Voice disorders in children

Dysphonia in Preschool-Aged Children: Efficacy of Voice Therapy

INTRODUCTION

Pediatric dysphonia is common, with a prevalence as high as 38% in school-aged children. Previous studies have shown the benefits of therapy in treating pediatric dysphonia; however, much of the literature that discusses these benefits address older school-aged children (6-18 years) and not those who are younger. The objective of this study is to examine the efficacy of voice therapy for preschool-aged patients, between ages 2 and 5 years old.

METHODS

An IRB-approved retrospective review was conducted of pediatric patients (age range 2-5 years) seen at multi-disciplinary voice clinics within Boston Children's Hospital, Department of Otolaryngology, between January 2015 and March 2023. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, number of therapy sessions, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) ratings, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed.

RESULTS

77 patients who were recommended voice therapy for dysphonia were reviewed. 51 (66.2%) were male and 26 (33.8%) were female. The mean age at first evaluation was 4.49 years old. Each patient underwent, on average, 5.29 sessions (SD = 2.16) and 1.87 months (SD = 2.79) of therapy. Patients experienced a 36.4% decrease in their CAPE-V Overall Severity score from pretherapy to post therapy. Patients diagnosed with vocal cord nodules experienced greater decrease in CAPE-V ratings than those with other etiologies for hoarseness (-18.18, P = 0.016). Age, schooling status, number of siblings, history of speech delay, and other medical co-morbidities had no significant effect on patients' overall CAPE-V ratings. pVHI parental rating of severity decreased 43.9% from pretherapy to post therapy. Total pVHI scores also decreased after treatment.

CONCLUSION

Voice therapy in younger preschool age children can be efficacious and result in improved vocal quality.

Sex-and Age-Based Etiological Analysis of 2901 Patients With Dysphonia in a Japanese Tertiary Medical Institute

OBJECTIVES

Societal aging is a grave concern in Japan, and its impact on voice clinics has not been investigated. This study aimed to clarify recent demographic features of geriatric dysphonia at a tertiary medical institute in Japan.

STUDY DESIGN

Retrospective study.

METHODS

The medical records of 2901 patients newly referred to the Voice Outpatient Clinic of the University of Tokyo Hospital between 2003 and 2020 were analyzed for age, sex, and etiology.

RESULTS

The mean ± standard deviation age of all patients was 53.2 ± 20.7 (median, 58; range, 0-95) years. The aging rate (ratio of patients aged ≥65 years) increased continuously during the study period, and the recent aging rate was the highest in the world (43%). However, its rate of increase has slowed over the past 10 years. The etiologies of dysphonia associated with the largest number of older patients were vocal fold immobility (32%), vocal fold atrophy (23%), and benign vocal fold lesions (11%). The highest aging rate was detected in patients with laryngeal cancer/leukoplakia, vocal tremor, vocal fold atrophy, sulcus vocalis, and vocal fold immobility.

CONCLUSIONS

Societal aging substantially increased the aging rate of patients with dysphonia in a Japanese voice clinic. The incidence of vocal fold immobility and atrophy is expected to continue to increase, whereas that of benign vocal fold lesions is expected to decrease.

Prevalence of Dysphonia in Children: A Systematic Review and Meta-Analysis

OBJECTIVES

To analyze the prevalence of pediatric voice disorders.

STUDY DESIGN

Systematic review (SR) and meta-analysis.

METHODS

The research question of this SR was "What is the prevalence of dysphonia in children?" An electronic search was performed using the Medical Literature Analysis and Retrieval System online (Medline), Literatura Latino-Americana e do Caribe em Ciências da Saúde, EMBASE, Web of Science, and SCOPUS database. A manual search was performed in gray literature (ProQuest and Banco Digital de Teses e Dissertações) and through the mapping of references. Studies that analyzed the prevalence of dysphonia in children with outcomes such as the overall degree of vocal deviation, laryngeal endoscopic imaging, acoustic analysis, and vocal self-assessments in the global context were included. The risk of bias was verified using a checklist of prevalence studies. A meta-analysis was performed using proportion analysis, and statistical heterogeneity was calculated using I² and t².

RESULTS

The initial search identified 796 articles, and 16 were selected. The risk of bias analysis showed that 62.5% (n = 10) of the articles had low methodological quality. The total prevalence of dysphonia was 15% based on the overall degree of vocal deviation, 29% based on laryngeal endoscopic imaging, 10% based on vocal self-assessment, and 19% regardless of the type of assessment performed. High heterogeneity was observed for all evaluation forms.

CONCLUSION

Children have a high prevalence of dysphonia. Studies on the prevalence of pediatric voice disorders have low methodological quality, and the prevalence rates obtained in these studies are heterogeneous, thus compromising the validity and generalization of the results.

Cross-Cultural Adaptation and Validation of the Persian Version of the Children's Voice Handicap Index-10 for Parents

OBJECTIVES

This study aimed to translate and evaluate the psychometric properties of the Children's Voice Handicap Index-10 for Parents (CVHI-10-P) in Persian for assessing voice-related quality of life in Persian-speaking children.

METHODS

The CVHI-10-P was translated into Persian and assessed for face and content validity by a panel of speech-language pathologists. The questionnaire was administered to 141 children aged 6-11 years, including 35 with voice disorders and 106 without. Reliability was measured using Cronbach's alpha, Spearman-Brown, and Guttman coefficients. Validity was evaluated through sensitivity, specificity, accuracy, precision, F-score metrics, and correlations with the Persian version of the Pediatric Voice Handicap Index (PVHI).

RESULTS

The translated CVHI-10-P demonstrated high reliability, with a Cronbach's alpha of 0.944 for the total score. Significant differences in CVHI scores between children with and without voice disorders confirmed the questionnaire's ability to distinguish between these groups. Receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.974, indicating excellent diagnostic accuracy. Pearson's correlation showed strong associations between CVHI and PVHI scores across all dimensions.

CONCLUSION

The Persian version of the CVHI-10-P is a reliable and valid tool for assessing the impact of voice disorders on the quality of life in Persian-speaking children. It offers a concise and effective means for parents to report their children's voice-related challenges.

The Effectiveness of Lee Silverman Voice Treatment (LSVT LOUD) on Children's Speech and Voice: A Scoping Review

BACKGROUND

This scoping review had as a primary goal a review of the literature and the an analysis of the possible effectiveness of the LSVT LOUD approach in children with voice and speech deficits.

METHODS

A search was conducted in the Scopus and PubMed databases in May of 2024. Eleven articles were obtained from the search. The standards of PRISMA recommendations were used for scoping reviews and the PCC framework was used for the eligibility criteria. Furthermore, the study used the instructions in the Cochrane Handbook for a quality assessment. The Mendeley Reference Manager software collected the studies and removed duplicates.

RESULTS

The reviewed studies employed formal and informal measures to assess voice and speech abilities in the children. Regarding the sample's characteristics, the studies mostly included children with Cerebral Palsy (CP) and also those with Down Syndrome (DS). All the studies reported that children with CP and DS undertook a total dose of the LSVT LOUD treatment. Significant post-treatment findings indicated increased speech function and sound pressure level, regarding the auditory-perceptual ratings of voice and speech improvement. In many studies, parents' and expert listeners' ratings of voice, perception of vocal loudness, speech, and communication indicated improvement.

CONCLUSIONS

The majority of the included studies provide positive evidence for the LSVT as an approach. However, the small sample size that featured in the studies, as well as their limitations, made these conclusions uncertain. Moreover, the study's findings provided recommendations that speech language therapists and other clinicians need to follow when setting a treatment plan with children with CP and DS.

Adaptation and Validation of the Lithuanian Version of the Pediatric Voice Handicap Index

OBJECTIVES

The aim of this study was to develop the Lithuanian version of the Pediatric Voice Handicap Index (pVHI) and to assess its psychometric characteristics.

METHODS

The Lithuanian version of the pVHI was prepared according to the standard requirements for the questionnaire translation and adaptation procedure. It also included forward and backward translations of the original questionnaire, as well as a committee review and psychometric testing of the final version of the pVHI. A total of 126 children between 4 and 13 years of age were included in the study. Two study groups were formed: a group consisting of children with dysphonia (n = 70) and a control group of children without any alterations in their voice (n = 56). The questionnaire was always completed by their parents. The results were statistically analysed to assess the reliability, validity, sensitivity and specificity of the Lithuanian version of the pVHI.

RESULTS

High internal consistency of the Lithuanian version of the pVHI was determined (Cronbach's α = 0.938). The test-retest analysis also showed a high correlation between the two tests (r = 0.949) for both the dysphonic and control groups. The mean overall pVHI score was significantly higher (P < 0.001) in the dysphonic group than in the control group: 26.16 ± 11.84 and 2.43 ± 2.61, respectively. Similar results were obtained for all domains of pVHI. The most sensitive and specific limiting value for discrimination between the clinical and control groups was the sum of 8 points.

CONCLUSIONS

The Lithuanian version of the pVHI is a reliable and valid instrument for the evaluation of the Voice Handicap Index in the pediatric population and can be easily applied in daily clinical practice.

Voice Disorder Prevalence and Vocal Health Characteristics in Children

Importance

Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children.

Objective

To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns.

Design, Setting, and Participants

This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023.

Main Outcomes and Measures

Caregivers were surveyed regarding their children's voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ2 tests, and logistic regression were used to compare children with and without voice problems.

Results

Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use-related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults.

Conclusions

The results of this survey study suggest that pediatric voice problems are relatively common and detract from quality of life. Specific environmental and behaviorial factors are associated with increased risk for voice disorders.

Adaptation and Validation of the Mandarin Chinese Version of the Pediatric Voice Handicap Index-10 (pVHI-10)

OBJECTIVES

The purpose of this study was to adapt and validate the Mandarin Chinese version of the pediatric Voice Handicap Index-10 (pVHI-10).

METHODS

A cross-sectional study was conducted from January 2018 to December 2019. A total of 422 parents completed the questionnaire, including 283 parents of children with voice disorders (dysphonic group) and 139 parents of children without voice disorders (control group). Internal consistency, test-retest reliability, clinical effectiveness, and cut-off value were evaluated.

RESULTS

In the dysphonic group, the internal consistency of the Mandarin Chinese version of pVHI-10 was excellent (Cronbach's α = 0.95). The test-retest reliability was excellent for the total score of the Mandarin Chinese version of pVHI-10 (interclass correlation coefficient = 0.916). The total scores as well as scores on individual items were significantly higher in the dyphonic group compared to those in the control group (P <0.001). In addition, the optimum cut-off value for the Mandarin Chinese version of pVHI-10 was 6.5 (87% sensitivity and 86.3% specificity, respectively).

CONCLUSION

The Mandarin Chinese version of the pVHI-10 is a valid tool that evaluates the quality of life of children with voice disorders from the parents' perspective.

Are Children with Cleft Palate at Increased Risk for Laryngeal Pathology?

To determine the prevalence of laryngeal pathology in children presenting with cleft palate with or without cleft lip (CP ± L) who underwent nasoendoscopy to assess palatal function. A secondary aim was to determine the relationship between patient demographics, resonance, articulation, and prevalence of laryngeal pathology in this population.

Retrospective, observational cohort study.

Outpatient pediatric cranio-facial anomalies clinic.

Children ≤18 years of age presenting with CP ± L (N = 215) who underwent nasoendoscopy, speech language pathology, plastic surgery, and otolaryngological evaluations between 2009 and 2020.

Laryngeal diagnosis by pediatric otolaryngologists.

21.9% of children presented with laryngeal pathology. Diagnoses included benign vocal fold lesions and laryngeal edema sufficiently severe to alter vocal fold edge contour. Likelihood of laryngeal pathology increased by approximately 12% with every increase of 1 year in age (P = .001, OR = 1.12). Children with laryngeal pathology were 50% more likely to have undergone palatal repair (P < .001, OR = 1.50). In addition, children with severely hypernasal resonance were 78% less likely to present with laryngeal pathology (P =.046, OR = 0.22).

This population is at increased risk for laryngeal pathologies as determined by nasoendoscopy. This finding underscores the importance of careful laryngeal imaging in assessing these children. Additional research is warranted to identify the mechanisms underlying the increased risk for morphological vocal fold changes.

The Occurrence of Laryngeal Pathologies in a Treatment-Seeking Pediatric Population

OBJECTIVES

The purpose of this study was to 1) describe the age- and sex-specific occurrence of laryngeal pathologies in a treatment-seeking pediatric population in the voice unit of Ghent University Hospital, Belgium, and 2) describe this population in terms of vocal parameters, vocal complaints, influencing factors, and treatment history and recommendation.

STUDY DESIGN

Retrospective, observational study.

METHODS

All patient records were analyzed for children (0-18 years) who consulted the ear, nose, and throat department of Ghent University Hospital for the first time between July 2015 and June 2021 with complaints of dysphonia. In total, 103 children (66 males, 37 females) with a mean age of 10.01 years (SD: 3.4, range 3.93-17.96) were included in this study. Laryngeal pathology was diagnosed using a flexible videolaryngo(strobo)scopy. The influence of age and sex on laryngeal etiology (organic/functional voice disorder) was examined using a Welch-modified t test and a Fisher's exact test, respectively.

RESULTS

Organic lesions were observed in 77.7% of the participants, with vocal fold nodules (VFNs) being the most common diagnosis (66.0%). A functional voice disorder was diagnosed in 22.3% of the children. Children with a functional voice disorder are significantly older than children with an organic voice disorder. There was no statistically significant difference between males and females in laryngeal etiology. Mean dysphonia severity index was -2.7 (SD: 3.2, range -9.3 to +3.7), the mean acoustic voice quality index 4.70 (SD: 1.5, range 2.35-8.27), and the mean pediatric voice handicap index 29.8 (SD: 13.6, range 5-60). The occurrence of vocal misuse was mentioned in 80.6% of the patient records.

CONCLUSION

Organic voice disorders, especially VFNs, are predominant in treatment-seeking children with dysphonia. Functional voice disorders become more common with increasing age during childhood. A disordered vocal quality, reduced vocal capabilities and reduced voice-related quality of life were found.

Auditory-perceptual evaluation of voice: comparing different speech tasks to identify children with and without laryngeal lesions

PURPOSE

To compare the vowel emission and number counting tasks in perceptual-auditory differentiation among children with and without laryngeal lesions.

METHODS

Observational, analytical, and cross-sectional methods were used. Medical records of 44 children were selected from a database of an otorhinolaryngology service at a University Hospital and they were divided into groups: without laryngeal lesion (WOLL), and with laryngeal lesion (WLL), with 33 and 11 children. For the auditory-perceptual evaluation, the vocal samples were separated according to the type of task. They were analyzed separately by a judge who analyzed the general degree of vocal deviation and assessed whether the child would pass or fail in the face of a screening situation.

RESULTS

There was a difference between the WOLL and WLL groups in terms of the overall degree of vocal deviation for the task of number counting, with a predominance of mild deviations in WOLL and moderate in WLL. In the screening, there was a difference between the groups during the number counting task, with more failures in the WLL. The groups were similar in the sustained vowel task, both in terms of the overall degree of vocal deviation and the vocal screening. Most children in the WLL failed in both tasks during vocal screening compared to the children in the WOLL who, in general, failed in only one task.

CONCLUSION

The task of number counting contributes to the auditory differentiation in children with and without laryngeal lesion, by identifying deviations of greater intensity in children with laryngeal lesion.

Auditory-perceptual evaluation of voice: comparing different speech tasks to identify children with and without laryngeal lesions

ABSTRACT Purpose To compare the vowel emission and number counting tasks in perceptual-auditory differentiation among children with and without laryngeal lesions. Methods Observational, analytical, and cross-sectional methods were used. Medical records of 44 children were selected from a database of an otorhinolaryngology service at a University Hospital and they were divided into groups: without laryngeal lesion (WOLL), and with laryngeal lesion (WLL), with 33 and 11 children. For the auditory-perceptual evaluation, the vocal samples were separated according to the type of task. They were analyzed separately by a judge who analyzed the general degree of vocal deviation and assessed whether the child would pass or fail in the face of a screening situation. Results There was a difference between the WOLL and WLL groups in terms of the overall degree of vocal deviation for the task of number counting, with a predominance of mild deviations in WOLL and moderate in WLL. In the screening, there was a difference between the groups during the number counting task, with more failures in the WLL. The groups were similar in the sustained vowel task, both in terms of the overall degree of vocal deviation and the vocal screening. Most children in the WLL failed in both tasks during vocal screening compared to the children in the WOLL who, in general, failed in only one task. Conclusion The task of number counting contributes to the auditory differentiation in children with and without laryngeal lesion, by identifying deviations of greater intensity in children with laryngeal lesion.

Fifteen-minute consultation: Guide to paediatric voice disorders

Paediatric voice disorders in the normal paediatric population ranges from 6% to 20%. We outline the important features in the initial evaluation of a persistent altered cry or voice in children and highlight the subsequent management currently used by ear, nose and throat (ENT) surgeons and speech and language therapists (SLTs). It is important to appreciate that there are stark differences between a child and adult larynx due to anatomical and physiological changes during development. The voice history elicited from both child and parent includes birth and developmental history, hearing, early feeding and respiratory function. Red flag symptoms or signs presenting with dysphonia include stridor, dysphagia, failure to thrive and recurrent chest infections. The most likely cause for dysphonia in children presenting to general paediatric practice and primary care will be secondary to laryngitis, hyperfunction and vocal cord nodules, and laryngopharyngeal reflux. Regarding treatment, in most cases a non-surgical option is preferred with voice therapy preferably delivered by a specialist paediatric voice SLT. The maximum effectiveness of behavioural or direct therapy is to children over 7 years, for in excess of 8 weeks with additional rigorous home rehearsal.

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.

Cut-off point for high dysphonia risk in children based on the Child Dysphonia Risk Screening Protocol: preliminary findings

OBJECTIVES

The objective of the study was to establish a cut-off point for high dysphonia risk in children using the Child Dysphonia Risk Screening Protocol (DRSP-C).

METHODS

Through a preliminary study, voice recordings of 59 children (4-12 years of age) were collected during an auditory-perceptual analysis using the Consensus Auditory-Perceptual Evaluation of Voice protocol. Thirty of the patients had voice disorders (patient group), and 29 did not (control group). A risk score for dysphonia was then calculated, and data were compared between groups. The relationship between overall degrees of deviation and questionnaire scores was analysed. The questionnaire's validity was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-off points were obtained based on diagnostic criteria for screening procedures.

RESULTS

The DRSP-C score was found to be higher for the patient group, as was the partial score for vocal behaviour. No correlation was found between overall degrees of dysphonia and questionnaire scores. The area under the ROC curve was measured as 0.678, denoting limited diagnostic capacity. The cut-off point was set at 16.50. Thus, above this value, dysphonia risk is higher.

CONCLUSION

A cut-off point for high dysphonia risk was calculated. The DRSP-C proved to be a promising tool for children's clinical vocal and health promotion and should be used in conjunction with General Dysphonia Risk Screening.

Auditory-perceptual and acoustic analysis of voices of HIV-infected children

PURPOSE

To compare vocal and acoustic parameters of HIV-infected children and non-HIV-infected children.

METHODS

Vocal samples were submitted to auditory-perceptual and acoustic analysis. Samples of the sustained vowel /ε/ and continuous speech of 74 children between 6 and incomplete 12 years old were analyzed, divided into two groups: 37 HIV-infected children (GHIV) and 37 non-HIV-infected children, the control group (CG), age and gender-matched and without previous vocal evaluation; they were all prepubescent by the Tanner Stages (MS, 2014). The children had their voices recorded and analyzed by VoxMetria 5.1, in the period between 2014 and 2015. The auditory-perceptual analysis assessed the overall degree of the vocal quality and was performed using a 100-point visual analogue scale, transformed into a 4 point numerical scale (0 = no vocal deviation and 4 = severe vocal deviation). The acoustic evaluation was based on the analysis of the vocal sample distribution in the Phonatory Deviation Diagram (PDD). The research was approved by the Ethics Committee under the number 122.746.

RESULTS

In the auditory-perceptual analysis, most children of both groups were evaluated as with no vocal deviation. No difference between the groups was found in the acoustic analysis using the PDD; most voice samples were within the normality area, in the quadrant 1, with a spread density distribution and a vertical shape.

CONCLUSION

HIV-infected children presented similar vocal quality to children without the illness, both for the perceptual-auditory and acoustic evaluation.

Vocal Evaluation of Children with Congenital Hypothyroidism

OBJECTIVE

To evaluate the vocal characteristics of a group of children with congenital hypothyroidism (CH) and the association of these characteristics with the children's clinical, laboratory, and therapeutic profiles.

MATHERIAL AND METHODS

Observational, analytical, cross-sectional study including 200 prepubertal children, of whom 100 had CH (study group [SG]) and 100 had no CH (control group [CG]). The following parameters were evaluated: 1) history (identification, complaints, and interfering variables), 2) auditory-perceptual and acoustic evaluation (samples analyzed by a group of specialists, and objectively by a computer program), 3) self-assessment scores in the Pediatric Voice-Related Quality-of-Life (PVRQoL) survey, 4) laryngological evaluation (presence or absence of laryngeal lesions and data regarding glottal closure), and 5) medical records (CH etiology, age at treatment initiation, disease severity at diagnosis, treatment quality, and thyroid function tests on the day of the examination).

RESULTS

In the perceptual assessment, 62.6% of the SG children passed, whereas 37.4% failed in the voice screening, but these results were comparable with those in the CG (P = 0.45). Both groups had mean/median acoustic measurements within the normal limits. The mean PVRQoL in the SG (99.3 ± 2.4) and CG (99.5 ± 1.7) were comparable (P = 1.00). Both SG (16.7%) and CG (15%) presented vocal cord lesions (P = 1.00). There was no association between voice/larynx characteristics and endocrinological data.

CONCLUSION

Prepubescent children diagnosed with CH during neonatal screening and who have a lifelong history of adequate treatment of CH showed similar vocal and laryngeal characteristics compared with children without CH.

Voice Outcomes of Adults Diagnosed with Pediatric Vocal Fold Nodules and Impact of Speech Therapy

Objective

To evaluate the voice outcomes of adults diagnosed with vocal fold nodules (VFNs) as children and to assess the impact of speech therapy on long-term voice outcomes.

Study Design

Prospective cohort study.

Setting

Large health care system.

Subjects and Methods

Subjects diagnosed with VFNs as children between the years 1996 and 2008 were identified within a medical record database of a large health care system. Included subjects were 3 to 12 years old at the time of diagnosis, had a documented laryngeal examination within 90 days of diagnosis, and were ≥18 years as of December 31, 2014. Qualified subjects were contacted by telephone and administered the Vocal Handicap Index–10 (VHI-10) and a 15-item questionnaire inquiring for confounding factors.

Results

A total of 155 subjects were included, with a mean age of 21.4 years (range, 18-29). The male:female ratio was 2.3:1. Mean VHI-10 score for the entire cohort was 5.4. Mean VHI-10 scores did not differ between those who received speech therapy (6.1) and those who did not (4.5; P = .08). Both groups were similar with respect to confounding risk factors that can contribute to dysphonia, although the no-therapy group had a disproportionately higher number of subjects who consumed >10 alcoholic drinks per week ( P = .01).

Conclusion

The majority of adults with VFNs as children will achieve a close-to-normal voice quality when they reach adulthood. In our cohort, speech therapy did not appear to have an impact on the long-term voice outcomes.

Large laryngeal vascular malformation in a 5-year-old child

A 5-year-old boy was admitted with stridor, which was initially interpreted as subglottic laryngitis. He had a history of prolonged hoarseness and his voice was deep for his age. The stridor persisted despite treatment with epinephrine inhalations and intravenous glucocorticoids. A direct laryngoscopy and blood work up did not support the suspected diagnosis. A MRI was then carried out, followed by angiography. The latter revealed an arteriovenous malformation (AVM) involving the lingual and superior thyroid arteries bilaterally. Owing to the rareness and extent of such an AVM, the patient was referred to Paris for further treatment. This case presents the difficulties in diagnostics and emphasises the importance of diagnostics and multidisciplinary approaches with regard to treatment of AVMs.

Intubation-Related Dysphonia Following Extreme Preterm Birth: Case Studies in Behavioural Voice Intervention

Many more children than ever before survive and thrive following preterm birth (Saigal & Doyle, 2008). To date, research has focussed on medical, developmental, neurological, and behavioral outcomes. As the number of surviving children increases and survivors reach school age and beyond, it has become apparent that many children experience difficulties with voice production (French et al., 2013). Following preterm birth, endotracheal intubation may be necessary to deliver surfactant or relieve respiratory distress during the neonatal period (Ho, Subramaniam, Henderson-Smart, & Davis, 2002). Intubation injury to the larynx and resultant dysphonia are well described in the literature (Bray, Cavalli, Eze, Mills, & Hartley, 2010). This article presents a brief review of the literature relevant to intubation-related injury following preterm birth and 2 case studies of voice outcomes following a trial of behavioral voice therapy in extremely preterm children who were intubated.

The prevalence of pediatric voice and swallowing problems in the United States

OBJECTIVES/HYPOTHESIS

Determine the prevalence of pediatric voice and swallowing problems in the United States.

METHODS

The 2012 National Health Interview Survey pediatric voice and language module was analyzed, identifying children reporting a voice or swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for voice or swallowing problems, diagnoses given, and severity of voice or swallowing problem were analyzed.

RESULTS

An estimated 839 ± 89 thousand children (1.4% ± 0.1%) reported a voice problem. Overall, 53.5% ± 1.9% were given a diagnosis for the voice problem and 22.8% ± 4.6% received voice services. Laryngitis (16.6% ± 5.5%) and allergies (10.4% ± 4.0%) were the most common diagnoses. A total of 16.4% graded the voice problem as a "big" or "very big" problem. An estimated 569 ± 63 thousand children (0.9% ± 0.1%) reported a swallowing problem. A total of 12.7% ± 3.8% received swallowing services and 13.4% ± 1.6% were given a diagnosis for their swallowing problem. Neurological problems were the most common diagnoses (11.1% ± 4.5%). A total of 17.9% graded the swallowing problem as a "big" or "very big" problem.

CONCLUSION

These data provide the first insight into the prevalence of childhood voice and swallowing problems, which affect approximately 1% of children annually. A relative minority seek care for their problem, despite the disease impact.