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Measurement reliability of phonation threshold pressure in pediatric subjects
Matthew R Hoffman1, Austin J Scholp1, Calvin D Hedberg1
1Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
Insights
Phonation threshold pressure (PTP) measurement in children is reliable using either labial or mechanical interruption methods. These noninvasive techniques can aid in pediatric voice assessments.
Area of Science:
- Speech and Hearing Sciences
- Laryngology
- Pediatric Voice Assessment
Background:
- Phonation threshold pressure (PTP) is sensitive to laryngeal biomechanics and often elevated in pathology.
- PTP measurement in children is limited due to task performance and reliability challenges.
- PTP is the minimum subglottal pressure (Ps) required for voice production.
Purpose of the Study:
- To evaluate the reliability of PTP and Ps measurements in children using labial and mechanical interruption techniques.
- To compare the efficacy of different interruption methods for PTP assessment in pediatric populations.
Main Methods:
- A pilot study involving 22 children aged 4-17 years.
- Two interruption methods were used: labial interruption (/pα/ task) and mechanical interruption (sustained /α/ with balloon valve).
- PTP and Ps were measured, and intrasubject coefficients of variation were calculated and compared across methods and with age.
Main Results:
- Mean PTP and Ps were higher with labial interruption compared to mechanical.
- Intrasubject variability for PTP and Ps was similar between the labial and mechanical methods.
- Reliability of mechanical interruption was age-dependent when using a mask.
Conclusions:
- Both labial and mechanical interruption methods offer comparable reliability for PTP measurement in children.
- Mechanical interruption with a mouthpiece may be preferable to a mask.
- PTP measurement is a reliable, noninvasive tool that can supplement pediatric voice evaluations.
Objectives/Hypothesis:
Phonation threshold pressure (PTP), the minimum subglottal pressure (Ps ) required for phonation, is sensitive to changes in laryngeal biomechanics and is often elevated with pathology. Little is reported on PTP in children; challenges with task performance and measurement reliability represent barriers to routine clinical assessment.
Study Design:
Pilot study evaluating PTP and Ps measurement reliability in children using labial and mechanical interruption.
Methods:
Twenty-two subjects aged 4 to 17 years (10.7 ± 3.9 years) participated. Ten trials were performed for each method; task order was randomized. For labial interruption, subjects produced /pα/ five times at softest (onset PTP) and comfortable amplitude. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times for 250 ms each; mechanical interruption was performed with a mouthpiece and mask. PTP was recorded as the difference between Ps and supraglottal pressure at phonation cessation (offset PTP). Mean PTP and Ps and intrasubject coefficients of variation were compared. Correlations with age were evaluated.
Results:
Mean PTP (P < .001) and Ps (P = .005) were higher for labial interruption. Intrasubject coefficients of variation for PTP (P = .554) and Ps (P = .305) were similar across methods. Coefficient of variation was related to age for mechanical-mask trials only (r = -0.628, P = .00175).
Conclusions:
Differences in means are likely related to differences in task and PTP hysteresis effect. Reliability is comparable with all methods; using a mouthpiece may be preferable to a mask for mechanical interruption. Measurement of PTP is noninvasive, reliable, and may be a useful adjunct in pediatric voice assessment.
Level Of Evidence:
3b Laryngoscope, 129:1520-1526, 2019.
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