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Published on: December 1, 2023
Diagnostic contributions of videolaryngostroboscopy in the pediatric population
Melissa Mortensen1, Madeline Schaberg, Peak Woo
1Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, PO Box 800713, Charlottesville, VA 22903, USA. mm6nj@virginia.edu
Insights
Videolaryngostroboscopy (VLS) offers significant diagnostic value in children with prolonged dysphonia, revealing conditions beyond vocal cord nodules. This technique aids in identifying subtle mucosal diseases and inflammatory processes often overlooked in pediatric patients.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Diagnostic Imaging
Background:
- Pediatric dysphonia affects 5% of children, often diagnosed via flexible laryngoscopy.
- Videolaryngostroboscopy (VLS) is standard for adult dysphonia but less common in children.
- Traditional methods may overlook subtle causes of pediatric dysphonia.
Purpose of the Study:
- To evaluate the additional diagnostic yield of VLS in children with prolonged dysphonia.
- To determine if VLS offers advantages over traditional flexible laryngoscopy for pediatric voice disorders.
Main Methods:
- Retrospective chart review of pediatric patients (3-17 years) with dysphonia from 2001-2006.
- Patients underwent flexible or rigid VLS after initial flexible laryngoscopy and speech therapy.
- Diagnosis was established post-VLS evaluation.
Main Results:
- Eighty pediatric patients were included; 80 underwent VLS.
- 132 diagnoses were made, including 68 benign mucosal diseases (nodules, polyps, cysts, sulci), 41 inflammatory, 11 functional, 6 congenital, 4 traumatic, and 2 neurologic disorders.
- VLS identified various benign mucosal lesions and inflammatory conditions contributing to dysphonia, often overlooked previously.
Conclusions:
- VLS provides crucial diagnostic information in pediatric dysphonia, especially when initial treatments fail.
- The technique helps differentiate benign mucosal disorders and identify inflammatory processes.
- VLS findings in pediatric patients with dysphonia are significant and previously unreported, highlighting its utility beyond vocal cord nodules.
Objective:
Videolaryngostroboscopy (VLS) is a standard technique used for evaluating adult patients with dysphonia. However, while pediatric dysphonia affects 5% of children, children with dysphonia are traditionally examined with a flexible nasal endoscope. The purpose of this study was to determine whether VLS provides additional diagnostic yield in children.
Design:
A retrospective medical chart review was conducted from 2001 to 2006.
Setting:
Tertiary care center.
Patients:
Pediatric patients aged 3 to 17 years (mean age, 11 years) who presented with prolonged dysphonia. All patients were previously examined by flexible laryngoscopy and treated with speech therapy for a presumed diagnosis of vocal cord nodules.
Interventions:
Flexible or rigid VLS was performed.
Main Outcome Measure:
The diagnosis per patient established after VLS.
Results:
Eighty patients were included in the study: 50 underwent rigid VLS; 28 underwent flexible VLS; and 2 did not tolerate either procedure. A total of 132 diagnoses were made, including 68 benign mucosal diseases (41 nodules, 15 polyps, 8 cysts, and 4 sulci), 41 inflammatory disorders, 11 functional disorders, 6 congenital disorders, 4 traumatic injuries, and 2 neurologic disorders. Many patients received more than 1 intervention for their dysphonia, including antireflux medication and speech therapy, but 16 patients also underwent phonomicrosurgery.
Conclusions:
Patients with a history of prolonged dysphonia for whom treatment has failed should be referred for evaluation by VLS. Videolaryngostroboscopy elucidates subtle features of different disease processes; clarifies the differences between benign mucosal disorders that might require surgical intervention; and helps identify inflammatory processes that contribute to dysphonia. To our knowledge, these findings have not previously been reported in the pediatric population. Although most pediatric dysphonia can be attributed to benign nodules, our results show that inflammatory conditions and benign lesions other than nodules contribute to dysphonia and are often overlooked and undertreated.
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