Pediatric Voice Disorders Research Articles

Analysis of 1782 Pediatric Hoarseness Cases: A Clinical Retrospect Study

ObjectiveThis study aims to clarify the clinical characteristics of pediatric voice disorders. MethodsThe clinical data of 1,782 pediatric patients presenting with voice disorders were retrospectively analyzed. These cases were categorized into four age-based cohorts: 0–3 years, 4–7 years, 8–11 years, and 12–15 years. Variables such as gender disparities, laryngoscopic manifestation, disease types, and acoustic parameters were thoroughly examined. ResultsA total of 1,782 children with acoustic hoarseness were included in this study, comprising 1,325 males and 457 females. When the sex ratio among the children in each group was compared, males were found to outnumber females. A notable male predominance was observed across all age groups.Laryngoscopic results revealed that the most prevalent condition was vocal cord nodules (1,363 cases, 76.48%), followed by vocal cord polyps (271 cases, 15.20%). Other diseases included laryngeal papillomas, vocal fold movement impairment, vocal cord cysts, functional dysphonia, leukoplakia of the vocal cords, and benign laryngeal tumors such as laryngeal amyloidosis and subglottic granular cell tumors. Among these, adenoid hypertrophy was presented in 382 children (21.44%). Additionally, the Reflux Finding Score (RFS) was conducted, and 799 cases (44.83%) were found to have a score above 7.The distribution of various diseases across different age groups indicated that children with vocal cord nodules (637 cases, 46.74%), vocal cord polyps (109 cases, 40.22%), and laryngeal papillomas (35, 36.84%) were predominantly found in the 4–7 years age group. Pediatric acute laryngitis (3 cases, 75%) and vocal fold movement impairment (8 cases, 36.36%) were more common in the 0–3 years age group. Functional dysphonia (4 cases, 66.67%) and vocal cord leukoplakia (4 cases, 80%) were mainly observed in the 12–15 years age group, while vocal cord cysts were predominantly seen in the 8–11 years age group (4 cases, 57.14%).A comparative analysis of acoustic parameters among 153 children showed statistically significant differences in jitter, fundamental frequency (F0), voice handicap index (VHI), reflux symptom index (RSI), and reflux finding score (RFS) across different pathologies. ConclusionThis study highlighted that vocal cord nodules, vocal cord polyps, and laryngeal papillomas were the primary causes of pediatric hoarseness, although the possibility of tumors and rare diseases cannot be disregarded. There was a noticeable gender bias towards males, and functional dysphonia was significantly more prevalent in older children.

Paediatric voice disorder: who to refer and how to assess? A summary of recent literature.

The purpose of this review is to update the reader with recent advances and current opinion on the assessment and management of paediatric voice disorders. Access to advanced multidisciplinary paediatric voice clinics has increased over the last decade. Often the assessment is combined between speech therapy/pathology and ENT surgery. Vocal fold nodules remain the most prevalent diagnosis at a paediatric voice clinic, but significant diseases will also present, for example laryngeal papilloma. Recently, more consideration of the psychosocial aspect of voice disorders and evaluation of auditory processing disorders have shown how these can have a negative impact. There also appears to be a lack of parental and teacher awareness of paediatric voice disorders and their significance. We would recommend multiparametric assessment and analysis of all children with a voice disorder. Most paediatric voice conditions will respond to skilled voice therapy. However, the exact techniques and dosage requires further evaluation and research. Paediatric voice conditions are common and should not be dismissed, as they may represent significant disease, for example papilloma, vagal palsy or have a significant psychosocial impact on the child.

Parents’ Perceptions of and Attitudes Toward Voice Therapy

PurposeThis study aimed to investigate Chinese parents’ perceptions of pediatric voice disorders to determine their level of health literacy and knowledge gaps to understand the determinants of initiating voice therapy for children with dysphonia. MethodA cross-sectional survey was conducted in three voice clinics in Chengdu, China, from October 1, 2021, to October 1, 2022. Impairment of children’s quality of life as perceived by parents was assessed using the pediatric Voice-Related Quality-of-Life (pVRQOL) scale. ResultsOverall, 206 parents whose children were recommended voice therapy were recruited (Mean ± SD age, 35.0 ± 4.62 years; male/female = 1:3). When otolaryngologists recommended that their children with dysphonia initiate voice therapy, most participants had positive responses (n = 176, 85.4%). The mean pVRQOL score was 40.8 in the accept group and 37.6 in the reject group (difference, 1.7; 95% CI, −4.98 1.69). Participants who had a more influential work status, had an only-child, had children with shorter-term voice symptoms, and visited specialized hospitals were more likely to have negative practices related to children’s voice therapy (P < 0.05). ConclusionsThis study represents an important first step in understanding Chinese parents' perceptions of and motivations for initiating voice therapy for their children with dysphonia. Initiation of treatment as recommended in pediatric populations depends on multiple factors, such as the duration of voice symptoms, family structure, and hospital type. It is imperative to promote public health care education on voice therapy among parents, as health care literacy is the primary driving factors in decision-making.

Preliminary analysis of the effect of individualized voice therapy on pediatric voice disorders

Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.

Voice Disorders in Children With Cleft Lip/Palate and Other Craniofacial Conditions

Purpose:This clinical focus article aims to provide speech-language pathologists (SLPs) working in cleft palate and craniofacial clinics with a review of the etiologies of pediatric voice disorders and the overlap with cleft lip and palate, craniofacial anomalies, and resonance disorders. It describes the recommended components of a voice evaluation and the relevance of this to the cleft palate and craniofacial clinic.Method:Literature on pediatric voice disorders and incidence in populations with cleft palate and craniofacial anomalies is reviewed. The recommended protocols for voice evaluation are described, and special considerations for the cleft palate and craniofacial team are discussed.Results:There are many different etiologies of voice disorders in children, and although the incidence of voice disorders is not necessarily higher in children with cleft palate than in the general population, there are some overlapping risk factors.Conclusions:SLPs working in cleft palate–craniofacial clinics should be aware of the etiologies and presentation of voice disorders. They can identify potential voice disorders and initiate referrals to a specialized team as appropriate to ensure optimal evaluation and treatment.

Management of Pediatric Voice Disorders: Perceived Knowledge, Confidence, Attitude and Practice Patterns Among School-based Speech-language Pathologists in Hong Kong

This survey evaluated the levels of self-perceived knowledge, confidence, attitude and practice patterns of school-based speech-language pathologists (SLPs) in Hong Kong regarding their management of pediatric voice disorders. SLPs with experience working in school settings in Hong Kong were invited to complete an anonymous online survey. The survey ascertained SLPs' perception of their knowledge, confidence, attitude and practice patterns regarding their management of pediatric voice disorders. It also explored the barriers and facilitators to effective service provision for children with voice problems in schools. A total of 85 responses were received, of which 56 respondents with complete responses were selected for analysis. Results showed that respondents in general did not consider themselves having sufficient knowledge on pediatric voice. They did not feel fully confident in managing pediatric voice cases. Even though they exhibited a positive attitude and agreed that pediatric voice management was important, discrepancies were noted between their attitude and practice. Barriers that hinder practice include the lack of professional guidelines, insufficient time and resource as well as difficulties to conduct comprehensive voice assessments with children. The study findings urge the needs of enhancing school-based SLPs' perceived knowledge and competence in managing pediatric voice disorders. The study also identifies strategic directions to improve service provision for children with voice disorders in schools.

A preliminary exploration of conversation sampling in pediatric voice disorders

Objective Current methods of eliciting running speech for subjective rating, or perceptual analysis, in the assessment of pediatric voice disorders are not standardized. Whilst different assessment tools have different requirements, a commonality is the requirement to judge the perceptual characteristics of the individual’s everyday speaking voice. However, it is unclear whether current practices yield ecologically valid running speech samples. The aim of this study was to analyse the length and characteristics of conversational responses, to stimuli that were designed to elicit running speech samples from pediatric clients. Method Twenty conversations, conducted as part of the evaluation of voice in a pediatric population, were analysed. Length of responses, number of responses and question types were recorded. Results The median maximum utterance length was 15.9 s; seven participants presented with a maximum of less than 10 s. Response length was significantly associated with question type, F = 10.68, p<.001. The most frequent number of responses produced was 11 (range = 17, IQR = 5, 11). There was a moderate correlation between response length and number of responses, r(18)=.53, p=.02. Discussion These data demonstrated that informal conversational methods did not consistently yield running speech samples of greater than 10 s in length, the minimum sample length recommended by the CAPE-V protocol. There was considerable variability in the characteristics of the responses produced by participants. Using a task such as a narrative re-tell might allow for better standardization of responses, including elicitation of vocal behaviors of interest, as well as yield a longer sample.

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...

Pediatric Voice Disorders from the Perspective of Rare Diseases

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. 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. 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. 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.

The Arabic version of pediatric voice related quality of life (PV-RQOL)

ObjectiveThere is still a lack of information available to clinicians regarding evaluation and treatment of pediatric voice disorders. The purpose of the present study was to develop an Arabic version of the pediatric V-RQoL. Subjectsand methods: 290 children and adolescents were included in the study. The PV-RQoL was translated into Arabic and pilot-tested on twenty participants with vocal complaints, and then amended culturally according to their suggestions. Then, application of the modified Arabic questionnaire in its final version, the APV-RQoL, was done on 130 patients with vocal complaint, out of them 70 patients were re-tested 14 days later, and 140 control without vocal complaints. ResultsThere was a statistically significant difference between the control and the voice disordered groups (P < 0.001).The APV-RQoL was proved to be reliable, showing high internal consistency and test-retest reliability with excellent item domain to domain correlation. Also, it was proved to be valid by confirmatory factor analysis, and by correlation with the Arabic PVHI scores, with high sensitivity and specificity. ConclusionThe Arabic version of PV-RQoL is considered to be a valid and reliable assessment tool used by parents of Arabic speaking children.

Surgical and therapeutic advances in the management of voice problems in children and young people.

The current article reviews advances in both the assessment of paediatric voice disorders, as well as surgical, medical and therapeutic treatments. It is important to evaluate the impact of a voice disorder from both the parent and child perspective. Outpatient laryngoscopy with stroboscopy is very possible even in young children; however, high-speed ultrasound is a plausible alternative. High-speed videolaryngoscopy, videokymography and dynamic computed tomography, offer potential for augmenting the assessment of vocal fold vibratory characteristics in children. The evidence to support the efficacy of both indirect and direct voice therapy interventions is growing. The management of vocal fold palsy has advanced to include laryngeal reinnervation. Intubation injury with/without surgical intervention offers challenge and gives rise to voice disorders that may be lifelong. Although assessment and management practices of paediatric voice disorders closely follow those applied to adults, there are important differences and a developmental approach is required when considering both surgical and therapeutic management. Children can benefit from both indirect and direct therapy treatments following an ear, nose and throat assessment which utilizes paediatric instrumentation and considers the health of the entire airway. Underlying medical contributory factors should be explored and treated. Voice disorders due to congenital and acquired changes of the vocal tract may be amenable to surgery.

Association Between the Development of Pediatric Voice Disorders and Singing in Children’s Choir

Pediatric vocal fold pathology is important because having a healthy voice free from disorders is crucial in a child's emotional and educational development. To determine whether there is an association between singing in a children's choir and the development of voice disorders. Prospective cohort study of children (aged 8 to 14 years) singers selected from local children's choirs and nonsingers selected from local schools evaluated at Clarós Otorhinolaryngology Clinic in Barcelona, Spain, from October 2016 through April 2018. Singing for a mean time of 7.5 hours per week for 2.5 years. The primary outcome of the study was the prevalence of voice disorders measured using videostroboscopy. The obtained values were analyzed statistically and used to compare the characteristics of the children and the frequency of voice disorders between the groups. Of 1495 enrolled children (745 male [49.8%]; median age, 9.3 years [range, 8-14 years]), 752 were singers and 743 were nonsingers. No differences in baseline characteristics were observed between the groups. Voice disorders were more frequent in the nonsinging group than in the singing group (32.4% vs 15.6%; difference, 16.8%; 95% CI, 12.3%-21.4%). Of 12 voice disorders considered in this study, all 12 were more frequent in the nonsinging group. Functional voice disorders were more frequent in the nonsinging group than in the singing group (20.2% vs 9.4%; difference, 10.8%; 95% CI, 7.2%-14.3%), as were organic voice disorders (12.2% vs 6.1%; difference, 6.1%; 95% CI, 2.6%-9.6%). Voice disorders were less common among children in the cohort who sing in choirs, possibly because of voice training and the commonly observed habit of attending regular ear, nose, and throat examination. Voice disorders may be prevented in nonsinging children if the same solicitude for voice is observed.

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...

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.

Histological changes in vocal fold growth and aging.

Sophisticated descriptions of the highly specialized vocal fold microarchitecture have been available for over three decades, but how this anatomy evolves with growth and aging remains an area of active investigation and, at times, a source of controversy. As our aging population expands and interest in pediatric voice disorders blossoms, it is timely to consider our contemporary understanding of evolving vocal fold histology and its implications for voice production. Novel applications of existing and emerging biotechnology, development of animal models and skillful use of human specimens have afforded greater insights into the histologic vocal fold changes seen throughout the lifespan in health and disease. Burgeoning knowledge has laid the foundation for more comprehensive models of vocal fold histology and has led to the development of innovative therapies for challenging voice disorders.

Can voice analysis be used to diagnose and monitor paediatric voice disorders?

Can voice analysis be used to diagnose and monitor paediatric voice disorders?

The paediatric voice clinic.

Prevalence of paediatric voice disorders has been reported as 6-9% in children of school age. The appropriate diagnosis and management of paediatric voice disorders is essential for progress in education and psychosocial development. This paper presents a review of a UK tertiary paediatric voice clinic experience of referral patterns, diagnosis, management and socioeconomic variations. An audit of 195 consecutive appointments (154 were new patients) between October 2009 and September 2013 at a monthly paediatric voice clinic based at the Royal Hospital for Sick Children in Glasgow. Of the 154 new patients, 86 were male and 68 were female. The age at first clinic appointment shows a trimodal peak at ages 5, 8 and 11 years. General practitioners were the main referral source (46%). Vocal cord nodules accounted for 52% of diagnoses with a male predominance. Clinic attendance was most common from Scottish Index of Multiple Deprivation groups 1 (most deprived) and 5 (least deprived). Analysis of the muscle tension dysphonia group indicates that they are more likely to come from social groups 4 or 5 (69%) and an older age group (mean age 10.4 years). A dedicated paediatric voice clinic is the optimal method for assessment, diagnosis and management of these patients. Diagnosis is possible on the majority of the patients in clinic, with the predominant pathology being vocal cord nodules that receive speech and language therapy. Socioeconomic group appears to have an influence on paediatric voice particularly vocal cord nodules and muscle tension dysphonia.

G442(P) The Paediatric Voice Clinic

BackgroundPrevalence of paediatric voice disorders has been reported as 6–9% in children of school age. The appropriate diagnosis and management of paediatric voice disorders is essential for progress in education...

Voice Treatment for Nonspecific Chronic Cough and Paradoxical Vocal Fold Motion Disorder in Children

Seminars in Speech and Language, Volume 34, No. 1, is devoted to types and treatment of voice disorders in children. School speechlanguage pathologists (SLPs) may sometimes find it difficult to put children with voice problems on their caseloads because they must show how the disorder affects academic performance. The authors in this issue of Seminars make clear that pediatric voice disorders do impact academic performance. Voice disorders are associated with school absenteeism; decreased participation in academic classes, physical education, and extracurricular activities; and negative attention from classmates and school personnel, thus impacting academic performance and social well-being. Some voice disorders, such as vocal nodules, are familiar to SLPs; others, such as paradoxical vocal fold motion disorder (PVFMD) and nonspecific chronic cough (NSCC), are less familiar. In their article in this issue, Gallena and Kerins describe the nature, assessment, and treatment of NSCC and PVFMD.

Paediatric voice disorders: Using acoustic & aerodynamic paediatric values and laryngeal photography as a parental educational tool

Paediatric voice disorders: Using acoustic & aerodynamic paediatric values and laryngeal photography as a parental educational tool