Using Hyaluronic Acid for Improving Vocal Function in a Prepubescent Boy With an Atrophied Right Vocal Fold.

OBJECTIVES: A single case study is reported of a child who underwent several surgical procedures as result of congenital grade III subglottic stenosis. The anterior aspect of the right vocal cord was damaged and underwent atrophy during one of these procedures. Now, an active 10-year-old, the patient has become increasingly aware of his vocal limitations on functional activities. Injection of hyaluronic acid into the vocal folds has been known to provide improved voice quality in adults although there are no known cases reported of this procedure in children. METHODS: This article reports voice outcomes after injection of hyaluronic acid into the Reinke's space in a single case study. Voice recordings were made before, after, and 1 month after injection. The voice recordings were subject to acoustic and perceptual analysis. RESULTS: Post and follow-up voice recordings demonstrate decreased jitter, shimmer, and harmonics-to-noise ratio. Perceptual evaluation indicates improved voice quality. CONCLUSION: Injection of hyaluronic acid in children who require voice augmentation is possible and may contribute to increased vocal function and improved voice outcomes.

Parent and Child Responses to the Pediatric Voice-Related Quality-of-Life Questionnaire.

OBJECTIVES: When assessing pediatric dysphonia, there are different approaches that can be taken in gathering a subjective view of the impact voice difficulties have on a child. Most valid questionnaires require parent-proxy reporting, although it has become increasingly important to gather the views of children themselves. This study reports a pilot study of an adaptation to the Pediatric Voice-Related Quality-of-Life Questionnaire (PVRQoL). METHODS: A total of 24 parent and child dyads were recruited from a tertiary pediatric voice clinic. Children were aged between 3 years and 8 months and 15 years and 3 months. Parents completed the existing PVRQoL questionnaire, whereas their children were given a child-adapted version. Follow-up completion of the child questionnaire was conducted after a 2-week period. RESULTS: There was a good correlation between the two time periods when children completed the adapted PVRQoL and also between parent and child responses. Of particular interest, however, was the different ratings on individual items by parents and their children with parents tending to overestimate the extent to which their children may be emotionally affected by their voice disorder. CONCLUSIONS: This study shows that children have much to tell about their own voice-related quality of life, so our conclusion is that they should also be self-assessed. The PVRQoL when adapted for use with children offers an additional insight that can be gathered in a relatively short timeframe and be considered with other assessments of vocal function.

Development of a minimum protocol for assessment in the paediatric voice clinic. Part 1: evaluating vocal function.

The European Laryngological Society (ELS) recommend that functional assessment of voice disorder in adults requires evaluation of a number of different parameters. The current paper presents a discussion of four of the five parameters highlighted in the ELS protocol: perceptual evaluation of voice, videostroboscopic examination, evaluation of aerodynamic performance in voice, and acoustic analysis. Subjective rating of voice in children is explored in a companion paper. These parameters have been extensively evaluated in adults, and a review of the literature pertaining to the paediatric population is presented.

Development of a minimum protocol for assessment in the paediatric voice clinic. Part 2: subjective measurement of symptoms of voice disorder.

The European Laryngological Society (ELS) recommend that functional assessment of voice disorder in adults requires evaluation of a number of different parameters. These include perceptual evaluation of voice, videostroboscopic imaging of vocal fold movement, acoustic analysis of specific voicing aspects, aerodynamic support for voicing, and a subjective rating of voice impact. No specific guidelines are available for children, but a similar range of parameters is needed to guide intervention and measure outcomes. The development of subjective voice measures for adults and their adaptations for the paediatric population are reviewed and compared to the research comparing these to evaluation of vocal function. The need for further refinement of child assessment measures, and a proposal of how these might be developed, is discussed.

Unplanned tracheostomy following pediatric cardiac surgery.

OBJECTIVE: To identify factors contributing to unplanned tracheostomy following cardiac surgery in children under 12 months without prior airway support. METHODS: Case series with chart review. RESULTS: Eleven patients were identified (eight male, three female). Eight were term, three preterm. Four had syndromes associated with cardiac disease. Age at cardiac surgery was 2.2 (0.1-5.2) months. Time between surgery and tracheostomy was 1.2 (0-3) months. Two groups were identified. The first had tracheobronchomalacia as the primary diagnosis (n = 9). Time post-surgery for tracheostomy was 1.2 (0.5-3) months. The second had bilateral vocal fold paralysis (n = 2). Both children had cardiac procedures that have recognized risk to the left recurrent laryngeal nerve (RLN). Both had cannulation of the right internal jugular vein at the time of surgery. Tracheostomy occurred within three days of the cardiac procedure. CONCLUSION: Investigations for tracheobronchomalacia should occur if a child continues to fail ventilator weaning or extubation following cardiac surgery. Risk of right RLN injury due to right vascular instrumentation should be minimized in left RLN prone procedures.