Voice outcomes and its impact on quality of life after open airway surgery in children.

INTRODUCTION: Open airway surgery is used to treat severe grades of laryngotracheal stenosis in children. Scarring of the airway following these procedures may lead to voice impairment and impact quality of life. This study was designed to characterize vocal outcome in children submitted reconstructive airway surgery and verify how this correlates to voice related quality of life in this population. MATERIAL AND METHODS: Children submitted to open airway surgery that had been decannulated for a minimum of 30 days and had functional speech were invited to participate. Pediatric Voice-Related Quality-of-Life survey (PVRQoL) was applied, consensus auditory perceptive of voice (CAPE-V) protocol was used for perceptual voice evaluation and acoustic analysis was performed using Praat software. RESULTS: Twenty children were enrolled in the study with an average age of 4 years and 8 months. Averages for PVRQoL exceeded normative values in 80% of the children. Half of the children had normal voice or mild dysphonia and half had moderate dysphonia, according to perceptual evaluation. Measures of F0, jitter and particularly shimmer were abnormal in most of the children. CONCLUSION: Voice quality varies from normal to moderately impaired in children following reconstructive airway surgery. Voice quality impacts quality of life in the majority of cases and the degree of dysphonia does not always correlate with voice related quality of life scores.

Bilateral Facial Paralysis and Deafness in a Child Treated for Acute Lymphoblastic Leukemia.

Involvement of the ear and temporal bone in acute leukemias are uncommon. We report a case of atypical mastoiditis with bilateral facial paralysis in a child diagnosed with Acute Lymphoblastic Leukemia (ALL). A 20-month-old male child was diagnosed with ALL and developed otorrhea unresponsive to antimicrobial treatment during the first week of chemotherapy followed by hearing loss, loss of balance, and bilateral facial paralysis. A CT scan of the mastoids showed cortical erosion of the temporal bone and presence of soft tissue contents filling the mastoid cells and external auditory canal bilaterally. Mastoidectomy was performed to collect material for analysis. Histopathologic examination of the material revealed an active chronic inflammatory process, with a moderate amount of plasma cells. Chemotherapy was reintroduced 3 weeks after the surgical procedure, and progressive improvement of otorrhea and imbalance was noted. Grade III House-Brackmann peripheral facial paralysis persisted on 6-month follow-up, and the patient is in rehabilitation program.