this population. However, this review may guide voice therapists when creating a treatment plan for a child with VFNs because it identifies, evaluates and summarizes the results of all relevant individual studies about voice therapy in paediatric VFNs. Voice therapy seems to be effective in treating paediatric patients with VFNs, given the fact that a considerable number of included studies report significant improvements after voice therapy. Both direct and indirect therapy approaches appear to have a positive effect on the phonation of children with VFNs.

Survey of Referral Patterns in Southwestern Mainland China: How Do Pediatricians Manage Children with Dysphonia

OBJECTIVE

Voice disorders are common in children and have a negative impact on their quality of life. However, presently, voice assessment and therapy are inaccessible in most pediatric departments of Mainland China. Thus, referring pediatric patients with voice disorders to otolaryngology is warranted for prompt and appropriate treatment. The purpose of this study is to investigate referral patterns and their influencing factors for pediatricians' managing children with dysphonia in Southwestern Mainland China.

STUDY DESIGN

Observational study.

METHODS

A 28-item questionnaire was designed by multidisciplinary experts, and an anonymous survey was performed online via Wenjuanxing between September 8, 2021 and October 8, 2021. The statistical analyses were performed using the independent sample median test, the linear/logistic regression model, the Kruskal-Wallis test, and Spearman's correlation test to determine any statistically significant relationships between the variables of interest.

RESULTS

Predominantly recruited from institutions in Southwestern China, 368 pediatricians were surveyed. (1) The majority of the pediatricians reported that ≤10% of children sought medical help for voice disorders; (2) only 22.1% of the pediatricians' hospitals had equipment for evaluating voice disorders; (3) 74.6% of the pediatricians would refer children with dysphonia to otolaryngology, and the older pediatricians were more likely to refer their patients than were the younger pediatricians (P = 0.022); (4) in the group that would make a referral (n = 250), the pediatricians who had worked longer (P = 0.037) and practised in the Grade-A tertiary hospitals (P = 0.044) were more likely to trust their experience as a reason for making a referral. For each year worked the probability of referring children with dysphonia depending on the pediatrician's experience increased by 3.4%.

CONCLUSION

Although the pediatricians encountered some barriers to diagnosing voice disorders, their attitude towards making referrals was positive. The age and work duration of the pediatricians and the hospital grade were the influencing factors in the referral patterns. Further publicity of vocal hygiene, ongoing education among Chinese pediatricians and the improvement of referral systems may be most useful for better managing children with dysphonia.

A sudden decrease in voice volume: A rare manifestation of spontaneous pneumomediastinum

Spontaneous pneumomediastinum (SPM) is a rare condition characterized by free air in the mediastinum that primarily affects young individuals between the ages of 10 and 30 years. The most frequent symptoms of SPM are chest pain and dyspnea. However, a decrease in voice volume without a change of tone is a rare presentation. SPM is generally a benign and self-limiting condition, but it can occasionally cause tension pneumothorax. If a young patient presents with a sudden decrease in voice volume without a change of tone, SPM should be considered as a possible diagnosis.

The Pharyngolaryngeal Venous Plexus: A Potential Pitfall in Surveillance Imaging of the Neck

BACKGROUND AND PURPOSE

Among patients undergoing serial neck CTs, we have observed variability in the appearance of the pharyngolaryngeal venous plexus, which comprises the postcricoid and posterior pharyngeal venous plexuses. We hypothesize changes in plexus appearance from therapeutic neck irradiation. The purposes of this study are to describe the CT appearance of the pharyngolaryngeal venous plexus among 2 groups undergoing serial neck CTs-patients with radiation therapy-treated laryngeal cancer and patients with medically treated lymphoma-and to assess for changes in plexus appearance attributable to radiation therapy.

MATERIALS AND METHODS

For this retrospective study of 98 patients (49 in each group), 448 contrast-enhanced neck CTs (222 laryngeal cancer; 226 lymphoma) were assessed. When visible, the plexus anteroposterior diameter was measured, and morphology was categorized.

RESULTS

At least 1 plexus component was identified in 36/49 patients with laryngeal cancer and 37/49 patients with lymphoma. There were no statistically significant differences in plexus visibility between the 2 groups. Median anteroposterior diameter was 2.1 mm for the postcricoid venous plexus and 1.6 mm for the posterior pharyngeal venous plexus. The most common morphology was "bilobed" for the postcricoid venous plexus and "linear" for the posterior pharyngeal venous plexus. The pharyngolaryngeal venous plexus and its components were commonly identifiable only on follow-up imaging.

CONCLUSIONS

Head and neck radiologists should be familiar with the typical location and variable appearance of the pharyngolaryngeal plexus components so as not to mistake them for neoplasm. Observed variability in plexus appearance is not attributable to radiation therapy.

Voice Disorders in Children: Experience in the Voice Unit at Universidad Católica Clinical Hospital

INTRODUCTION

Dysphonia in children is a common symptom, its prevalence varies between 6% and 23%. There is a broad differential diagnosis and the recommendation is to evaluate dysphonic children with an adequate laryngeal visualization method to achieve an accurate diagnosis and treatment.

OBJECTIVE

To describe the experience in the diagnosis of dysphonia in children in the voice unit at Universidad Católica Clinical Hospital Santiago, Chile.

METHODS AND MATERIALS

A retrospective chart review was conducted of all new pediatric patients treated in the voice unit at Universidad Católica Clinical Hospital between 2012 and 2019. Demographic data, diagnosis, and in-office laryngoscopies were reviewed. All patients were evaluated by the same work team consisting of two Otolaryngologists specialized in vocal pathology and a speech voice therapist.

RESULTS

A total of 126 new pediatric patients between the ages of 0 to 18 years were evaluated in the voice unit at Universidad Católica Clinical Hospital Santiago, Chile. The majority were males (54%) with an average age of 9 years. 40% of the diagnosis corresponded to vocal nodules, 26% to vocal cord cysts, the remaining to a group of less frequent diagnosis. Two different groups were studied, the first group evaluated during the years 2012-2015 with flexible fibre-optic laryngoscopy and rigid videolaryngostroboscopy (VLS); the second group evaluated between the years 2015-2019 with distal chip flexible videolaryngoscopy, distal chip flexible VLS and rigid VLS. In the second group, the diagnosis of vocal nodules decreased, and the diagnosis of vocal cord cysts increased in comparison to the first group.

CONCLUSION

Pediatric patients with dysphonia must be evaluated by a multidisciplinary team of experts and adequate equipment. VLS should be considered the gold standard in the diagnosis of vocal cord pathology in pediatric population.

Laryngeal Microsurgery for the Treatment of Vocal Nodules and Cysts in Dysphonic Children

INTRODUCTION

Vocal nodules and cysts are frequent causes of infantile dysphonia. Vocal therapy is the first treatment. Microsurgery has restricted indications, especially for nodules.

OBJECTIVE

To describe our experience with microsurgery for nodules and cysts in children.

METHODS

Dysphonic children (aged 4-18 years) with the diagnosis of nodules and vocal cysts were initially selected. Of these children, only those were included who had undergone microsurgery. For nodules and cysts, the microsurgery was indicated in cases of failure of vocal therapy and in cases of voice worsening or doubts about the diagnosis. All children were submitted to auditory perceptual vocal analysis and videolaryngostroboscopy (before and after surgery, after 6 months). Surgical outcomes were: total improvement (disappearance of vocal symptoms and of the laryngeal lesions); partial improvement (partial improvement of symptoms and/or maintenance of lesions); no improvement (maintenance or worsening of the symptoms and/or persistence of the lesions). -Results: There were 78 children with vocal nodules and 27 children with vocal cysts. Surgery was indicated for 12 children with vocal nodules (15.4%) and 12 children with cysts (44.4%). Total improvement registered for nodules and cysts was 75 and 83.4%, respectively. Partial improvement for both lesions was 25 and 16.6%, respectively.

CONCLUSION

The best outcome for laryngeal microsurgery in dysphonic children was for vocal cysts. So, we encourage laryngologists for this conduct in vocal cysts. The success of microsurgery for vocal nodules was lower, and in these cases voice therapy seems to be the best treatment.