Laryngeal reconstruction in children. Assessment of vocal quality.

During the past decade, the outcome of laryngotracheal reconstruction in children has improved substantially regarding airway patency. Now that we feel comfortable with airway results, attention should be directed toward vocal quality. The aims of this article are to present our evaluation process, which has been developed during the past 3 years, and our assessment of results. Six patients who underwent successful laryngotracheal reconstruction and could be examined preoperatively and postoperatively were studied. Information about disease and reconstruction techniques was recorded. Vocal quality assessment was done using psychoacoustic evaluation and objective techniques, including acoustic analysis. Children offer a specific challenge, especially when their chronological or developmental age is younger than 3 years. Objective assessment still lacks the ability of using cooperative patients, and adequate samples for acoustic analysis are difficult to obtain and standardize. Preoperative abnormalities continued to persist postoperatively. Laryngotracheal reconstruction is instrumental in making oral communication possible, but the vocal quality is disturbed in most patients.

Vocal quality of decannulated children following laryngeal reconstruction.

Laryngotracheal reconstruction with expansion surgery is a reliable method for treatment of laryngotracheal stenosis in children. It allows for decannulation of the patient and restoration of vocal communication. Previous information regarding vocal quality in these patients has been scant. Sixteen children who underwent successful laryngotracheal reconstruction were evaluated using a standardized voice assessment during each of the following: phoneme prolongation, counting, storytelling, and spontaneous conversation. Interjudge ratings were obtained to establish reliability. The location and severity of the laryngotracheal stenosis and the method of treatment were reviewed. Twelve children have a functional voice compared to six preoperatively. Overall, vocal parameters suggested a particular pattern consisting of a lower than optimal pitch and a restricted pitch range. Laryngotracheal reconstruction does make oral communication possible for children who would otherwise have persistent tracheotomy. However, vocal quality appears to be disturbed in most of the patients.