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Prevalence of Voice Disturbances in the Pediatric Craniofacial Patient Population
Mark A Fritz1, Scott M Rickert2
1Department of Otolaryngology, New York University School of Medicine, New York, New York, USA mark.andrew.fritz@gmail.com.
Insights
Pediatric craniofacial patients often experience voice disturbances, with dysphonia being common, frequently due to iatrogenic causes. The pediatric Voice Handicap Index (pVHI) effectively quantifies voice-related disability in this population.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Speech-Language Pathology
Background:
- Craniofacial disorders are associated with a higher incidence of voice disturbances in children.
- Understanding the prevalence and characteristics of these voice issues is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of voice disturbances in pediatric patients with craniofacial conditions.
- To validate the pediatric Voice Handicap Index (pVHI) as a tool for assessing voice-related disability in this population.
Main Methods:
- A case series with chart review was conducted at a tertiary care center.
- 366 pediatric patients were evaluated by a pediatric otolaryngologist in a craniofacial clinic.
- Patients completed the pVHI, and underwent laryngoscopy and videostroboscopy to characterize voice disturbances.
Main Results:
- 77% of patients were referred for airway or voice issues. Dysphonia was present in 10.7% of referred patients, with over half linked to iatrogenic causes.
- Hypernasality and hyponasality affected 31.7% and 21.3% of patients, respectively.
- pVHI scores varied significantly based on the type of voice disturbance, indicating its utility in quantifying disability.
Conclusions:
- Pediatric craniofacial patients exhibit a higher prevalence of dysphonia compared to the general pediatric population.
- Iatrogenic factors are a significant cause of dysphonia in this cohort.
- The pVHI is a valuable tool for quantifying voice-related disability, including dysphonia, hypernasality, and hyponasality, in pediatric craniofacial patients.
Objective:
To report on the prevalence of voice disturbances in the pediatric craniofacial population and to prove that the pediatric Voice Handicap Index (pVHI) is a useful questionnaire for this unique population.
Study Design:
Case series with chart review.
Setting:
Tertiary care center.
Subjects:
Pediatric patients seen by a pediatric otolaryngologist in a craniofacial clinic.
Methods:
Consecutive patients (N = 366) seen by a single pediatric otolaryngologist in a craniofacial clinic from July 2011 to September 2012 were included. Any patient specifically referred for airway problems or voice difficulties completed a pVHI questionnaire. Patients each underwent an evaluation including flexible fiberoptic laryngoscopy and videostroboscopy. Voice disturbance was further characterized into dysphonia, hypernasality, or hyponasality.
Results:
Of all the patients evaluated, 280 (77%) were specifically referred for airway problems or voice disturbance. Of those referred, 39 (10.7%) were found to have an organic vocal fold pathology causing dysphonia, as seen on the videostroboscopic examination; 53.7% of these lesions were attributable to potential iatrogenic causes. Hypernasality and hyponasality were seen in 116 (31.7%) and 78 (21.3%) patients, respectively. The pVHI was 3.95, 26.3, 11.34, and 10.53 for those with no voice disturbance, dysphonia, hypernasality, and hyponasality, respectively.
Conclusion:
Pediatric patients with craniofacial disorders have a higher prevalence of dysphonia than the general pediatric population. The majority of causes of dysphonia in these patients are possibly iatrogenic in origin. The pVHI serves as a useful questionnaire in this unique patient cohort to quantify the disability from not only dysphonia but also hypernasality and hyponasality.
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