Predictors of voice outcome in pediatric non-selective laryngeal reinnervation.

OBJECTIVES: Non-selective laryngeal reinnervation (NSLR) using the ansa cervicalis to the recurrent laryngeal nerve (RLN) is a promising treatment option for pediatric unilateral neuronal vocal fold movement impairment (VFMI). The aim is to describe our clinical outcomes with this technique and to identify preoperative characteristics that may predict postoperative voice outcomes. METHODS: This is a cohort study of pediatric patients with unilateral neuronal VFMI, who underwent NSLR from March 2012 to July 2018. Pre- and postoperative Pediatric Voice Related Quality of Life (PVRQOL) questionnaires, Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) ratings, and objective voice measures were obtained. In addition, patients underwent preoperative laryngeal electromyography (LEMG). RESULTS: Thirty-two patients were identified. Twenty-one had complete data sets for analysis. The mean duration of VFMI was 9.02 years (range 1.1-26.1 years). There were significant improvements in PVRQOL (P = .0005), in all CAPE-V subsets (P ≤ .0001 to .0195), mean and maximum intensities (P = .0342 and 0.0110, respectively), cepstral peak prominence (P = .0001), and cepstral spectral index of dysphonia (P ≤ .0001). A worse preoperative LEMG correlated with a greater change in maximum phonation time (P = .0162) and maximum intensity (P = .0346). Age at injury and duration of injury had no significant impact on voice outcomes; however, patients with concurrent posterior glottic insufficiency did have smaller changes in PVRQOL (P = .012). CONCLUSION: NSLR is an effective treatment for pediatric unilateral neuronal VFMI even many years after initial RLN injury. LEMG may help predict voice outcomes of reinnervation in pediatric patients, but further data is still needed. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1525-1531, 2020.

Transoral rigid 70-degree laryngoscopy in a pediatric voice clinic.

OBJECTIVE: Complaints of dysphonia and dysphagia frequently require rigid or flexible laryngoscopy in the office to aid in diagnosis. For young children, flexible laryngoscopy can be uncomfortable and often requires multiple adults to restrain the child. Rigid laryngoscopy does not result in crying but does require patient cooperation; thus, it is used primarily in adults. This project describes our experience using rigid laryngoscopy in a pediatric cohort. METHODS: This was a retrospective chart review of patients at a pediatric voice clinic who underwent laryngoscopy from December 2011 through March 2017. Data analysis is via Student t test and descriptive analysis. RESULTS: Three hundred and eleven patients were identified with 423 unique laryngoscopy exams. Of those, 212 of the exams were flexible and 210 were rigid. One patient did not tolerate either rigid or flexible exam. There was a statistically significant difference in age between children diagnosed via rigid mean 10.92 years (range 2.39-19.14 years) versus flexible mean 6.51 years (range 0.41-19.29 years), P ≤ 0.01. Of the 44 children under 3 years of age, flexible laryngoscopy was used almost exclusively, with 43 of 44 (97.7%) flexible scope exams. Rigid laryngoscopy was performed on 24 of 115 (20.9%) children aged 3 to 5 years, 26 of 40 (65%) aged 6 years, and 159 of 223 (71.3%) aged 7 and older. CONCLUSION: Transoral 70o rigid laryngoscopy can be used in select children as young as 3 years of age. This modality allows for improved visualization of lesions with greater comfort for patients. Laryngoscope, 129:1657-1659, 2019.

Laryngeal ultrasound and pediatric vocal fold nodules.

OBJECTIVES/HYPOTHESIS: The term vocal fold nodules refers to bilateral thickening of the membranous folds with minimal impairment of the vibratory properties of the mucosa. Nodules are thought to be related to repetitive mechanical stress, associated with voice use patterns. Diagnosis is typically made in the office via either rigid or flexible laryngeal stroboscopy. Depending on the individual child, obtaining an optimal view of the larynx can be difficult if not impossible. Recent advances in high-frequency ultrasonography allows for transcervical examination of laryngeal structures. The goal of this project was to determine if laryngeal ultrasound (LUS) can be used to identify vocal fold nodules in dysphonic children. STUDY DESIGN: Prospective case-control study in which the patient acted as his or her own control. METHODS: Forty-six pediatric patients were recruited for participation in this study; the mean age was 4.8 years. Twenty-three did not have any vocal fold lesions and 23 had a diagnosis of vocal fold nodules on laryngeal stroboscopy. Recorded LUSs were reviewed by two pediatric radiologists who were blinded to the nodule status. RESULTS: There was substantial inter-rater agreement (κ = 0.70, 95% confidence interval [CI]: 0.50-0.89) between the two radiologists regarding the presence of nodules. There was also substantial agreement (κ = 0.87, 95% CI: 0.72-1) between LUS and laryngeal stroboscopy. Sensitivity of LUS was 100% (95% CI: 85%-100%) and specificity was 87% (95% CI: 66%-97%). CONCLUSIONS: LUS can be used to identify vocal fold nodules in children with substantial agreement with laryngeal stroboscopy. LEVEL OF EVIDENCE: 3b Laryngoscope, 127:676-678, 2017.