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Carroll LM, Zur KB. Benjamin Defect: Children with Posterior Glottic Defects and Vocal Fold Immobility. J Voice 2024:S0892-1997(24)00185-1. [PMID: 39003212 DOI: 10.1016/j.jvoice.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Linda M Carroll
- The Children's Hospital of Philadelphia, Division of Pediatric Otolaryngology, Philadelphia, Pennsylvania.
| | - Karen B Zur
- Division of Pediatric Otolaryngology, E. Mortimer Newlin Endowed Chair in Pediatric Otolaryngology and Human Communication, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
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Lang B, Dallape S, Mehanna R, Russell J. Post Intubation Phonatory Insufficiency: A novel surgical treatment. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Zur KB, Douglas J, Carroll LM. Intubation-Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients. Laryngoscope 2021; 131:2550-2557. [PMID: 33956345 DOI: 10.1002/lary.29592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability. STUDY DESIGN Retrospective Study. METHODS Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale. RESULTS Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0-3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS-2 and BDSS-3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS-1 (mild) or BDSS-2. History of multiple and prolonged intubations were seen more frequently in BDSS-2 or BDSS-3. Post-op pVHI reduced an average of 15 points for BDSS-0 to BDSS-2, but only 3 points for BDSS-3. Post-op pVHI matched normal values for preintervention dysphonic children. CONCLUSIONS The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher-grade BDs, whereas low GA is more likely to be associated with BDSS-1 to BDSS-2. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Karen B Zur
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Otolaryngology: Head & Neck Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jennifer Douglas
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Otolaryngology: Head & Neck Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Linda M Carroll
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
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Simpson SJ, Champion Z, Hall GL, French N, Reynolds V. Upper Airway Pathology Contributes to Respiratory Symptoms in Children Born Very Preterm. J Pediatr 2019; 213:46-51. [PMID: 31402143 DOI: 10.1016/j.jpeds.2019.06.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the role of upper airway dysfunction, indicated by altered vocal quality (dysphonia), on the respiratory symptoms of children surviving very preterm birth. STUDY DESIGN Children born <32 weeks of gestation participated in 2 separate assessments during midchildhood. The first visit assessed voice quality by a subjective evaluation using the Consensus Auditory-Perceptual Evaluation of Voice and a computerized analysis of the properties of the voice via the Acoustic Voice Quality Index. The second assessment recorded parentally reported respiratory symptoms and measures of lung function, including spirometry, lung volumes, oscillatory mechanics, and a cardiopulmonary exercise test. RESULTS Preterm children (n = 35; median gestation 24.3 weeks) underwent paired voice and lung assessments at approximately 11 years of age. Preterm children with dysphonia (n = 25) reported significantly more respiratory symptoms than those with normal voices (n = 10) including wheeze (92% vs 40%; P = .001) and asthma diagnosed by a physician (60% vs 10%; P = .007). Lung function outcomes were generally not different between the dysphonic group and the group with normal voice (P > .05), except for the oscillatory mechanics measures, which were all at least 0.5 z score lower in the dysphonic group (Xrs8 mean difference = -0.91 z scores, P = .003; fres = 1.06 z scores, P = .019; AX = -0.87 z scores, P = .010; Rrs8 = 0.63 z scores, P = .068). CONCLUSIONS The upper airway may play a role in the respiratory symptoms experienced by some very preterm children and should be considered by clinicians, especially when symptoms are in the presence of normal lung function and are refractory to treatment.
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Affiliation(s)
- Shannon J Simpson
- Telethon Kids Institute; School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University.
| | | | - Graham L Hall
- Telethon Kids Institute; School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University
| | - Noel French
- King Edward Memorial Hospital, Perth, Western Australia
| | - Victoria Reynolds
- State University College of New York at Plattsburgh, Plattsburgh, NY
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Dysphonia in extremely preterm children: A longitudinal observation. LOGOP PHONIATR VOCO 2015; 41:154-8. [DOI: 10.3109/14015439.2015.1054307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Victoria Reynolds
- University of Western Australia, School of Paediatrics and Child Health, Crawley, Australia
| | - Suzanne Meldrum
- University of Western Australia, School of Paediatrics and Child Health, Crawley, Australia
- Edith Cowan University, School of Psychology and Speech Pathology, Joondalup, Australia
| | - Karen Simmer
- University of Western Australia, School of Paediatrics and Child Health, Crawley, Australia
- King Edward Memorial Hospital, Department of Neonatal Paediatrics, Subiaco, Australia
| | - Shyan Vijayasekaran
- University of Western Australia, School of Paediatrics and Child Health, Crawley, Australia
- Princess Margaret Hospital, Department of Paediatric Otorhinolaryngology and Head and Neck Surgery, Subiaco, Australia
- University of Western Australia, School of Surgery, Crawley, Australia
| | - Noel French
- King Edward Memorial Hospital, Department of Neonatal Paediatrics, Subiaco, Australia
- State Child Development Centre, West Perth, Australia
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Laryngeal pathology at school age following very preterm birth. Int J Pediatr Otorhinolaryngol 2015; 79:398-404. [PMID: 25613933 DOI: 10.1016/j.ijporl.2014.12.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/23/2014] [Accepted: 12/25/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intubation injury resulting in laryngeal pathology is recognised as a possible complication of preterm birth, yet few published studies have examined such pathology and its relation to voice outcomes. This study reports on the results of prospective laryngeal function examinations of a cohort of very preterm children, all of whom presented with significant dysphonia at school age. MATERIALS AND METHODS The laryngeal pathology of 20 very preterm children, born between 23 and 29 weeks gestation, was examined under halogen and stroboscopic conditions. Laryngeal structure and function were assessed using a rigid laryngoscope or a flexible nasendoscope. The approach was selected based on the age and/or likely compliance of the child. RESULTS Nineteen children were found to have structural laryngeal pathology. Fourteen children presented with a chink to the posterior glottis and all demonstrated at least a mild degree of supraglottic hyperfunction. Other common findings were arytenoid prolapse and vocal fold immobility. More isolated findings included posterior scar band, vocal fold atrophy, arytenoid oedema and growth on the vocal folds. One child who presented with structural laryngeal pathology was never intubated. DISCUSSION Supraglottic hyperfunction was common to all participants, regardless of the nature and extent of underlying structural laryngeal pathology. Posterior glottic chink was the most common pattern of incomplete vocal fold closure. These data support the hypothesis that very preterm children adopt supraglottic tightening to compensate for underlying laryngeal pathology. The mechanism underlying laryngeal damage in the child who was not intubated is unclear. CONCLUSIONS Voice quality of very preterm children is affected by both laryngeal structure and function. A trial of behavioural voice treatment is recommended to evaluate any therapeutic response in this population.
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Affiliation(s)
- Victoria Reynolds
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
| | - Suzanne Meldrum
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; School of Psychology and Speech Pathology, Faculty of Health, Engineering and Science, Edith Cowan University, Perth, WA, Australia
| | - Karen Simmer
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Shyan Vijayasekaran
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; Department of Otolaryngology and Head and Neck Surgery, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Surgery, University of Western Australia, Perth, WA, Australia
| | - Noel French
- Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, WA, Australia; State Child Development Centre, Health Department of Western Australia, Perth, WA, Australia
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Intubation-Related Dysphonia Following Extreme Preterm Birth: Case Studies in Behavioural Voice Intervention. ACTA ACUST UNITED AC 2014. [DOI: 10.1044/vvd24.3.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many more children than ever before survive and thrive following preterm birth (Saigal & Doyle, 2008). To date, research has focussed on medical, developmental, neurological, and behavioral outcomes. As the number of surviving children increases and survivors reach school age and beyond, it has become apparent that many children experience difficulties with voice production (French et al., 2013). Following preterm birth, endotracheal intubation may be necessary to deliver surfactant or relieve respiratory distress during the neonatal period (Ho, Subramaniam, Henderson-Smart, & Davis, 2002). Intubation injury to the larynx and resultant dysphonia are well described in the literature (Bray, Cavalli, Eze, Mills, & Hartley, 2010). This article presents a brief review of the literature relevant to intubation-related injury following preterm birth and 2 case studies of voice outcomes following a trial of behavioral voice therapy in extremely preterm children who were intubated.
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Affiliation(s)
- Victoria Reynolds
- School of Paediatrics and Child Health, University of Western Australia
Perth, Western Australia
- Speech Pathology Department, Princess Margaret Hospital for Children
Subiaco, Western Australia
| | - Suzanne Meldrum
- Speech Pathology Department, Princess Margaret Hospital for Children
Subiaco, Western Australia
- School of Psychology and Social Science, Edith Cowan University
Perth, Western Australia
| | - Karen Simmer
- School of Paediatrics and Child Health, University of Western Australia
Perth, Western Australia
- Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children
Subiaco, Western Australia
- Centre for Neonatal Research and Education, University of Western Australia
Perth, Western Australia
| | - Shyan Vijayasekaran
- Department of Otolaryngology and Head and Neck Surgery, Princess Margaret Hospital for Children
Subiaco, Western Australia
- Schools of Surgery and Paediatrics and Child Health, University of Western Australia
Perth, Western Australia
| | - Noel French
- Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children
Subiaco, Western Australia
- Centre for Neonatal Research and Education, University of Western Australia
Perth, Western Australia
- State Child Development Centre, Health Department of Western Australia
Perth, Western Australia
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Dysphonia in very preterm children: a review of the evidence. Neonatology 2014; 106:69-73. [PMID: 24819149 DOI: 10.1159/000360841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/25/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intubation is a known risk factor for dysphonia yet is essential in the perinatal care of many very preterm infants. Children born preterm, who are frequently resuscitated with endotracheal intubation, may be at risk of dysphonia at school age and beyond. OBJECTIVES To identify and describe the evidence pertaining to long-term voice outcomes and risk factors for developing dysphonia in preterm children. RESULTS In addition to case studies and series, three larger-scale studies have reported on dysphonia and voice outcomes in preterm children. Studies reporting treatment outcomes were not available. Factors associated with poor voice outcomes included female gender, birth weight <1,000 g, birth at <27 weeks' gestation, surgical closure of patent ductus arteriosus, emergency versus elective intubations and multiple intubations. Adverse voice outcomes were associated with laryngeal pathology and compensatory supraglottic compression. CONCLUSIONS Dysphonia is a newly reported, long-term complication of preterm birth, yet the number of relevant studies remains limited. Further research is required to confirm the risk factors for developing dysphonia, which will inform future voice treatment studies.
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Affiliation(s)
- Victoria Reynolds
- School of Paediatrics and Child Health, University of Western Australia, Perth, W.A., Australia
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