Voice problems after pediatric laryngotracheal reconstruction: videolaryngostroboscopic, acoustic, and perceptual...

Children with laryngotracheal stenosis undergo laryngotracheal reconstruction (LTR) to permit tracheostomy decannulation. We conducted voice assessments of 8 pediatric LTR patients with voice problems. Perceptual ratings and acoustic measures were taken in 5 patients and videolaryngoscopy/laryngostroboscopy was conducted in all 8. Results of perceptual evaluation were abnormal for hoarseness, breathiness and pitch. Acoustic analysis revealed a markedly decreased fundamental frequency of phonation, diminished frequency range, decreased vocal intensity, and shortened maximum phonation time. Videolaryngostroboscopic findings are summarized as follows: 2 patients had severe glottal insufficiency, 3 patients had vocal fold asymmetry in stiffness and position, and 3 patients demonstrated phonation using supraglottal structures. Use of the stroboscope contributed to diagnosis in 3 of 8 patients. Reverse (inhalatory) phonation was observed in three patients. Concomitant articulation problems were exhibited frequently. Sentence production was shortened by the decreased phonatory duration. When coupled with the abnormal voice quality, speech intelligibility was significantly affected. Voice problems following decannulation were observed to persist as a long-term difficulty in some LTR patients.