Pediatric Voice-related Quality Of Life Scores Research Articles

The Effect of Parental Smoking on Voice-Related Quality of Life in the Pediatric Population

Exposure to cigarette smoke has significant effects on the respiratory mucosa. However, little is known about the effects of household smoke exposure on children's voice-related quality of life. The aim of this study was to elucidate the effect of parental smoking (PS) on voice-related quality of life in the pediatric population. The Pediatric Voice-related Quality of Life (PVRQoL) instrument was administered to the parents of 104 healthy children without any known voice disorder. The children were evaluated in two groups. The first group of children had no PS history and no household smoke exposure (non-PS group), in the second group, at least one parent of the child consumed tobacco products in the house (PS group). Social emotional and physical functional subdomains of the PVRQoL were also calculated. A total of 104 surveys were analyzed. The overall percentage of dysphonia in the PS group was 23.6%, whereas it was 6.1% in the non-PS group. The mean PVRQoL scores were 89.1 (±13.8) in the PS group and 97.7 (±4.7) in the non-PS group (P < 0.001). The mean physical functional-PVRQoL score was 35.4 (±7.2) in the PS group and 39.0 (±6.0) in the non-PS group. The mean social emotional-PVRQoL scores were 51.2 (±9.3) in the PS group and 57.2 (±5.6) in the non-PS group. The overall voice quality was significantly lower in the PS group than in the non-PS group. Exposure to PS has negative effects on voice-related quality of life in children that cannot be underestimated. Parents should be informed about the detrimental effects of passive smoking on the voice quality of their children. Inclusion of items in pediatric voice surveys about PS that lead to dysphonia would be suggested.

The Arabic translation, cultural adaptation, and validation of the pediatric voice-related quality of life survey

ObjectiveThe aim of this study was to develop an Arabic version of the pediatric voice-related quality of life (PVRQOL) and test its validity and reliability. Subjectsand methods: Fifty-one children with voice problems were included in the study along with 60 control children without any voice disorders. The translated Arabic PVRQOL and the Arabic pediatric voice handicap index (PVHI) have been distributed to the study subjects. The Arabic PVRQOL was tested for its internal consistency, test-retest reliability, and clinical validity.Results: the Arabic PVRQOL showed strong internal consistency and excellent test-retest reliability (Cronbach α = 0.9 and ICC = 0.92 respectively). There was a significant difference between the patients and control group regarding Arabic PVRQOL scores (P < 0.0001). Also, significant correlation was demonstrated between the Arabic PVRQOL and Arabic PVHI. ConclusionThe Arabic version of PVRQOL maintained its validity and reliability and may be considered in the assessment of voice disorders for Arabic speaking children.

Pediatric Dysphonia: A Cross-Sectional Survey of Subspecialty and Primary Care Clinics

ObjectivesPrevalence data for pediatric dysphonia are sparse and primarily collected either in the community or within pediatric otolaryngology clinics. The objectives were to determine the prevalence of dysphonia in children undergoing outpatient medical evaluation, and to ascertain whether the prevalence varies across pediatric subspecialty clinic populations in comparison to primary care. Study DesignCross-sectional survey. SettingTertiary care military medical center. Subjects and methodsFive hundred sixteen surveys were administered to caregivers of children undergoing evaluation in pediatric primary care and subspecialty clinics consisting of the pediatric voice-related quality of life (PVRQOL) instrument and questions regarding previous voice-related symptoms and diagnoses. Survey responses and PVRQOL scores were stratified by clinic type and compared to general pediatrics. ResultsA total of 492 surveys were analyzed. The overall prevalence of dysphonia in this cohort based on PVRQOL is 19.3%. Every clinic except endocrinology and ophthalmology individually had an elevated prevalence compared to the expected community prevalence (11%). Compared to general pediatrics, PVRQOL scores were lower in developmental pediatrics (P < 0.001), genetics (P < 0.001), and otolaryngology (P = 0.033) clinics. Children from genetics and developmental pediatrics were more likely to have had speech therapy. ConclusionsIn this cohort of children seeking care within a medical center, overall prevalence of dysphonia was quite high in comparison to community-based prevalence data. Not surprisingly, patients of developmental pediatrics, genetics and pediatric otolaryngology have lower PVRQOL scores than primary care. These results emphasize that all practitioners caring for children should seek to identify voice disorders and reinforce that subspecialists who treat developmentally challenged children should exert particular vigilance.

Indirect vs Direct Voice Therapy for Children With Vocal Nodules

ImportanceBenign vocal fold nodules affect 12% to 22% of the pediatric population, and 95% of otolaryngologists recommend voice therapy as treatment. However, no randomized clinical trials that we are aware of have shown its benefits.ObjectiveTo determine the impact of voice therapy in children with vocal fold nodules according to pretherapy and posttherapy scores on the Pediatric Voice-Related Quality of Life (PVRQOL) survey; secondary objectives included changes in phonatory parameters.Design, Setting, and ParticipantsFor this multicenter randomized clinical trial, 114 children ages 6 to 10 years with vocal fold nodules, PVRQOL scores less than 87.5, and dysphonia for longer than 12 weeks were recruited from outpatient voice and speech clinics. This age range was identified because these patients have not experienced pubertal changes of the larynx, tolerate stroboscopy, and cooperate with voice therapy. Participants were blinded to treatment arm.InterventionsParticipants received either indirect or direct therapy for 8 to 12 weeks. Indirect therapy focused on education and discussion of voice principles, while direct treatment used the stimulus, response, antecedent paradigm.Main Outcomes and MeasuresThe primary outcome measure was PVRQOL score change before and after treatment. Secondary phonatory measures were also compared.ResultsOverall, 114 children were recruited for study (mean [SD] age, 8 [1.4] years; 83 males [73%]); with 57 randomized to receive either indirect or direct therapy. Both direct and indirect therapy approaches showed significant differences in PVRQOL scores pretherapy to posttherapy. The mean increase in PVRQOL score for direct therapy was 19.2, and 14.7 for indirect therapy (difference, 4.5; 95.3% CI, −10.8 to 19.8). Of 44 participants in the direct therapy group, 27 (61%) achieved a clinically meaningful PVRQOL improvement, compared with 26 of 49 (53%) for indirect therapy (difference, 8%; 95% CI, −12 to 28). Post hoc stratification showed robust effects in the direct therapy group for older children (Cohen d = 0.50) and the latter two-thirds of participants (Cohen d = 0.46). Vocal fold nodules reduced in size in 31% (22 of 70) and completely resolved in 11% (8 of 70) of participants who consented to a second set of images after going through the recruitment process.Conclusions and RelevanceBoth direct and indirect voice therapy improved voice-related quality of life in children with vocal fold nodules, although there was no significant difference between approaches. Future studies may focus upon which voice therapy approaches are effective in treating age-defined populations.Trial Registrationclinicaltrials.gov Identifier: NCT01255735

Analysis of voice-related quality of life in children.

To analyze the voice-related quality of life of children with dysphonia and without voice disorders in a population sample of Belo Horizonte, Minas Gerais state, Brazil. Study participants were 420 children, 98 with dysphonia and 322 without voice disorders, aged six to 10 years, enrolled in public and private elementary schools. The random sample was divided into two groups: dysphonic children (study group - SG) and children without vocal disorders (control group - CG). Assessment of the children's voices was performed by four voice-expert speech-language pathologists with more than 10 years of experience in this field, using the auditory-perceptual parameter of overall severity of dysphonia graded in four points. The results were analyzed based on the evaluation of children's voices conducted by the speech-language pathologist that presented the highest intra-rater agreement, using the Kappa statistical method. The Pediatric Voice-related Quality-of-Life (PVRQoL) survey was answered by the children's parents/legal guardians. Descriptive statistical analysis of the data was conducted using the Student's t-Test. Of the 420 children evaluated, 98 were dysphonic (SG) and 322 presented no voice alteration (CG). Analysis of the three PVRQoL scores (total, physical, and social-emotional) showed no difference between the groups tested (SG and CG). No difference was observed in PVRQoL values regarding the degree of vocal deviation. Dysphonia does not have a negative impact on the voice-related quality of life of children considering the response of secondary informants.

Evaluation of Pediatric Voice Handicap Index and Pediatric Voice Related Quality of Life before and after adenotonsillectomy in pediatric population

ObjectiveTo study changes in Pediatric Voice Handicap Index (PVHI) and Pediatric Voice Related Quality of Life (PVRQOL) before and after adenotonsillectomy in short term follow up. MethodsQuasi-experimental (before and after study). Eighty-six children aged 3–13 years (58 boys, 28 girls) with adenotonsillar problems (whether with obstructive or infectious surgical indications) who were admitted for adenotonsillectomy procedure. Parents of children were asked to complete PVHI and PVRQOL questionnaires prior to surgery and 1 month after it. ResultsReliability of the PVRQOL and PVHI was established by evaluation of Cronbach α value. Cronbach α for PVHI was 0.92 and for PVRQOL it was 0.83. Preoperative values for the PVHI were: mean±SD; 14.39±14.65. Preoperative values for the PVRQOL were: mean±SD; 92.60±10.82. PVHI showed significant improvement after surgery: mean±SD; 2.93±6.98 (P<0.001). Postoperative PVRQOL had a significant improvement: mean±SD; 98.11±5.82 (P<0.001). ConclusionAdenotonsillectomy improved PVHI and PVRQOL scores in children with adenotonsillar problems, regardless of obstructive or infectious surgical indications.

Pediatric Dysphonia: A Cross‐sectional Survey of Subspecialty Care Clinics

Objectives: 1) Determine the prevalence of caretaker reported dysphonia in children undergoing medical evaluation. 2) Determine whether subspecialty pediatric clinics are associated with variable patterns of pediatric dysphonia compared to primary care. Methods: Cross-sectional survey recording demographic data, caretaker perception of their child’s voice, and the validated pediatric voice related quality of life (PVRQOL) instrument administered to caregivers of children undergoing evaluation in primary care and subspecialty clinics. Survey responses and PVRQOL scores were stratified by clinic type and compared to general pediatrics using Fisher’s exact test for categorical data and the Wilcoxon Mann Whitney test for interval data. Results: A total of 406 complete surveys were analyzed. The mean PVRQOL score for all children was 90.6 (95%CI:88.7, 92.4). Compared to general pediatrics, PVRQOL scores were lower in developmental pediatrics ( P = .0004), genetics ( P = .0240), and otolaryngology ( P = .0332) clinics. Children in developmental pediatrics also were more likely to have a prior speech evaluation ( P &lt; .001) and speech therapy ( P = .001). Otolaryngology patients were more likely to have undergone speech evaluation ( P = .030). Of note, no difference was found comparing PVRQOL scores in general pediatrics to gastroenterology ( P = .2086) or pulmonology ( P = .6633). Conclusions: Children undergoing evaluation in developmental pediatrics, genetics, and otolaryngology have lower PVRQOL scores than children evaluated in primary care. No other significant differences between subspecialty clinics were identified. These data reinforce that all practitioners caring for children should seek to identify voice disorders and highlight the importance of subspecialists who treat developmentally challenged children to exert particular vigilance.

Quality of Life and Voice Outcomes after Thyroid Ala Graft Laryngotracheal Reconstruction in Young Children

(1) To assess the long-term impact of thyroid ala cartilage laryngotracheal reconstruction (TAC-LTR) on health-related quality of life (QOL) in infants using 4 validated instruments: Health Utility Index version 3 (HUI3), Pediatric Voice-Related QOL (PVRQOL), Impact on Family Questionnaire, and a visual analog scale and (2) to perform acoustic and perceptual voice assessments to evaluate longterm voice quality outcomes. Prospective study. Tertiary academic pediatric hospital. Eligible children who received TAC-LTR before the age of 24 months between 1995 and 2007. Interviews with parents and children using 4 validated instruments, voice analyses, and endoscopic evaluation were performed. Twelve patients (7 male, 5 female, median age 10 years) were enrolled over a 6-month period. The mean age at LTR was 5 months (range, 1-20 months), and the mean study followup period was 9 years (range, 2-14 years). The average speech HUI3, PVRQOL, and Impact on Family scores were 0.83 (95% confidence interval = 0.74, 0.92), 0.93 (interquartile range [IQR] = 0.81, 1.00), and 0.65 (IQR = 0.54, 0.92), respectively. All acoustic scores were either normal or mildly abnormal for the variables jitter, shimmer, noise-to-harmonic ratio, peak amplitude variation, and fundamental frequency. The Consensus Auditory-Perceptual Evaluation of Voice overall severity score was in the normal to mildly abnormal range for 8 of 9 patients. This is the first study to explore and quantify longterm QOL and voice quality in children following LTR with thyroid ala graft at a very young age. Most patients had very good functional voice outcome as evidenced by the HUI3 and PVRQOL scores. This was corroborated by acoustic and perceptual voice assessments.

Outcomes of early infancy laryngeal reconstruction on health- and voice-related quality of life

Objective We aimed to study the voice, voice-related quality of life (VRQoL) and health-related quality of life (HRQoL) of children who in early infancy underwent a laryngeal split (cotton plasty operation) at the Helsinki University Central Hospital between January 1990 and December 2005. Methods A retrospective review identified 17 children, of whom 10 fulfilled the inclusion criteria and participated in the study. Age- and gender-matched volunteers formed a control group. We used generic 16D and 17D questionnaires to assess HRQoL; the Pediatric Voice Outcomes Survey (PVOS) and the pediatric voice-related quality of life (PVRQoL) instrument served to assess VRQoL. The children underwent indirect laryngoscopy and perceptual voice assessment. Results HRQoL and PVRQoL scores did not differ between subjects and controls. The subjects had lower PVOS scores than did the controls ( P < 0.01). Perceptual assessment revealed that the subjects’ voices were worse off according to the following dimensions: voice is strained, voice is hoarse or husky, and voice is weak/does not resonate ( P < 0.05). Conclusions This study adds to the knowledge on the long-term effects of laryngeal split on children through assessment of their HRQoL and PVRQoL. The study subjects’ lower PVOS scores and findings of perceptual assessment point to the effect of cotton plasty on VRQoL and voice.

Use of 532-nm Pulsed Potassium Titanyl Phosphate Laser and Adjuvant Intralesional Bevacizumab for Aggressive Respiratory Papillomatosis in Children

To describe the initial pediatric experience with intralesional bevacizumab (Avastin) treatment for children with severe, recurrent respiratory papilloma (RRP). Retrospective medical chart review. Tertiary care multidisciplinary aerodigestive center. Three children, aged 3 to 6 years, with severe RRP requiring more than 4 operative interventions in 1 year whose parents (or legal guardians) consented to adjuvant treatment with intralesional bevacizumab. All 3 children were treated as follows: surgical debridement with a microdebrider, pulsed potassium titanyl phosphate laser treatments, and adjuvant intralesional injections with bevacizumab (1.25 mg total). Time interval between operative interventions, Derkay severity scale for RRP, and pediatric voice-related quality of life (PVRQOL) scores. All 3 children demonstrated increased time between operative interventions. Two children had a substantial decrease in their Derkay score and improved PVRQOL scores. One child, although time between operative interventions improved, did not have any change in Derkay score and required further adjuvant therapy. Injectable bevacizumab appears to show some efficacy in prolonging the time between treatments and therefore reducing the number of treatments per year in children with severe RRP. However, before any meaningful conclusions can be drawn, further studies must be conducted in the form of head-to-head trials looking specifically at the issues of time between treatment intervals, efficacy of one adjunct over another, vocal outcomes, and whether several adjunctive treatments confer advantage over 1 treatment. In-depth and careful informed consent is mandatory for these studies so that parents are aware of the risks and benefits (known and unknown) before such individualized decisions are made.

Pediatric Voice-Related Quality of Life: Findings in Healthy Children and in Common Laryngeal Disorders

Although several instruments have been validated to assess voice quality, the incidence and degree of impairment in normal, healthy children has not been widely reported. It is hypothesized that healthy children outside a medical setting do not demonstrate impairment as measured by the Pediatric Voice-Related Quality of Life (PVRQOL) instrument; in contrast, patients with vocal fold paralysis (VFP), vocal nodules (VNs), and paradoxical vocal fold dysfunction (PVFD) have significant impairment as compared to control populations. The PVRQOL was measured prospectively in children with VFP, VNs, and PVFD. The findings were compared to findings in 100 children surveyed at the 2006 Wisconsin State Fair. Of the 100 surveys of healthy children and their parents, 95 were completed correctly; their mean (+/- SD) PVRQOL score was 96.8 +/- 5.85. The VFP patients (n = 11; mean PVRQOL score, 70.5 +/- 28.6) reported significant impairment (p < .0001, unpaired t-test). This was also true of patients with VNs (n = 13; PVRQOL score, 84.8 +/- 9.4; p < .0001) and PVFD (n = 25; PVRQOL score, 86.7 +/- 14.3; p < .0001); statistically significant differences were also noted for the Social-Emotional and Physical-Functional domains for each of the 3 disease states compared to the group of healthy children (p < .001). The PVRQOL scores of healthy children reveal essentially no self-reported vocal impairment. In contrast, common disorders such as VNs, VFP, and PVFD demonstrate statistically significant impairment in age-matched children for total PVRQOL, as well as for the Social-Emotional and Physical-Functional domains. This is the first report of normative PVRQOL data in children.

The impact of gender and age on voice related quality of life in children: Normative data

Although several instruments are available to measure voice quality in children, their application to a normal population and major demographic subgroups has not been described. It is hypothesized that there is no measurable difference in self-reported voice related quality of life between gender and age groups within a population of normal children as measured by the Pediatric Voice-Related Quality of Life (PVRQOL) instrument. The PVRQOL instrument was used to prospectively survey a cohort of children in series at the Wisconsin State Fair. PVRQOL scores may range from 0 (complete dysfunction) to 100 (no dysfunction). Comparisons were made between age and gender groups in order to test the null hypothesis. Of the 100 surveys completed by parents of children, 93 were performed correctly and had evaluable data (age range 2-17 years, mean 9.8). The mean PVRQOL score was 97.0+/-5.6. There was no difference between females and males (97.5+/-5.83 versus 96.5+/-5.3, p>0.05, unpaired t-test); however, within the pre-pubescent school age subjects, a diminished PVRQOL was reported for boys (95.5+/-6.37) as compared to girls (98.5+/-3.10, p<0.05, unpaired t-test). Further subgroup analysis revealed no significant difference (p>0.05) between age groups or gender. Amongst a random group of children without voice complaints queried outside of a medical center, self-reported PVRQOL showed no significant dysfunction. This is the first report of gender and age-specific normative PVRQOL data in children. A score of 86 or greater on the PVRQOL instrument represents a normal voice related quality of life.

Validation of the Pediatric Voice-Related Quality-of-Life Survey

To validate the Pediatric Voice-Related Quality-of-Life (PVRQOL) survey, which was designed to assess voice changes over time in the pediatric population. Prospective longitudinal study. Outpatient pediatric otolaryngology office practice. One hundred twenty parents of children aged 2 through 18 years having a variety of otolaryngological diagnoses including disorders that affect the voice. The previously validated Pediatric Voice Outcomes Survey and the PVRQOL were jointly administered to the parents of the study participants. Test-retest reliability was accomplished by having 70 caregivers repeat the instrument 2 weeks after the initial visit. The Cronbach alpha value was calculated to determine reliability. Instrument validity was determined by examining convergent and discriminant validity. Correlation of PVRQOL scores with Pediatric Voice Outcomes Survey scores. Reliability of the PVRQOL was established by evaluating the Cronbach alpha value (.96; P<.001) and by test-retest reliability (weighted kappa value, 0.8). Validity of the PVQROL was tested by evaluating its ability to show significant change in voice-related quality-of-life after adenoidectomy (discriminant validity) (P<.001). The PVQROL also proved valid when the overall score was correlated with the previously validated Pediatric Voice Outcomes Survey (r = 0.7; P<.001). The PVRQOL is a more comprehensive survey than the previously validated Pediatric Voice Outcomes Survey and is another valid instrument to examine the health-related quality-of-life issues in pediatric voice disorders.