Pediatric Voice-Related Quality Of Life Research Articles

Clinical analysis of 102 cases of pediatric vocal fold nodules

Objective:To evaluate the impact of vocal fold nodules on the quality of life of children, and to compare the efficacy between conservative management（voice hygiene education, etc.） and laryngeal microsurgery. Methods:A retrospective study was performed on 102 children with vocal fold nodules, who received treatment in Children's Hospital of Fudan University during the period from January 2020 to December 2022. According to the regime, the patients were divided into conservative management group and surgical treatment group; Cases are divided into pre-school age group （2-5 years old） and school-age group （6-12 years old） based on age. The pediatric voice-related quality of life （pVRQOL） was used to evaluate the impact of vocal fold nodules on the quality of life of children and differences in efficacy between two treatment regimens. Results:The pVRQOL scores of vocal fold nodule grades 1, 2, and 3 were 91.58±8.17, 78.87±12.49, 72.50±12.08, respectively. There were statistical differences between grade 1 and grade 2, and between grade 2 and grade 3. There were statistical differences between grade 1 grade 2, grade 2 and grade 3 （P<0.001）, suggesting that the higher the rating of vocal cord nodules, the lower the pVRQOL score of patients was. The pVRQOL score of the school-age group was 69.83±11.11, which is lower than that of the preschool group（87.59±8.63）, and the difference was statistically significant （P=0.042）. Vocal fold nodules had a significant impact on the pVRQOL score of school-age children. In the conservative management group, the pVRQOL scores before and after treatment were 83.99±12.66 and 87.26±9.58, respectively, and there was significant difference between the two groups（P=0.046）. Indirect voice therapy such as voice hygiene education could improve children's pVRQOL scores and was more effective for school-age children（P<0.001）. The microsurgical treatment had a more significant improvement in the pVRQOL score of children. Conclusion:The higher the rating of vocal fold nodules, the greater the impact on the quality of life of patients. Vocal fold nodules had a greater impact on the quality of life of school-age children than that of preschool children. Voice hygiene education could improve the quality of life of children, which was more evident in the school-age group. Compared with voice hygiene therapy, laryngeal microsurgery had a more significant effect on improving the pVRQOL score of patients. It is recommended to undergo laryngeal microsurgery for the treatment of vocal fold nodules for the requirement of improving the quality of life related to voice. During the 6-month follow-up period after surgery in this study, the short-term efficacy of laryngeal microsurgery in treating vocal cord nodules in children is clear, but the long-term efficacy needs further research.

Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency.

Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency.

Pediatric voice-related quality of life and acoustic analysis of voice: a study in schoolchildren

ABSTRACT Purpose: to assess the self-reported voice-related quality of life of schoolchildren without voice complaints and correlate it to acoustic parameters of voice. Methods: the research population comprised 31 children, mean age 6.5 (±0.17) years. The children’s perception of their voice-related quality of life was verified with the Pediatric Voice-Related Quality of Life Survey, which has 10 closed-ended questions and three domains. The acoustic parameters assessed were fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, and noise rate, besides the phonatory deviation diagram, based on the analysis of the emission of the sustained vowel /ɛ/ for 5 seconds. Results: all the children obtained scores close to 100% in the three domains of the Pediatric Voice-Related Quality of Life Survey. As for the acoustic parameters, most of them presented abnormal values in the phonatory deviation diagram and in shimmer. There was a difference between girls and boys only in fundamental frequency. Conclusion: the pediatric self-reported voice-related quality of life of the children studied had a positive impact, despite the acoustic changes found in the voices. There was no correlation between the pediatric voice-related quality of life and the acoustic parameters in voice in the group studied.

QUALITY OF LIFE IN DYSPHONIC CHILDREN MEASURED ON PEDIATRIC VOICE-RELATED QUALITY OF LIFE (PVRQOL) SCALE IN SERBIA.

SUMMARYHoarseness occurs in children of both genders, from the earliest age and beyond, and is caused by improper use or overuse of vocal apparatus. The study included 91 hoarse children aged 6-12 (study group) and 243 healthy children (control group) of the same age. The study group underwent detailed medical history, phoniatric examination, larynx fiber endoscopy, allergy treatment, audiologic treatment, and pulmonary treatment. Pediatric Voice-Related Quality of Life questionnaire, Serbian version (PVRQOL) was completed by parents of both groups of children. We did not find statistically significant differences in the hoarse children based on diagnosis (muscle tension disorder and vocal fold nodules) and age in physical domain, socio-emotional and global domain score (p>0.01). The results showed that parents did not recognize hoarseness as a health problem in children. There were significant gender differences in the group of children with hoarseness, i.e. parents in all three PVRQOL questionnaire domains recognized hoarseness as a significant health problem in girls, but not in boys. The presence of hoarseness impairs the quality of life in pediatric population. Social and emotional domains indicated greater impact in boys.

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.

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 application of parental version of pediatric voice-related quality of life in children with voice disorders

Objective:To evaluate the influence of voice disorders on children's quality of life through the parental version of pediatric voice-related quality of life（pVRQOL）. Method:Three hundred and eighty-six children from August 2017 to December 2018 were enrolled in this study. A total of 214 parents of children had voice disorders（dysphonic group）, and 172 parents of children were without voice disorders（control group）. Both groups were filled out the questionnaire containing the parental version of pVRQOL. Result:① The most common disease in children with voice disorder was vocal fold nodule, and boys were more susceptible to voice disorder than girls（71.5%, 28.5%）; ②In dysphonic group, the scores of total（91.40±8.63, 97.94±4.23）, physiology and function（87.55±10.98, 96.99±6.10）, social emotion（98.86 ±3.29, 99.73±1.08） were lower than those in control group（P<0.01）; ③In dysphonic group, there was a correlation between the parents' overall evaluation of the children's voice quality and the three dimensions of the parental version of pVRQOL（total: r=-0.398, P<0.01, physical function: r=-0.448, P<0.01, social-emotion: r=-0.125, P<0.05）. Conclusion:Voice disorders could cause a negative impact on children's voice related quality of life. pVRQOL could be applied to assess the voice-related quality of life in children with voice disorders.

Measuring Patient-Reported Health-Related Quality of Life in Velopharyngeal Insufficiency: Reliability and Validity of the Brazilian Portuguese Version of the VELO Instrument.

To test the Brazilian Portuguese velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for reliability and validity. Cross-sectional methodological study. Tertiary craniofacial medical center. Participants with VPI (VPI group, n = 60), with cleft and without VPI (no VPI/cleft group, n = 60), and with no cleft nor VPI (no VPI/no cleft group, n = 60) and their parents (n = 180). All patients with VPI 8+ years old and their parents completed the Brazilian-Portuguese VELO instrument and other questionnaires (Pediatric Quality of Life Inventory4.0, PedsQL4.0; Pediatric Voice-Related Quality of Life, PVRQOL; and Intelligibility in Context Scale, ICS) at baseline; patients with VPI and their parents completed the VELO instrument again 2 weeks later. The VELO instrument was tested for internal consistency, test-retest reliability, discriminant validity (participants with VPI against participants with no VPI), concurrent validity against other questionnaires, criterion validity against hypernasality severity, and construct validity against nasal air emission and overall velopharyngeal competence (speech construct) and velopharyngeal gap (anatomic construct). The VELO had excellent internal consistency (Cronbach α 0.99 for parents and 0.98 for participants with VPI) and test-retest reliability (all intraclass correlation coefficient > 0.87). The VELO discriminated well between VPI group and unaffected groups (all P < .05). The VELO was significantly correlated with the PedsQL4.0, PVRQOL, and ICS (-r > 0.75; P < .001). The VELO met criterion validity, speech construct validity, and anatomic construct validity (r > 0.7; P < .001). The Brazilian-Portuguese VELO instrument demonstrated reliability (internal consistency and test-retest) and validity (discriminant, concurrent, criterion, and construct).

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

Validation of the Mandarin Chinese Version of the Pediatric Voice-Related Quality of Life (pVRQOL)

The purposes of this study were to adapt and validate the English version of the pediatric Voice-Related Quality of Life questionnaire into Mandarin Chinese, and to determine the cutoff point for screening children with and without voice disorders. A total of 377 parents were enrolled from May 2016 to June 2017, including 195 parents of children with voice disorder (patient group) and 182 parents of children without voice disorder (control group). The internal consistency, test-retest, contents and clinical validity, and sensitivity and specificity were analyzed. The clinical cutoff point was determined. The questionnaire showed strong internal consistency in the patient group (α = 0.89 for the total score, α = 0.88 for the social-emotional domain, and α = 0.81 for the physical functioning domain) and good test-retest reliability (intra-class correlation coefficient = 0.93), as well as moderate to strong contents validity (r = 0.72-0.95). The total score and subscales scores in the patient group were significantly higher than the control group (P < 0.001). The mean score of the physical functioning domain was lower than that of the social-emotional domain in the patient group. The clinical cutoff point was 96.25 (sensitivity = 78.0%, specificity = 100.0%). The Mandarin Chinese version of pediatric Voice-related Quality of Life questionnaire was a valid and reliable questionnaire, which can be used as a screening test for the pediatric population with and without voice disorders.

Vocal Evaluation of Children with Congenital Hypothyroidism

To evaluate the vocal characteristics of a group of children with congenital hypothyroidism (CH) and the association of these characteristics with the children's clinical, laboratory, and therapeutic profiles. Observational, analytical, cross-sectional study including 200 prepubertal children, of whom 100 had CH (study group [SG]) and 100 had no CH (control group [CG]). The following parameters were evaluated: 1) history (identification, complaints, and interfering variables), 2) auditory-perceptual and acoustic evaluation (samples analyzed by a group of specialists, and objectively by a computer program), 3) self-assessment scores in the Pediatric Voice-Related Quality-of-Life (PVRQoL) survey, 4) laryngological evaluation (presence or absence of laryngeal lesions and data regarding glottal closure), and 5) medical records (CH etiology, age at treatment initiation, disease severity at diagnosis, treatment quality, and thyroid function tests on the day of the examination). In the perceptual assessment, 62.6% of the SG children passed, whereas 37.4% failed in the voice screening, but these results were comparable with those in the CG (P = 0.45). Both groups had mean/median acoustic measurements within the normal limits. The mean PVRQoL in the SG (99.3 ± 2.4) and CG (99.5 ± 1.7) were comparable (P = 1.00). Both SG (16.7%) and CG (15%) presented vocal cord lesions (P = 1.00). There was no association between voice/larynx characteristics and endocrinological data. Prepubescent children diagnosed with CH during neonatal screening and who have a lifelong history of adequate treatment of CH showed similar vocal and laryngeal characteristics compared with children without CH.

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.

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.

Voice related quality of life in pediatric patients with a history of prematurity

ObjectiveTo determine incidence of dysphonia in patients with history of prematurity and evaluate the correlation between dysphonia and risk factors unique to premature infants. The aim of this study is to determine parent-perceived vocal quality in patients with history of prematurity and whether duration of intubation, number of intubations, and incidence of patent ductus arteriosus repair were correlated with these perceptions. MethodsCohort study of premature patients presenting to outpatient clinics from January 2010 to January 2013 in tertiary care center. Patients gestational age ≤37 weeks at birth without history of tracheostomy or known vocal fold pathology were eligible. A volunteer sample was obtained from patients presenting in Otolaryngology clinics from January 2010 to January 2013 whose parents agreed to complete surveys. Outcomes were assessed via parental completion of pediatric voice outcomes score (pVOS) and pediatric voice-related quality of life (pVRQOL) instruments. The primary outcome assessed was the incidence of dysphonia in infants with a history of prematurity without known vocal pathology. Additionally, patient factors associated with dysphonia were evaluated. The hypothesis tested was formulated prior to data collection. ResultsSixty-nine participants were included. Mean age at follow-up was 28 (3–197) months. Mean gestational age was 29 (23–37) weeks. Mean intubation duration was 3 (0–22) weeks and median number of intubations was 1 (range 0–5). Voice outcome scores varied widely with pVRQOL scores demonstrating a mean of 89.2±18.1 (25–100) and pVOS with a mean of 11.4±2.2 (0–13). Univariate analysis utilized Spearman correlation coefficients for continuous variables and Wilcoxon Two-sample test for categorical groups. Significance was set at p<0.05. All significant univariate associations were placed in a multivariate model. Duration of intubation ≥4 weeks was the only factor which correlated with dysphonia on multivariate analysis (p=0.0028, OR=6.4, 95% CI=1.9–21.6). ConclusionsThe data suggest that prolonged intubation is associated with poorer long term parent-perceived voice quality in premature patients. Further study is required to correlate parent perceptions with objective vocal quality data and physical findings of vocal pathology. These data may increase the clinician's suspicion for and evaluation of dysphonia in this population.

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.

Use of Adjuvant Intralesional Bevacizumab for Aggressive Respiratory Papillomatosis in Children

Juvenile recurrent respiratory papillomatosis (RRP) can be an aggressive disease process necessitating frequent trips to the operating room with multiple anesthetics for tumor debulking and airway preservation. Adjuvant therapy, such as that which is reported in this article, may help reduce the number of operative procedures affected children need each year and therefore may also affect their overall quality of life (QOL). To describe our experience with intralesional bevacizumab (Avastin) treatment for children with severe RRP by comparing median number of surgical procedures per year, median duration of time between procedures, Derkay staging, and voice QOL before and after bevacizumab treatment. Prospective, consecutive case series. Tertiary care aerodigestive center. Ten children, aged 18 months to 18 years, with severe RRP necessitating more than 4 operative interventions in 1 year whose parents (or legal guardians) consented to intralesional bevacizumab treatment. Intralesional bevacizumab administered at concentration of 2.5 mg/mL for 3 consecutive injections (with 532-nm pulsed KTP [potassium titanyl phosphate] laser when necessary) at intervals of 2 to 3 weeks. Time between surgical procedures, number of procedures per year, Derkay staging, total Pediatric Voice-Related Quality of Life (PVRQOL) score, Emotional PVRQOL score, and Physical PVRQOL score defined by comparing the year leading up to first of 3 bevacizumab injections with the year following the third bevacizumab injection. The median duration of time between surgical procedures increased by 5.9 weeks after bevacizumab (P = .002). The median number of procedures per year decreased by 4 (P = .002). Derkay staging decreased by 6 (P = .03). The median total PVRQOL score increased by 25.5 (P = .02), the median Emotional PVRQOL score increased by 11.3 (P = .047), and the median Physical PVRQOL score increased by 14.3 (P = .047). Intralesional bevacizumab treatment may increase duration of time between surgical procedures and decrease number of procedures per year, while improving voice QOL.

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.