Vocal cord abnormalities in children with velopharyngeal valving problems

Abstract

AbstractTwenty‐seven subjects with borderline velopharyngeal valving mechanisms diagnosed as having hoarseness with or without vocal cord pathology participated in a follow‐up study. The mean age of the subjects was 13 years, two months, and they were recalled an average of 4.7 years following initial study.The reassessment protocol included an evaluation of speech, velopharyngeal valving, behavioral and health histories, and laryngoscopy. Upon follow‐up, 70 percent of the subjects retained vocal cord abnormalities. The eight subjects who had normal cords continued to demonstrate hoarse voice quality. Only 53 percent of the subjects who retained some atypical condition of the cords showed the same condition upon re‐evaluation. In each case, the condition retained was vocal cord nodules.The subjects who no longer showed vocal cord pathology had an average age of 15 years, eight months, as opposed to an average of 12 years, one month for those children who retained abnormalities. This difference was significant, indicating that age was an important factor in remission.Surgical removal of vocal cord nodules without attention to improving the velopharyngeal valving mechanism proved to be an ineffective approach to management; however, improvement in valving mechanism was usually associated with improvement in the vocal cord condition although it did not always eliminate it.None of the subjects in this study demonstrated an unequivocally adequate velopharyngeal valving mechanism. This was true even in the group of subjects who retained hoarseness but lost vocal cord pathology.The study suggests that careful differential diagnosis is essential in the management of these laryngeal problems which are perhaps the result of laryngeal modification compensatory to poor velopharyngeal valving mechanisms. Investigations of laryngeal anatomy and physiology and study of functional correlates to both hoarseness and vocal cord pathology in these patients, is essential.