Pediatric Voice Handicap Index Research Articles

Development and Validation of the Children’s Voice Questionnaire (CVQ)

This study developed and validated the children's voice questionnaire (CVQ), a new self-administered instrument for children, and evaluated its internal consistency and reliability. Observational, prospective, cross-sectional study. The initial preparation of the CVQ was conducted in four steps. First, individual interviews were conducted with dysphonic and non-dysphonic children and their parents, teachers, and speech pathologists. Second, the responses collected from the interviews were arranged into a comprehensive list of 175 items. Third, this list was reduced to a preliminary 21-item version of the questionnaire, which was tested as a pilot with 254 children. Fourth, a further reduction to 18 items was performed to construct the final version of the CVQ. The questionnaire was then administered to 342 children (73 dysphonic, 269 non-dysphonic) aged 6-18. Simultaneously, the parents of these children completed the pediatric voice handicap index (pVHI). Finally, after 2 weeks, 30 randomly selected children (nine dysphonic, 21 non-dysphonic) completed the CVQ again to evaluate test-retest reliability. High reliability was found for the CVQ (Cronbach's α=0.94). Test-retest revealed strong and statistically significant reliability (r=0.79, P<0.001). A highly significant group difference was found between the CVQ scores obtained for the dysphonic and non-dysphonic groups (t[78.25]=6.22, P<0.001). In addition, significant medium-to-strong positive correlations were found between the children's evaluations using the CVQ and their parents' evaluations using the pVHI (0.59<r<0.66, P<0.01). The newly developed CVQ is a valid and reliable instrument. Findings reveal general agreement between children and their parents, but also show that children's perspective on their dysphonia is not equivalent to the parent's perspective. This demonstrates that combining both perspectives provides a more holistic and complete overview of dysphonic children's voice-related quality of life. The self-administered CVQ reliably differentiates dysphonic from non-dysphonic children and may serve as a valuable tool for the initial or ongoing evaluation of children with voice disorders in clinical and research settings.

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

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. Retrospective, observational study. 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. 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. 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.

Pediatric Dysphonia: When to Refer.

The reported prevalence of voice disorders in the pediatric population varies widely between studies, ranging from 3.9% to 23%. Despite this, not all children with dysphonia are referred to a voice specialist for further evaluation. The objective of this study is to examine the relationship between dysphonia history, voice assessment, and laryngeal findings to help guide referrals of dysphonic children. A retrospective review was conducted of pediatric patients at a tertiary voice clinic between January 2014 and December 2017. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, laryngeal exam findings, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed. Of 475 patients initially identified, 459 met inclusion criteria and were reviewed. In all, 272 (59.3%) were male and 187 (40.7%) were female. Mean age at first presentation was 8.6 years old (range: 2-18). Males were more likely to present at a younger age than females. CAPE-V data were available for 439 patients, and pVHI data were available for 109 patients. The mean CAPE-V Overall Severity score was 38.2. The mean total pVHI score was 25.4. Males had higher CAPE-V Overall Severity (40.0 vs. 35.4), Roughness (32.2 vs. 27.6), and Strain scores (37.2 vs. 32.4) than females. Patient pVHI scores did not differ by gender. In all, 283 patients self-reported a length of symptoms prior to evaluation. Children with a longer duration of symptoms prior to evaluation had higher CAPE-V Overall Severity scores. Diagnoses of vocal fold movement impairment and benign vocal fold lesions that were not nodules were associated with higher average CAPE-V Overall Severity scores. Overall, 310 patients (67.5%) were recommended intervention for their dysphonia. These patients had higher CAPE-V Overall Severity scores than those who were solely recommended observation (42.8 vs. 28.0). Males were more likely than females to present with dysphonia and presented with more severe perceptual dysphonia scores on average. The length of symptoms and certain diagnoses correlated with higher CAPE-V Scores. Referrals to a pediatric voice clinic should be considered in patients with a dysphonia history lasting greater than 3 months and in patients with more severe symptoms.

The Clinical Impact of Vagal Nerve Stimulator Implantation on Laryngopharyngeal Function in Children: A Single-Center Experience.

A vagal nerve stimulator (VNS) has been established as the treatment of choice for children with refractory epilepsy. The outcomes of the procedure have been well documented in adults but are less clear in children. The goal of our study was to review laryngopharyngeal (LP) function following VNS implantation in children. Case series with chart review. Tertiary-care children's hospital. Voice, swallowing, and sleep apnea symptoms were extracted from the charts of children who underwent VNS implantation between 2013 and 2021. A questionnaire was sent to parents of implanted children to ascertain the degree of the social and functional impact of the implant. There were 69 patients, aged 2.3 to 21.4 years old, who met the inclusion criteria. LP symptoms were most common during the first year following implantation; 26 patients (37.6%) demonstrated at least 1 symptom (voice alteration, chronic cough, sleep-disordered breathing, or dysphagia), and 15 patients required adjustments to their implant settings. The incidence of symptoms and the need to adjust VNS settings significantly dropped during years 2 to 5 and 6 to 8 (22% vs 7% and 5%, respectively, p = .0002). The mean score of the Pediatric Voice Handicap Index differed greatly from a normal control group on each subscale and the total score. LPdysfunction in children following VNS implantation is comparable to adults, with the most burden noticed during the first year after implantation. The presence of voice alterations did not correlate with the presence of dysphagia and sleep-disordered breathing. Thorough evaluation, preferably by a multidisciplinary team, is required to assess LP dysfunction postoperatively.

Voice Therapy Efficacy in Pediatric Professional Voice Users With Vocal Fold Nodules: A Preliminary Study

Vocal fold nodules are the most common diagnosis in children with dysphonia. It is also frequently seen in professional voice users who uses their voice as an occupational tool. It can be caused by excessive or hyperfunctional use of the voice leading to phonotrauma. Children who learn the Quran by heart and recite it use their voices excessively and it causes voice problems. Voice therapy can play an important role in regulating phonotraumatic behaviors and improving voice quality, thereby replacing surgical intervention in some cases or acting as a complementary therapy to improve eventual therapeutic outcomes. Our aim was to find the efficacy of group voice therapy compared to individual voice therapy in a group of pediatric professional voice users who go to the same religious school. To determine group therapy efficacy, 24 students between the age of nine and 14, were evaluated and 16 of them had vocal fold nodules. Therapy sessions started with 16 students whose ages ranged from nine to 14 with a mean of 11,3 ± 1,4 years old. They were divided into two groups: group and individual therapy groups. Treatment comprised both direct and indirect voice therapy and lasted 6 weeks. Three of the participants were dropped out due to absence. Pre- and post-therapy measures were collected from 13 participants using perceptual evaluation, videostroboscopy measures, and the pediatric voice handicap index to determine the efficacy of group voice therapy compared to individual voice therapy with a group of pediatric professional voice users with vocal fold nodules. As a result of our study, eight of participants were found to have healthy vocal folds; the s/z ratio was significantly different between groups and within group therapy participants pre- and post-therapy. No significant difference was found in other parameters; except noise harmonic ratio (NHR). NHR was found significantly different between pre- and post-therapy when individual therapy and group therapy were compared. Although both treatments were shown to be beneficial in the management of vocal fold nodules, individual therapy was found to be somewhat more effective. In pediatric voice therapy, group therapy is an effective option to reach out to more individuals with voice disorders. It can be beneficial for time management and cost effectiveness in voice therapy.

Pediatric Voice Handicap Index (pVHI): A Tool for Evaluating the Reliability and Validity of Voice Therapy in Children With Benign Vocal Fold Nodules

benign vocal fold lesions (BVFLs) represent the most common etiology of voice disorders in paediatric population, cause of dysphonia by preventing full vocal fold closure and modifying vibratory characteristics. Of those pathologies, vocal fold nodules represent almost 63% of the cases in children between 0-14 years. Management may include a combination of phonosurgery, voice therapy and pharmacological treatment, but almost 95% of otolaryngologists recommend voice therapy as primary treatment. The Pediatric Voice Handicap Index (pVHI) is nowadays widely used and accepted in the evaluation and monitoring of paediatric patients with dysphonia. The aim of our study was to demonstrate the reliability and validity of PVHI in the evaluation of the effects of voice therapy as treatment of vocal fold nodules in the paediatric population. in this retrospective chart review twenty-seven (27) dysphonic patients with bilateral vocal fold nodules were treated with behavioral voice therapy approaches, and the PVHI surveys was administered to each patient parent's before and after therapy. The age of the patients ranged from 4 to 14 years (mean age 8.7 y-o); 17 (63%) were male and 10 (37%) females. according to our results, behavioral voice therapy effectively improved pVHI scores from pre- to post-treatment in paediatric patients with bilateral vocal fold nodules.

Impacto de la disfonía en la calidad de vida en la edad infantil

IntroductionVoice disorders can negatively affect the child's self-esteem and pose a problem for their socialization. The P-VHI (Pediatric Voice Handicap Index) is a quality of life questionnaire adapted for use in children that studies the impact of dysphonia on the functional, physical and emotional levels. MethodsRetrospective, observational and analytical study of a group of 87 patients aged between 5 and 14 years old with a diagnosis of dysphonia. The control group consisted of 31 patients same age range in whom was discarded the presence of otorhinolaryngological disease. We collected the data referred to age, sex, family environment and sport practice of both groups and analyzed their relationship with the presence of dysphonia. The impact of dysphonia on children's quality of life was studied using the Pediatric Voice Handicap Index (P-VHI) questionnaire. ResultsWe found a statistically significant relationship between the dysphonia and the male sex (65.5% in the group with dysphonia vs. 29% in the control group), having siblings (89.7% vs. 71%) and having a family history of voice disorders (33.3% vs. 3.2%). In the P-VHI questionnaire for all categories a significantly higher score was obtained in the group with dysphonia compared to the control group. ConclusiónDysphonia negatively affects children in the physical, emotional and social spheres. It is convenient an early detection, diagnosis and treatment, proportional to the impact generated.

Evaluation of Voice After Open Airway Surgery in Children: A Systematic Review.

ObjectiveThis review aims to describe the methods used to assess the vocal quality and quality of life of children after airway reconstruction and their limitations.Data SourcesA systematic review was carried out in 10 databases for articles published between 2000 and 2021 following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses).Review MethodsArticles were included that described perceptual voice assessment with or without acoustic measures and/or voice quality impact questionnaires. Articles with no description of a specific voice assessment were excluded.ResultsA total of 12 studies were included, yielding 263 patients. The mean age at evaluation was 9 years. Follow-up varied from 5 months to 20 years with most patients being evaluated at least a year after surgery. Methods used to evaluate voice were perceptual, aerodynamic, and acoustic analysis and quality of life questionnaires. CAPE-V (Consensus Auditory Perceptual Evaluation–Voice) was the most used auditory-perceptual instrument (72.7%). Of the acoustic parameters, fundamental frequency and maximum phonation time were the most described (58.3%), and among the quality of life assessment questionnaires, pVHI (Pediatric Voice Handicap Index) was the most used (54.5%).ConclusionMultidimensional evaluations tailored to the individual child can be recommended after open airway surgery. CAPE-V scale, fundamental frequency, maximum phonation time, and pVHI are the most frequently used methods; therefore, their use may help broaden communication among authors. In the multitude of methods available, cognitive ability and degree of voice disturbance should be considered since they are the most important limiting factors in this population.

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

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

Telehealth for Treatment of Pediatric Dysphonia

Vocal fold nodules are the most common etiology of chronic dysphonia in the pediatric population. Voice therapy is an effective first line of treatment, with increasing evidence supporting the use of telepractice in speech pathology. Despite this, there is limited data on its effectiveness in the pediatric population. The aim of this retrospective study was to investigate the feasibility and efficacy of telepractice in delivering voice therapy to children diagnosed with vocal fold nodules. A retrospective review was conducted of patients treated with virtual voice therapy from April 2020 to June 2021. Patients were included if diagnosed with vocal fold nodules, 2-18 years of age, and completed therapy in a virtual format. Data includes demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores. Twenty-three children were included, 17 (74%) male and six (26%) female (with an age range of 2.4-9.9 years at the start of therapy). Prior to treatment, the average CAPE-V Overall Severity score was 37.9 (SD 13.8); the average posttreatment score was 22.4 (SD 10.2). The average pVHI total score prior to treatment was 26.3 (SD 12.1), with an average posttreatment score of 20.2 (SD 11.7). Patients who underwent virtual voice therapy had improved posttreatment CAPE-V severity scores than those prior to treatment (average difference = -15.5 points; 95% CI: -8.3 to -22.7; P < 0.001). An increased number of therapy sessions was associated with both higher initial CAPE-V severity scores (r = 0.72; P < 0.01) and a greater decrease in posttreatment CAPE-V scores (r = -0.55; P < 0.01). Virtual voice therapy may be feasible and efficacious in treating dysphonic children diagnosed with vocal fold nodules. Significant improvements were found in perceptual CAPE-V scores in overall severity; positive changes were also seen in parental measures of quality of life. Delivery of voice therapy in a telehealth format may increase access of care and should be considered as a treatment option.

The Effectiveness of Vocal Hygiene Education With Resonant Voice Therapy for School-Aged Children With Vocal Nodules

This study evaluated the effectiveness of vocal hygiene education with resonant voice therapy for school-aged children with vocal nodules. A pre-test/post-test control group design was employed. Seventeen children aged between 6 and 9 years old with vocal nodules were randomly assigned to three groups: a treatment group, a placebo group and a control group. Children in the treatment group (n = 7) received six consecutive, weekly, one-hour sessions of vocal hygiene education with resonant voice therapy. Children in the placebo group (n = 5) received six consecutive, weekly, one-hour sessions on presentation skills training. Children in the control group (n = 5) did not receive any form of treatment. Subjective outcome measures included auditory-perceptual evaluation of overall dysphonia severity, the Pediatric Voice Handicap Index (pVHI) and the Children's Voice Handicap Index-10 (CVHI-10). Objective outcome measures included acoustic analysis of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio. Significant improvements in perceptual ratings of overall dysphonia severity levels and pVHI scores were found in the treatment group. No significant changes in acoustic measures and CVHI-10 scores were noted in any of the three groups. Interestingly, an improvement in perceptual overall dysphonia severity levels at post-evaluation was observed in the no treatment control group.

Development, Validation, and Reliability of the Teacher-Reported Pediatric Voice Handicap Index.

The purpose of this study was to develop a novel teacher-reported pediatric voice outcome measure and to investigate its psychometric properties. In the first stage, a new instrument, the Teacher-Reported Pediatric Voice Handicap Index (TRPVHI), was developed. After item generation, a panel of experts evaluated the items to assess the content validity. Subsequently, the final version of the preliminary instrument was applied to teachers of 306 children (57 dysphonic and 249 vocally healthy) between the ages of 4 and 11 years. Eventually, the construct validity, criterion-related validity, test-retest reliability, and internal consistency of the developed instrument were examined. The items with a content validity ratio less than .8 were modified or removed, and accordingly, the preliminary version of the index was finalized. After the application of the preliminary version, item reduction was made based on the factor analysis. The index is composed of 27 questions and three subscales: Functional, Physical, and Emotional. A significant difference was observed between the dysphonic and vocally healthy children for the TRPVHI scores (p < .001). A positive moderate correlation was determined between the Pediatric Voice Handicap Index and TRPVHI scores. Correlation coefficients between the test and retest scores of the TRPVHI were in the range of .92-.98. Cronbach's alpha values computed to assess the internal consistency were in the range of .94-.98. The TRPVHI is the only valid and reliable teacher-reported outcome measure of the effects of voice disorders on children. It is anticipated that the deployment of the TRPVHI in conjunction with other subjective tools, both in the initial evaluation and the follow-up of the treatment results, will allow a better understanding of the physical, functional, and emotional effects of voice disorders on children. Furthermore, it can potentially lead further research to enable the use of the TRPVHI for screening purposes.

Readability analysis of Spanish language patient-reported outcome measures in pediatric otolaryngology

BackgroundPediatric otolaryngology encompasses interactions with a young patient, parent and/or guardian, and the provider. As healthcare transitions toward patient-centered care, clinicians are using direct tools of measurement such as patient-reported outcome measures (PROM) as a modality of communication between the patient and healthcare provider. Therefore, literacy levels of both the patient and their parent or guardian must be considered. Moreover, PROMs administered in pediatric audiology and otolaryngology in Spanish were found to be above the recommended reading level. Assessing the readability of Spanish translated PROMs is vital in providing safe, accurate, and quality care. The goal of this study is to analyze the readability of PROMs in pediatric otolaryngology and assess their compliance with readability recommendations. MethodsPediatric otolaryngology PROMs were identified from Powell's systematic review on pediatric otolaryngology PROMs. Spanish pediatric otolaryngology PROMs were selected from a literature search through PubMed (pubmed.ncbi.nlm.nih.gov) and Google scholar databases (scholar.google.com). After completion of the literature search, seven PROMs were identified. Only four PROMs Spanish validations included the translation of the PROM in their publication. The authors of the remaining PROMs were contacted via email. Ultimately, eight pediatric otolaryngology PROMs were included in this study. The PROMs included were assessed by a Latin Spanish translator for grammar, syntax, and comprehension ease. ResultsFour out of eight PROMs (50%) included in our study had readabilities above the recommended sixth-grade level. The following PROMs were noted with readabilities above the recommended level: tonsil & adenoid health status instrument (TAHSI), the nasal quality of life survey (SN-5), Spanish pediatric voice handicap index (P–VHI), and velopharyngeal insufficiency effects on life outcome (VELO). ConclusionsCurrently, some Spanish translated pediatric PROMs are written at a reading level above the recommended range for patients and their families.

Pediatric Voice Handicap Index (pVHI): Validation in European Portuguese Children

ObjectivesTo determine reliability and validity of the European Portuguese pVHI version (pVHI-EP). Study designCross-sectional design. MethodsThe pVHI-EP and the talkative and global voice assessment scales were administered to the caregivers of children aged from 3 to 16 years old with and without dysphonia. Reliability (internal consistency and test-retest) was analyzed. The validity analyses performed were: (1) content validity by analyzing the percentage of missing data; (2) construct validity with intraclass correlation coefficients among pVHI-EP domains and overall score; (3) concurrent validity was conducted between pVHI-EP, the caregivers’ judgment of the child's voice severity on a visual analog scale and the Speech-Language Pathologist perceptual voice assessment; (4) known-groups validity between children with and without dysphonia, and (5) predictive validity by calculating receiver operating characteristics, sensitivity and specificity and determining cut-off points. ResultsA total of 283 children (61.5% boys, mean age 8.3 years) participated in the study. The pVHI-EP showed an excellent internal consistency for the pVHI-EP total data. Strong to moderate test-retest reliability confirms pVHI-EP reproducibility. Excellent to good intraclass correlation coefficients between the pVHI-EP overall and the domains confirms its construct validity. Weak to moderate concurrent validity with visual analog scale and Speech-Language Pathologist perceptual voice assessment was confirmed. The pVHI-EP significantly distinguished two groups of different voice conditions. A cut-off point of 10.5 with 95.9% sensitivity and 92.5% specificity was determined for the overall score of the pVHI-EP. ConclusionsThe pVHI-EP is a reliable and valid caregiver voice outcome tool for EP children with dysphonia.

Intubation-Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients.

We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability. Retrospective Study. Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale. Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0-3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS-2 and BDSS-3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS-1 (mild) or BDSS-2. History of multiple and prolonged intubations were seen more frequently in BDSS-2 or BDSS-3. Post-op pVHI reduced an average of 15 points for BDSS-0 to BDSS-2, but only 3 points for BDSS-3. Post-op pVHI matched normal values for preintervention dysphonic children. The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher-grade BDs, whereas low GA is more likely to be associated with BDSS-1 to BDSS-2. 4 Laryngoscope, 131:2550-2557, 2021.

Vocal Fold Injection Augmentation for Post-Airway Reconstruction Dysphonia: A Case Series.

Post airway reconstruction dysphonia (PARD) is common and has a significant effect on the quality of life of patients. Vocal fold injection augmentation (VFIA) is one treatment that can be used to improve glottic insufficiency in some patients. The goal of this study was to characterize the use and outcomes of VFIA for PARD. Retrospective chart review from January 2007 to July 2018 at a tertiary pediatric care center. Consecutive patients with PARD who underwent VFIA, who had a preoperative voice evaluation and a follow-up evaluation within 3 months after VFIA (fat, carboxymethylcellulose gel, hyaluronic acid). Thirty-four patients (20 female) underwent VFIA. The mean age at the time of the injection was 13.6 years (SD 6.1). Twenty patients (58.8%) had a history of prematurity and a mean of 1.8 open airway surgeries. After injection, 29/34 patients (85.3%) noted a subjective voice improvement. The baseline Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) overall severity score decreased by a mean of 5.7 (SD = 19.6) points, P = .12. Total pediatric Voice Handicap Index (pVHI) improved by 6.0 (SD = 19.5) points, from 57.4 (SD = 20.0) to 51.4 (SD = 17.2), P = .09. Functional pVHI subscore demonstrated a significant improvement, with a decrease of 3.4 (SD = 7.3) points, P = .02. All procedures were performed as an overnight observation and no complication occurred. Patients with PARD represent a complex subset of patients. VFIA is a straightforward intervention that may improve voice perception. Many patients reported subjective improvement despite minimal objective measurement. Further work is warranted to elucidate the role of injection in management of PARD.

Prevalence of Dysphonia in Children with Adenotonsillar Problems and the Impact of Surgery on Voice.

Adenotonsillar problems might affect the voices of patients with pediatric dysphonia, which is very common. This study aimed to evaluate the prevalence of dysphonia in patients with adenotonsillar problems and to demonstrate the impact of tonsillectomy and adenoidectomy (T & A) on their voice postoperatively. Single-institution retrospective study. Subjects were recruited from those children admitted for the purpose of T & A, and all underwent the auditory-perceptual assessment by speech therapists preoperatively. If children demonstrated scores >2 in the G parameter, we performed subjective (pediatric voice handicap index [pVHI], severity, talkativeness scale) and objective (Multi-Dimensional Voice Program) voice analyses preoperatively and 1 and 3 months postoperatively. Among the 1,197 patients, 91 (7.6%) patients showed dysphonia with a score >2 in the G parameter preoperatively. The follow-up voice analysis was completed in 51 and 22 patients after 1 and 3 months, respectively. Although there were no significant differences in the amount of speech preoperatively and postoperatively, the average visual analog scale score for dysphonia severity was significantly decreased at postoperative 1 month and postoperative 3 months. The average total pVHI score, jitter, shimmer, noise-to-harmonic ratio, and soft phonation index were significantly decreased at 1 and 3 months postoperatively. Subjective scores given by parents did not correlate with the acoustic parameters; however, the postoperative subjective parameters were significantly correlated with objective parameters. Voice problems were significantly improved after T & A in the short term and long term. In those with pediatric dysphonia, decreased mouth breathing and compliance with vocal hygiene would be helpful for voice improvement. 4 Laryngoscope, 131:2369-2375, 2021.

The Effect of the Mother's Participation in Therapy on Children with Vocal Fold Nodules.

Vocal fold nodules (VFN) are a bilateral epithelial thickening of the membranous vocal folds. In this study, children with VFN and their mothers took part in voice therapy. We then compared acoustic analyzes and subjective evaluations to those in previous literature to determine whether voice therapy is more effective for children with VFN when their mothers also take part in therapy. Children aged eight to 12 years who were diagnosed with bilateral VFN between January 2018 and January 2020 were included in this study. Participating children diagnosed with bilateral VFN were divided into two groups based on the wishes and cooperation of their families. Group 1 consisted of 16 patients; Group 2 included 17 patients. The children in Group 1 received voice therapy alone; children in Group 2 took part in therapy with their mothers. For all participants, the average fundemental frequency (F0), jitter percentages, shimmer percentages, maximum phonation time (MPT) and s/z ratios were measured. Pediatric voice handicap index (p-VHI) values were calculated as well. The two groups' measures pre-treatment and post-treatment were compared. Except for p-VHI, no significant difference was observed between the two groups. However, p-VHI post-treatment was significantly lower in Group 2 than in Group 1. Involving the families and even teachers of children with VFN in voice therapy can increase the effectiveness of therapy. The family's involvement increases the child's motivation in therapy. The mother's presence during therapy, supporting the child or even doing the work with the child, can be a very important source of motivation for the child, who may already be tired from school and other activities. Thus, the mother's involvement increases the child's compliance with and interest in therapy.

Dysphonia in Children. Descriptive Analysis of the Factors Involved, Clinical Parameters and Impact on Quality of Life

IntroductionThe prevalence of dysphonia in children is estimated at around 6%. Dysphonia in this age group is usually due to misuse of the voice that leads to the development of vocal fold injuries. This condition can negatively affect the child's self-esteem. The aim of the study is to describe the epidemiology of voice disorders in children in our area, perform an examination of the voice, as well as identify the impact of this pathology on quality of life. Material and methodWe present a descriptive study with 87 patients aged between 5 and 14 years old, diagnosed with dysphonia. Data collection was carried out in our centre between January 2016 and April 2019. We analysed epidemiological and clinical factors. The impact on quality of life was studied using the Pediatric Voice Handicap Index questionnaire. Results87 patients, 57 men (65.5%) and 30 women (34.5%) were included. Mean age 8.5 years (SD: 2.08; range 4–13). The most frequent phonatory disturbance was global muscle tension (88.5%). In the laryngoscopic examination, the most frequent finding was the presence of vocal nodules (45.9%). The average score on the Pediatric Voice Handicap Index was 24.3 points in total; 4.9 on the functional scale; 17.6 on the physical scale and 1.8 on the emotional scale. ConclusionA correct anamnesis that includes the family environment and practice of team sport is essential. The physical examination should include a laryngoscopic examination. There is an impact on the quality of life of patients with dysphonia perceived by them and their families; the physical component is perceived to be most affected. We consider a multidisciplinary approach to this condition necessary.

Barriers to Voice Therapy in Dysphonic Children

The most common etiologies of dysphonia in the pediatric population are vocal fold nodules and muscle tension dysphonia. Vocal therapy is the first line treatment for these disorders in children. Despite this, not all children undergo therapy. The goal of this study is to examine how factors such as patient demographics and parental perceptions differ between children that choose to undergo or not to undergo voice therapy. A retrospective review was conducted of all pediatric patients seen at a tertiary voice clinic between January 2014 and December 2017. Patients were included if diagnosed with vocal fold nodules and/or muscle tension dysphonia. Patients were divided into groups of children that received voice therapy at our institution and those that did not. Data include demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores. Distance to therapy site was approximated using patient zip codes. Three hundred and forty-six children were included, 224 (65%) boys and 122 (35%) girls. In the 2 years following initial diagnosis, 74 (21%) children participated in voice therapy at our institution. Patients who underwent voice therapy were older than those who did not (mean age: 9.1 [SD 3.5] vs 7.6 [SD 3.8] years; P=0.004). Patients who received voice therapy were more likely to live closer to the therapy site (mean distance: 15.5 [SD 13.0] vs 24.3 [SD 23.9] miles; P< 0.001). Likelihood of receiving voice therapy did not differ by gender or health insurance status (private vs public). Patients who underwent voice therapy had significantly greater CAPE-V Overall Severity scores than those who did not (mean score: 44.6 [SD 19.4] vs 37.4 [SD 18.0]; P = 0.003). Higher CAPE-V Strain scores were associated with increased likelihood of voice therapy. pVHI scores did not differ between the two groups. Older age, shorter distance to therapy site, and increased CAPE-V Overall Severity and Strain scores were associated with higher likelihood of receiving voice therapy. Gender, insurance status, and pVHI scores did not affect likelihood of receiving voice therapy. Patients may primarily consider ease of access and necessity of treatment when considering voice therapy.