Evaluation of Pediatric Posterior Glottic Diastasis Using Dynamic Voice Computed Tomography

Area of Science:

• Laryngology
• Pediatric Otolaryngology
• Voice Disorders

Background:

• Posterior glottic diastasis (PGD) is a significant cause of dysphonia in children with a history of airway reconstruction or prolonged intubation.
• Endoscopic posterior cricoid reduction (ePCR) is a surgical technique to address PGD by reducing the posterior glottic gap.

Purpose of the Study:

• To describe pediatric PGD using dynamic voice computed tomography (DVCT).
• To establish surgical parameters for ePCR by comparing posterior glottic gaps in dysphonic and non-dysphonic children.
• To evaluate the efficacy of ePCR in improving voice function.

Main Methods:

• Retrospective review of DVCTs from 2014-2023 in pediatric patients undergoing ePCR and non-dysphonic controls.
• Analysis of ePCR operative reports, pre- and postoperative Pediatric Voice Handicap Index (pVHI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores, and aerodynamic measures.

Main Results:

• Dysphonic patients (n=17) had significantly larger posterior glottic gaps (median 2.4 mm) compared to non-dysphonic controls (n=19, median 1.3 mm).
• The average width of cricoid removed during ePCR was 1.6 mm.
• Significant improvements were observed in pVHI (55.5 to 34.6) and CAPE-V (52.7 to 36.5) scores post-ePCR.

Conclusions:

• A posterior glottic gap of 1.3 mm is tolerated in children without dysphonia.
• Pediatric patients with PGD present with a median gap of 2.4 mm, which was effectively reduced by 1.6 mm via ePCR.
• ePCR demonstrated significant improvement in dysphonia, optimizing management for pediatric PGD.