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Dysphonia in extremely preterm children: A longitudinal observation
Victoria Reynolds1, Suzanne Meldrum1,2, Karen Simmer1,3
1a University of Western Australia, School of Paediatrics and Child Health , Crawley , Australia.
Insights
Dysphonia, or voice disorders, can persist in extremely preterm children despite some improvement. Individual voice quality varies, and further research is needed to understand these voice problems.
Area of Science:
- Pediatric Otolaryngology
- Neonatology
- Speech-Language Pathology
Background:
- Dysphonia is a recognized complication of preterm birth.
- Childhood voice disorders often resolve spontaneously, but prognosis is unknown for extremely preterm infants with laryngeal pathology.
- Neonatal intubation can lead to structural laryngeal issues and supraglottic hyperfunction, impacting voice quality.
Purpose of the Study:
- To assess the incidence and severity of dysphonia in children born at < 25 weeks' gestation.
- To evaluate changes in voice quality over time in this population.
- To explore individual variability in voice disorder progression.
Main Methods:
- Pilot study involving 10 extremely preterm children (9.67-17.08 years) undergoing repeat voice assessment.
- Primary outcome: Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) severity scores.
- Secondary outcomes: Acoustic Voice Quality Index and Pediatric Voice Handicap Index scores.
Main Results:
- Perceptual dysphonia severity scores significantly decreased on repeat assessment.
- No significant changes observed in objective voice measures or quality of life scores.
- Significant individual variation in CAPE-V scores (-36 to +1); no participant achieved normal voice quality.
Conclusions:
- Group data analysis masked considerable individual variability in voice disorder progression.
- Dysphonia appears persistent in extremely preterm children, with unknown underlying mechanisms for individual variation.
- Further research is crucial for understanding voice disorder progression and informing treatment.
Introduction:
Dysphonia is a potential long-term complication of preterm birth. Childhood voice disorders caused by vocal hyperfunction resolve with pubertal changes to the vocal mechanism in many cases. In extremely preterm children, whose voice quality is affected by supraglottic hyperfunction adapted secondary to underlying structural laryngeal pathology sustained during neonatal intubation, the prognosis is unknown.
Methods:
A pilot study was conducted to assess the incidence and severity of dysphonia in children born at < 25 weeks' gestation. Ten individuals, aged between 9.67 and 17.08 years, presented for repeat assessment in a replication and extension of the original study. The mean period between assessments was 2.85 (SD 0.38) years. The primary outcome measure was the severity score on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), with the Acoustic Voice Quality Index score as the secondary outcome measure. Scores on the Pediatric Voice Handicap Index were also compared.
Results:
Perceptual dysphonia severity scores were significantly lower on repeat assessment, but no differences were observed in objective or quality of life scores. Individual variation was observed: the difference in CAPE-V scores ranged from -36 to + 1. No participant presented with normal voice quality on repeat assessment.
Discussion:
Analysis of group data masked individual variability in this series. Mechanisms underlying such individual variation are currently unknown. These data suggest that dysphonia is persistent in extremely preterm children.
Conclusion:
Further investigation is warranted to elucidate the progression of voice disorders in extremely preterm children, to inform prognostic predictors and treatment decisions.
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