Pediatric Voice Research Articles

Evaluation of Pediatric Voice Handicap Index in Children With Allergic Rhinitis

The study sought to determine impact of voice disability on children with allergic rhinitis (AR). The Turkish version of the Pediatric Voice Handicap Index (pVHI) was used to assess the impact of voice disability on functional, physical, and emotional aspects of voice and oral communication. The degree of talkativeness was also determined. One hundred twenty-three children with AR aged 6-17 years and age-matched 84 children of controls without present or past record of voice disorder were admitted in the cross-sectional study. The pVHI was carried out by an otolaryngologist. Children with AR show higher scores on pVHI compared to healthy children, indicating a greater chance of voice disorders observed in them (P < 0.001). The scores of three domains and total score of pVHI were prevalent in children with AR. In addition, as the severity of AR increased, high scores of pVHI were observed (P = 0.044). The mean talkativeness scores in AR group were lower than those of the healthy controls (P < 0.001). In children with AR, voice disorders are more frequently observed and correlate positively with AR severity.

Adaptation and Validation to the Mexican Spanish of the Pediatric Voice Handicap Index (pVHI) in Patients from 3 to 17 Years of Age with Operated Laryngotracheal Stenosis vs Not Operated and Healthy Controls

Background: Voice quality is a measure of quality of life. We need an instrument with the consideration of culture and uses of the Latin-American Spanish. The aim was to carry out validation of the pVHI into Mexican Spanish and find differences in non-operated severe laryngotracheal stenosis patients (NOLTS) and operated laryngotracheal stenosis (OLTS) vs. healthy patients. The first validation of this instrument was incomplete. Methods: Cohort study from a Mexican reference hospital between 2015 to 2017. Forty NOLTS patients, 40 OLTS and 80 healthy controls diagnosed by rigid/flexible laringoscopy. All translation phases were performed. Final version was applied to parent proxy. Statistical analysis was Cronbach's Alpha, intra-class correlation coefficient (ICC), construct validity (validation) and Kruskal-Wallis test (comparisons). Findings 160 patients of 3 to 17 years (median 7 years). Cronbach's alpha was 0.92, 0.92, and 0.90 and ICC was 0.91 and 0.90 (p=0.001) (functional-physical and emotional domains respectively). Inter-item Pearson's coefficients were 0.64 to 0.93 (p=0.01 bilateral). The construct validation found a one-dimensional scale and identifies some items shared for physical and functional domains. NOLTS patients obtained the worst score with a mean of 32.26 comparing with OLTS and healthy controls (p=0.0001), with moderate to severe voice handicap in 16 patients (10%). The largest number of quiet listener patients was in the NOLTS preschool group. We found significant differences both in the talkativeness and in overall voice severity, among all groups (p= 0.0001). Interpretation: The pVHI translated and validated into Mexican Spanish is valid and reliable. It could be divided in two subscales: functional and emotional (confirmatory factor analysis). All pVHI parameters are significantly affected in patients with NOLTS with a voice handicap index in ranges of moderate to severe and significant differences in all measurements between groups. The laryngotracheal plasty surgery recovers the handicap approximately 20 points. Funding: None Declaration of interest: We declared no conflict of interest with any person, foundation of company from any of the authors. Ethics Approval Statement: The study was approved by the Clinical Research Ethics Committee of our hospital and written informed consent was obtained from the participants parents.

Turkish Adaptation of the Pediatric Voice Related Quality of Life Survey: A validity and reliability study

ObjectivesChildhood voice disorders have increased in recent years reduce not only communication of the child, but also; the quality of life by affecting the socio-emotional state. MethodsIn the study, it is aimed to test validity and reliability of Pediatric Voice Related Quality of Life Survey (PVRQOL)'s Turkish adaptation. A total of 223 individuals aged between 2 years and 18 years, with and without voice problems were involved in this study. ResultsStatistically significant differences were found between study and control groups for total score and sub domain scores for PVRQOL (p < 0,001). Total score of quality of life was higher in the control group. Cronbach alpha coefficient for overall PVRQOL was 0,922; dimension of physical function was 0,894 and socio-emotional domain was 0,804. In the test-retest reliability test, overall PVRQOL was found to be 0,732; physical functional sub domain was 0,734; socio-emotional sub domain was 0,721. The validity of the questionnaire was determined by factor analysis. ConclusionThe results suggest that the Turkish version of the PVRQOL has reliability and validity, and may play a crucial role in evaluating children with voice disorders.

Design and Implementation of an Interactive Website for Pediatric Voice Therapy-The Concept of In-Between Care: A Telehealth Model.

Purpose: This article describes the design and implementation of a web-based portal developed to provide supported home practice between weekly voice therapy sessions delivered through telehealth to children with voice disorders. This in-between care consisted of supported home practice that was remotely monitored by speech-language pathologists (SLPs). Methods: A web-based voice therapy portal (VTP) was developed as a platform so participants could complete voice therapy home practice by an interdisciplinary team of SLPs (specialized in pediatric voice therapy), telehealth specialists, biomedical informaticians, and interface designers. The VTP was subsequently field tested in a group of children with voice disorders, participating in a larger telehealth study. Results: Building the VTP for supported home practice for pediatric voice therapy was challenging, but successful. Key interactive features of the final site included 11 vocal hygiene questions, traditional voice therapy exercises grouped into levels, audio/visual voice therapy demonstrations, a store-and-retrieval system for voice samples, message/chat function, written guidelines for weekly therapy exercises, and questionnaires for parents to complete after each therapy session. Ten participants (9-14 years of age) diagnosed with a voice disorder were enrolled for eight weekly telehealth voice therapy sessions with follow-up in-between care provided using the VTP. Conclusion: The development and implementation of the VTP as a novel platform for the delivery of voice therapy home practice sessions were effective. We found that a versatile individual, who can work with all project staff (speak the language of both SLPs and information technologists), is essential to the development process. Once the website was established, participants and SLPs effectively utilized the web-based VTP. They found it feasible and useful for needed in-between care and reinforcement of therapeutic exercises.

Voice Change Following Adenotonsillectomy in Pediatric Population: Myth or Reality?-A Pilot Study.

Modifications in the structure of pharynx following adenotonsillectomy are presumed to cause changes in the voice characteristics of patients. Data on effect of tonsillectomy/adenotonsillectomy on changes in voice among Indian children are sparse. This study was thus conducted to study the effect of adenotonsillectomy/tonsillectomy on childrens' voice. It was a prospective observational study of children aged 4-15years undergoing tonsillectomy with or without adenoidectomy. Measures of voice were noted preoperatively, 1 and 3months post-operatively. Subjective evaluation was done using Paediatric Voice Outcome Survey (PVOS) questionnaire administered to participants' parents. Objective evaluation was done by recording and analyzing using PRAAT voice analysis software which is an open-software tool. Statistical analysis was done using the statistical software SPSS 17.0 version. There were 31 children between 4 and 14years of age 65% being male. Adenotonsillectomy was done in 83.5%. There was statistically significant difference in the subjective scores (PVOS) pre-operatively and 3month postoperative score (p value = 0.001). However, there was no statistically significant difference between any other pre op and post op parameters. Though the only significant post tonsillectomy voice changes noted was subjective by parents 3months later, it does raise concern whether this could be a reality and not a myth. Further studies with larger number of patients, including involving the subjective evaluation (PVOS) by another person in addition to patients' parent need to be undertaken to address this issue.

Respiratory Tract Infections and Voice Quality in 4-Year-old Children in the STEPS Study

Health-related factors are part of the multifactorial background of dysphonia in children. Respiratory tract infections affect the same systems and structures that are used for voice production. The purpose of this study was to investigate if the number of respiratory tract infections or the viral etiology were significant predictors for a more hoarse voice quality. The participants were 4-year-old children who participated in the multidisciplinary STEPS study (Steps to the Healthy Development and Well-being of Children) where they were followed up from pregnancy or birth to 4 years of age. Data were collected through questionnaires and a health diary filled in by the parents. Some of the children were followed up more intensively for respiratory tract infections during the first 2 years of life, and nasal swab samples were taken at the onset of respiratory symptoms. Our participants were 489 of these children who had participated in the follow-up for at least 1 year and for whom data on respiratory tract infections and data on voice quality were available. The number of hospitalizations due to respiratory tract infections was a significant predictor for a more hoarse voice quality. Neither the number of rhinovirus infections nor the number of respiratory syncytial virus infections was statistically significant predictors for a more hoarse voice quality. Based on our results, we would suggest including questions on the presence of respiratory tract infections that have led to hospitalization in the pediatric voice anamnesis. Whether the viral etiology of respiratory tract infections is of importance or not requires further research.

Advances in Pediatric Voice Therapy

Purpose The treatment of pediatric voice disorders has received increased interest in recent years. This article provides a review of the current literature regarding pediatric voice therapy, inclu...

A Practical Discussion of Current Approaches to Providing Voice Therapy to Children With Dysphonia

No AccessSIG 3 Voice and Voice DisordersArticle1 Jan 2018A Practical Discussion of Current Approaches to Providing Voice Therapy to Children With Dysphonia Susan Baker Brehm, Barbara Weinrich, and Lisa Kelchner Susan Baker Brehm Department of Speech Pathology and Audiology, Miami UniversityOxford, OH Google Scholar More articles by this author , Barbara Weinrich Department of Speech Pathology and Audiology, Miami UniversityOxford, OH Center for Pediatric Voice Disorders, Cincinnati Children's Hospital Medical CenterCincinnati, OH Google Scholar More articles by this author and Lisa Kelchner Communication Sciences and Disorders, University of CincinnatiCincinnati, OH Center for Pediatric Voice Disorders, Cincinnati Children's Hospital Medical CenterCincinnati, OH Google Scholar More articles by this author https://doi.org/10.1044/persp3.SIG3.40 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In Dysphonia in children has the potential to impact social, educational, and occupational outcomes. Although there is a growing body of literature that documents treatment effectiveness of behavioral voice intervention in children with vocal fold lesions such as vocal fold nodules, establishing efficacy through large randomized controlled trials is difficult in this patient population due to ethical considerations, varying age and cognitive levels, and parent involvement/time. Examination of some barriers to care in this population as well as potential solutions for creating greater access to care for children and families is discussed in this article. References Akif Kilic, M., Okur, E., Yildirim, I., & Guzelsoy, S. (2004). The prevalence of vocal fold nodules in school age children.International Journal of Pediatric Otorhinolaryngology, 68, 409–412. CrossrefGoogle Scholar Akin Şenkal, Ö., & Çiyiltepe, M. (2013). Effects of voice therapy in school-age children.Journal of Voice, 27(6), 787.e19–787.e25. CrossrefGoogle Scholar Asay, T. R., & Lambert, M. J. (1999). The empirical case of the common factors in psychotherapy: Quantitative findings.In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 23–55). Washington, DC: American Psychological Association. Google Scholar Bhattacharyya, N. (2015). The prevalence of pediatric voice and swallowing problems in the United States.Laryngoscope, 125, 746–750. Google Scholar Boyle, B. (2000). Voice disorders in school children.Support for Learning, 15, 15–17. Google Scholar Braden, M. N., & van Leer, E. (2017). Effect of MP4 therapy videos on adherence to voice therapy home practice in children with dysphonia.Journal of Voice, 31(1), 114.e17–114.e23. Google Scholar Connor, N., Cohen, S., Theis, S., Thibeault, S., Heatley, D., & Bless, D. (2008). Attitudes of children with dysphonia.Journal of Voice, 22(2), 197–209. CrossrefGoogle Scholar De Bodt, M. S., Ketelslagers, K., Peeters, T., Wuyts, F. L., Mertens, F., Pattyn, J., … Van de Heyning, P. (2007). Evolution of vocal fold nodules from childhood to adolescence.Journal of Voice, 21(2), 151–156. Google Scholar Powell, M., Filter, M., & Williams, B. (1989). A longitudinal study of the prevalence of voice disorders in children from a rural school.Journal of Communication Disorders, 22, 375–382. Google Scholar Reynolds, V., Meldrum, S., Simmer, K., Vijayasekaran, S., & French, N. P. (2016). A randomized, controlled trial of behavioral voice therapy for dysphonia related to prematurity of birth.Journal of Voice, 31(2), e9–e17. Google Scholar Ruddy, B. H., Lewis, V., & Sapienza, C. (2013). The role of the speech-language pathologist in the schools for the treatment of voice disorders: Working within the framework of the Individuals with Disabilities Education Improvement Act.Seminars in Speech and Language, 34(2), 55–62. CrossrefMedlineGoogle Scholar Tezcaner, C. Z., Karatayli Ozgursoy, S., Sati, I., & Dursun, G. (2009). Changes after voice therapy in objective and subjective voice measurements of pediatric patients with vocal nodules.European Archives of Oto-Rhino-Laryngology, 266(12), 1923–1927. CrossrefGoogle Scholar Trani, M., Ghidini, A., Bergamini, G., & Presutti, L. (2007). Voice therapy in pediatric functional dysphonia: A prospective study.International Journal of Pediatric Otorhinolaryngology, 71(3), 379–384. CrossrefGoogle Scholar Valadez, V., Ysunza, A., Ocharan-Hernandez, E., Garrido-Bustamante, N., Sanchez-Valerio, A., & Pamplona, M. (2012). Voice parameter and videonasolaryngoscopy in children with vocal nodules: A longitudinal study, before, and after therapy.International Journal of Pediatric Otorhinolaryngology, 76, 1361–1365. Google Scholar Zacharias, S. R. C., Kelchner, L., & Creaghead, N. (2013). Teachers' perceptions of adolescent females with voice disorders.Language, Speech, and Hearing Services in Schools, 44(2), 174–182. ASHAWireGoogle Scholar Additional Resources FiguresReferencesRelatedDetailsCited byAmerican Journal of Speech-Language Pathology31:2 (678-688)10 Mar 2022Telepractice Considerations for Evaluation and Treatment of Voice Disorders: Tailoring to Specific PopulationsBrett Myers, Elizabeth Hary, Julia Ellerston and Julie M. Barkmeier-Kraemer Volume 3Issue 3January 2018Pages: 40-46 Get Permissions Add to your Mendeley library HistoryReceived: Jun 2, 2017Revised: Jun 2, 2017Accepted: Jul 13, 2017 Published in issue: Jan 1, 2018 Metrics Topicsasha-topicsasha-sigsasha-article-typesCopyright & PermissionsCopyright © 2018 American Speech-Language-Hearing AssociationPDF downloadLoading ...

Reliability and validity of the Chinese pediatric voice handicap index

ObjectivesTo evaluate the reliability and validity of the Chinese version of pediatric voice handicap index (pVHI). Material and methodsThe original English version-pVHI was translated into Chinese. Parents of 52 children with voice dysphonia and 43 children with no history or symptoms of voice problems were asked to fill the Chinese pVHI questionnaires twice with an interval of 2 weeks. GRB (Grade, Roughness, Breathiness) scale was used for perceptual assessment by two otolaryngologists and one speech pathologist for each child's voice. The internal consistency was assessed using Cronbach's alpha coefficient. Pearson's correlation coefficient was used to evaluate the test-retest reliability. The Kendall's coefficient of concordance W was used to assess the consistency of GRB scores of 3 voice specialists. The nonparametric Mann-Whitney test was used to assess the differences between the dysphonia group and controls. The correlation between pVHI and GRB scores were assessed using Pearson's correlation coefficient. ResultsThe internal consistency of total score and three subscales scores of Chinese pVHI were 0.788–0.944. The test-retest reliability was 0.631–0.887(P < .001). The pVHI scores of control group significantly were lower than the pathological group (P = .000). The GRB scores of 3 voice specialists have an excellent consistency (W = 0.694–0.807, P = .000). The pVHI scores positively correlated with GRB assessment (P < .01). ConclusionsThe Chinese version of pVHI had a good reliability and validity. It can be applicable and useful supplementary tool for evaluating parents' perception of their children's dysphonia.

The Perception of Breathiness in the Voices of Pediatric Speakers

The perception of pediatric voice quality has been investigated using clinical protocols developed for adult voices and acoustic analyses designed to identify important physical parameters associated with normal and dysphonic pediatric voices. Laboratory investigations of adult dysphonia have included sophisticated methods, including a psychoacoustic approach that involves a single-variable matching task (SVMT), characterized by high inter- and intra-listener reliability, and analyses that include bio-inspired models of auditory perception that have provided valuable information regarding adult voice quality. To establish the utility of a psychoacoustic approach to the investigation of voice quality perception in the context of pediatric voices? Six listeners judged the breathiness of 20 synthetic vowel stimuli using an SVMT. To support comparisons with previous data, stimuli were modeled after four pediatric speakers and synthesized using Klatt with five parameter settings that influence the perception of breathiness. The population average breathiness judgments were modeled with acoustic measures of loudness ratio, pitch strength, and cepstral peak. Listeners reliably judged the perceived breathiness of pediatric voices, as with previous investigations of breathiness in adult dysphonic voices. Breathiness judgments were accurately modeled by loudness ratio (r2 = 0.93), pitch strength (r2 = 0.91), and cepstral peak (r2 = 0.82). Model accuracy was not affected significantly by including stimulus fundamental frequency and was slightly higher for pediatric than for adult voices. The SVMT proved robust for pediatric voices spanning a wide range of breathiness. The data indicate that this is a promising approach for future investigation of pediatric voice quality.

Adaptation and validation of Mandarin Chinese version of the pediatric Voice Handicap Index (pVHI)

ObjectiveThe aim of this study was to adapt and validate the English version of pediatric voice handicap index (pVHI) into Mandarin Chinese. MethodsA cross-sectional study was performed from May 2016 to April 2017. A total of 367 parents participated in this study, and 338 parents completed the translated questionnaire without missing data, including 213 parents of children with voice disorders (patients group), and 125 parents of children without voice disorders (control group). The internal consistency, test-retest reliability, contents validity, construct validity, clinical validity, and cutoff point were calculated. ResultsThe most common voice disorder in the patients group was vocal fold nodules (77.9%), followed by chronic laryngitis (18.8%), and vocal fold polyps (3.3%). The prevalence for voice disorders was higher in boys (67.1%) than girls (32.9%). The most common vocal misuse and abuse habit was shouting loudly (n = 186, 87.3%), followed by speaking for a long time (n = 158, 74.2%), and crying loudly (n = 99, 46.5%). The internal consistency for the Mandarin Chinese version of pVHI was excellent in patients group (Cronbach α = 0.95). The inter-class correlation coefficient indicated strong test-retest reliability (ICC = 0.99). The principal-component analysis demonstrated three-factor eigenvalues greater than 1, and the cumulative proportion was 66.23%. The mean total scores and mean subscales scores were significantly higher in the patients group than the control group (p < 0.05). The physical domain had the highest mean score among the three subscales (functional, physical and emotional) in the patients group. The optimal cutoff point of the Mandarin Chinese version of pVHI was 9.5 points with a sensitivity of 80.3% and a specificity of 84.8%. ConclusionThe Mandarin Chinese version of pVHI was a reliable and valid tool to assess the parents' perception about their children's voice disorders. It is recommended that it can be used as a screening tool for discriminating between children with and without dysphonia.

Health-related quality of life in children with dysphonia and validation of the French Pediatric Voice Handicap Index

Objective: voice disorders are common in the pediatric population and can negatively affect children's quality of life. The pediatric voice handicap Index (pVHI) is a valid instrument to assess parental perception of their children voice but it is not translated into French language. The aim of the present study was to adapt a French version of the pVHI and to evaluate its psychometric properties including construct validity, reliability, and some aspects of external validity.Patients and Method: we performed a cross sectional study including 32 dysphonic children and 60 children with no history of voice problems between 3 and 12 years of age. The original pVHI was translated into French language according to forward-backward rules and then administered to parents or caregivers. Construct validity and internal consistency were explored using confirmatory factor analysis and Cronbach's alpha. The questionnaire was filled twice to assess test-retest reliability using the intra-class correlation coefficient. The external validity was explored by comparing the French pVHI total and subscales scores between dysphonic and asymptomatic children. Correlations between the French pVHI and both the perceptual GRBAS scale and the health-related quality of life (HRQOL) survey “Vécu et Santé Perçu de l’Adolescent et de l’Enfant” (VSP-Ap) were also performed.Results: the structure of the French pVHI showed a good fit with excellent reliability (α = 0.929) and high test-retest reliability. Significant differences were found between the group of dysphonic children and the control group (p < 0.001). The French pVHI scores were positively correlated to all parameters of the GRBAS scale (p < 0.05). Significant negative correlations were found between the Functional domain of the pVHI and various domains of the VSP-Ap as Leisure Activities, Schooling and Sentimental Relationship (p < 0.05).Conclusion: the French pVHI is considered to be a valid and reliable instrument to assess voice-related quality of life in children with voice disorder. We recommend its use in the multidimensional protocols for assessing voice disorder in the pediatric population.

Reliability and Validation of the Turkish Version of the Pediatric Voice-Related Quality of Life Survey

To evaluate the effect of dysphonia in children, several methods have been developed, including the Pediatric Voice Outcome Survey, the Pediatric Voice Handicap Index, and the Pediatric Voice-Related Quality of Life (PVRQOL) Survey. The aim of this study was to analyze the validity of the Turkish version of the PVRQOL Survey. The PVRQOL Survey consists of 10 questions that evaluate the effects of dysphonia on quality of life. We translated it into Turkish by working with two translators and faculty from the English Grammar and Literature Department. The Turkish version was translated back into English by two bilingual individuals to assess accuracy. The final version was tested by 15 parents for pilot study. Following the pilot study, we enrolled 52 children who had been admitted to the outpatient clinic with dysphonia and 79 children who had no voice complaints. The parents of the children under 7 years were asked to answer the survey. Children aged between 7 and 9 years completed the survey with their parents, and children over 9 years completed the survey by themselves. The results of the pilot study revealed no difference between the two groups. Intergroup comparisons revealed that there were statistically significant differences between the control and patient groups in terms of question responses. When the total scores of the two groups were compared, there was a significant difference. The Turkish version is a valid and reliable instrument for assessing dysphonic patients and healthy subjects.

Health-related quality of life in patients with cleft palate: Validity and reliability of the VPI Effects on Life Outcomes (VELO) questionnaire translated to Dutch

BackgroundDisease-specific health-related quality of life (HRQOL) questionnaires provide the clinician with important information regarding the impact of the disease on functioning and well-being. For patients with velopharyngeal insufficiency (VPI), the VPI Effects on Life Outcomes (VELO) questionnaire was developed and validated in English by Skirko et al. (2012). However, a valid and reliable Dutch translation of this questionnaire is not available yet. MethodsThe English questionnaire was translated to Dutch following a forward-backward translation procedure. A linguistic validation and the evaluation of the internal consistency (Cronbach's α) of this Dutch version were performed based on the responses of 39 parents of patients with cleft (lip and) palate (mean age: 6.8 years) (parent report) and the responses of 14 patients older than 8 years (mean age: 9.5 years) (child report). Additionally, the concurrent validity was assessed by comparing the scores on the parent report to those on the pediatric voice handicap index. Furthermore, the validity of the parent proxy assessment and the relationship between age and responses on the VELO questionnaire were investigated. Based on the responses of an age and gender matched control group without cleft palate, the discriminant validity was evaluated. ResultsThe parent report was easy to complete for all parents. Nine of the fourteen (64%) patients were able to complete the child report independently. The median scores on the parent report and the child report were 82.7 and 95.1 respectively. The patient group had a significantly worse perception of HRQOL compared to the control group (p < 0.001; p = 0.029). There were no significant differences between the responses of the parent and their child's (p = 0.345). A significant positive correlation was found between the score on the parent report and the age of the patients (p = 0.001). Furthermore, a significant negative correlation was found between the parent report and the P-VHI (p < 0.001). Cronbach's α was 0.955 and 0.817 for the parent report and the child report respectively. ConclusionThe Dutch VELO questionnaire is a valid, reliable and user-friendly tool that provides important information about HRQOL in patients with cleft (lip and) palate.

Reliability and validity of the Dutch pediatric Voice Handicap Index

IntroductionThe pediatric voice handicap index (pVHI) has been developed to provide a better insight into the parents' perception of their child's voice related quality of life. The purpose of the present study was to validate the Dutch pVHI by evaluating its internal consistency and reliability. Furthermore, we determined the optimal cut-off point for a normal pVHI score. MethodsAll items of the English pVHI were translated into Dutch. Parents of children in our dysphonic and control group were asked to fill out the questionnaire. For the test re-test analysis we used a different study group who filled out the pVHI twice as part of a large follow up study. Internal consistency was analyzed through Cronbach's α coefficient. The test-retest reliability was assessed by determining Pearson's correlation coefficient. Mann-Whitney test was used to compare the scores of the questionnaire of the control group with the dysphonic group. By calculating receiver operating characteristic (ROC) curves, sensitivity and specificity we were able to set a cut-off point. ResultsWe obtained data from 122 asymptomatic children and from 79 dysphonic children. The scores of the questionnaire significantly differed between both groups. The internal consistency showed an overall Cronbach α coefficient of 0.96 and an excellent test-retest reliability of the total pVHI questionnaire with a Pearson's correlation coefficient of 0.90. A cut-off point for the total pVHI questionnaire was set at 7 points with a specificity of 85% and sensitivity of 100%. A cut-off point for the VAS score was set at 13 with a specificity of 93% and sensitivity of 97%. ConclusionsThe Dutch pVHI is a valid and reliable tool for the assessment of children with voice problems. By setting a cut-off point for the score of the total pVHI questionnaire of 7 points and the VAS score of 13, the pVHI might be used as a screening tool to assess dysphonic complaints and the pVHI might be a useful and complementary tool to identify children with dysphonia.

Multiple Perspectives on the Barriers to Identification and Management of Pediatric Voice Disorders

Pediatric voice disorders are typically a low-incidence population in the average caseload of clinicians working within school and general clinic settings. This occurs despite evidence of a fairly high prevalence of childhood voice disorders and the multiple impacts the voice disorder may have on a child's social development, the perception of the child by others, and the child's academic success. There are multiple barriers that affect the identification of children with abnormal vocal qualities and their access to services. These include: the reliance on school personnel, the ability of parents and caretakers to identify abnormal vocal qualities and signs of misuse, the access to specialized medical services for appropriate diagnosis, and treatment planning and issues related to the Speech-Language Pathologists' perception of their skills and competence regarding voice management for pediatric populations. These barriers and possible solutions to them are discussed with perspectives from the school, clinic and university settings.

Pediatric Vocal Fold Nodule Etiology: What Are Its Usual Causes in Children?

In this study, the relation between phonotrauma and presence of siblings and social activities was investigated, and the incidence of voice disorders in the mothers of children with vocal fold nodules was studied with objective (clinical voice analysis) and subjective (laryngostroboscopy, Voice Handicap Index) methods. Twenty-nine children with vocal fold nodules (age range 5-14 years), 45 age-matched children without any voice disorders as a control group, and their mothers were included in the study. All patients had laryngostroboscopy and clinical voice analysis, and their mothers filled out the Pediatric Voice Handicap Index. We noted the most common place or situation where children used their voice in excessively high volume according to their mothers, including home, school, sportive activities, and singing or reciting poem activities, to recognize the major cause of phonotrauma. In addition, presence of siblings was recorded. It was found that 15 patients (51.7%) had younger siblings, seven patients (24.1%) had older siblings, five patients (17.2%) had both younger and older siblings, and two patients (6.8%) did not have any siblings. It was seen that excessive usage of high-volume voice at home had a correlation with presence of only younger siblings, and both younger and older siblings tended to cause phonotrauma at home (86.7%). Additionally, eight boys (44.4%) reported presence of sportive activities, whereas none of the girls had such an activity (P = 0.012). Presence of siblings seems to be an important factor for vocal nodule formation. Maternal relationship does not seem to be a major factor for vocal misuse.

Voice outcome and voice-related quality of life after surgery for pediatric laryngotracheal stenosis.

To evaluate the long-term outcome of voice quality and voice-related quality of life after open airway surgery for pediatric laryngotracheal stenosis. Prospective cohort study. Children under the age of 18 years at time of follow-up and with a history of open airway surgery for acquired laryngotracheal stenosis were included in this analysis. To assess voice-related quality of life, the pediatric voice handicap (pVHI) index was completed by the patients' parents. The dysphonia severity index (DSI) was used as an objective measurement for voice quality. Fifty-five parents completed the pVHI, and 38 children completed the DSI. This showed high pVHI values and low total DSI scores, indicating significant voice disturbance. After multivariate analysis, the presence of comorbidities and glottic involvement of the stenosis are associated with poor long-term voice-related quality of life. Significant voice disturbance is common after surgery for pediatric laryngotracheal stenosis. Glottic involvement of the stenosis and comorbidities is associated with poor voice-related quality of life. Evaluation of pre- and postoperative voice quality and voice-related quality of life is advised for children treated for laryngotracheal stenosis. 2B. Laryngoscope, 127:1707-1711, 2017.

Pediatric Voice and Swallowing Disorders Related to Vocal Fold Immobility: the Use of Laryngeal EMG

Vocal fold immobility is a common cause of voice and swallowing disorders in children. The etiology of vocal fold immobility can be iatrogenic, idiopathic, neurological, or traumatic. Unilateral vocal fold immobility manifests as a weak or breathy voice and swallowing disorders such as aspiration. In contrast, bilateral vocal fold immobility typically presents with stridor or respiratory distress. Treatment for vocal fold immobility is based on symptoms. Patients with respiratory distress due to bilateral vocal fold immobility often require a tracheotomy, vocal cordotomy, arytenoidectomy, arytenoid abduction, or procedures to open the glottic airway. Surgical intervention for unilateral vocal fold immobility can include injection laryngoplasty, type 1 thyroplasty, or laryngeal reinnervation procedures. Timing for intervention with unilateral vocal fold immobility is difficult to determine for iatrogenic, traumatic, or neurologic injuries. Laryngeal electromyography (EMG) can help differentiate a neurologic etiology from vocal fold immobility from arytenoid dislocation. This diagnostic and prognostic information can help determine timing for definitive procedures such as laryngeal reinnervation.

Validation of the Airway-Dyspnoea-Voice-Swallow (ADVS) scale and Patient-Reported Outcome Measure (PROM) as disease-specific instruments in paediatric laryngotracheal stenosis.

To validate the Airway-Dyspnoea-Voice-Swallow (ADVS) instrument as a disease-specific Patient-Reported Outcome Measure in paediatric laryngotracheal stenosis. Prospective observational study. A quaternary referral centre for complex airway disease. Forty-eight patients (30 males) with a mean age of 49 ± 49 months who underwent laryngotracheal surgery or microlaryngoscopy and bronchoscopy (MLB) following laryngotracheal surgery. Airway-Dyspnoea-Voice-Swallow summary scale and Patient-Reported Outcome Measure (PROM), Paediatric Quality of Life (PedsQL) scale, Paediatric Voice Handicap Index (pVHI) and Lansky performance scale were administered to patients before and 6-8 weeks following airway examination/surgery. Most patients (73%) had intubation-related subglottic stenosis, and 60% of patients had prior airway treatments. The majority of patients (77%) had more than one major chronic morbidity, and the commonest procedures were diagnostic MLB (49%), followed by airway dilation (29%). Cronbach-α value for the ADVS PROM was 0.71 overall and 0.85, 0.86 and 0.64 for the dyspnoea, voice and swallow domains, respectively. Rank correlations between Dyspnoea, Voice and Swallow summary scale and PROM scores were 0.83, 0.71 and 0.81, respectively (P < 0.0001). For those patients undergoing diagnostic MLB, pre- and post-examination scores were highly correlated (intraclass correlations >0.75). There was a significant rank correlation between ADVS PROM score and Lansky performance score (r = -0.68; P < 0.0001). There were significant correlations between PROM score and PedsQL (r = -0.57; P < 0.0001) and between voice domain of the PROM and pVHI (r = 0.78; P < 0.0001). There were strong correlations between Myer-Cotton stenosis severity and dyspnoea scale and PROM score (r = 0.68; P < 0.0001). There were significant differences in voice and swallow ADVS scales and PROM scores between patients with and without concomitant laryngeal/oesophageal pathology. Patient age and presence of high dyspnoea and swallowing PROM scores were independently associated with poorer quality of life and performance status. These series of observations validate the ADVS instrument as a disease-specific outcome measure for paediatric laryngotracheal stenosis. Dyspnoea and swallowing dysfunction appear to have the greatest impact on quality of life. More widespread adoption of the ADVS instrument could help create a shared language for outcomes communication and benchmarking for children with this complex condition.