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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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2
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Engeseth MS, Engan M, Clemm H, Vollsæter M, Nilsen RM, Markestad T, Halvorsen T, Røksund OD. Voice and Exercise Related Respiratory Symptoms in Extremely Preterm Born Children After Neonatal Patent Ductus Arteriosus. Front Pediatr 2020; 8:150. [PMID: 32322565 PMCID: PMC7156623 DOI: 10.3389/fped.2020.00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate voice characteristics and exercise related respiratory symptoms in extremely preterm born 11-year-old children, focusing particularly on associations with management of a patent ductus arteriosus (PDA). Study design: Prospective follow-up of all children born in Norway during 1999-2000 at gestational age <28 weeks or with birthweight <1,000 g. Neonatal data were obtained prospectively on custom-made registration forms completed by neonatologists. Voice characteristics and exercise related respiratory symptoms were obtained at 11 years by parental questionnaires. Result: Questionnaires were returned for 228/372 (61%) eligible children, of whom 137 had no history of PDA. PDA had been noted in 91 participants, of whom 36 had been treated conservatively, 21 with indomethacin, and 34 with surgery. Compared to the children treated with indomethacin or conservatively, the odds ratio (95% confidence interval) for the surgically treated children were 3.4 (1.3; 9.2) for having breathing problems during exercise, 16.9 (2.0; 143.0) for having a hoarse voice, 4.7 (1.3; 16.7) for a voice that breaks when shouting, 4.6 (1.1; 19.1) for a voice that disturbs singing, and 3.7 (1.1; 12.3) for problems shouting or speaking loudly. The significance of surgery per se was uncertain since the duration of mechanical ventilation was associated with the same outcomes. Conclusion: Extremely preterm born children with a neonatal history of PDA surgery had more problems with voice and breathing during exercise in mid-childhood than those whose PDA had been handled otherwise. The study underlines the causal heterogeneity of exercise related respiratory symptoms in preterm born children.
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Affiliation(s)
- Merete S Engeseth
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Mette Engan
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hege Clemm
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Roy M Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Trond Markestad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ola D Røksund
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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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 MV, Madden SK, Ryan AB. The influence of premature birth on laryngeal development for phonation. Int J Pediatr Otorhinolaryngol 2019; 122:165-169. [PMID: 31035174 DOI: 10.1016/j.ijporl.2019.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Dysphonia is a known consequence of premature birth, and is usually associated with endotracheal intubation in the neonatal period or surgical ligation of persistent patent ductus arteriosus. Recently, cases of dysphonia, in the absence of these causative factors, have been reported. OBJECTIVES This review seeks to identify literature pertaining to those aspects of laryngeal development that may potentially be disrupted by premature birth. The purpose of the review is to determine whether there is any possible anatomical or physiological explanation for dysphonia to arose solely from premature birth. METHODS This scoping review was conducted in accordance with the guidelines prescribed by Arskey and O'Malley (2005). Fifteen relevant papers were identified. Results were categorized into age-related categories, to identify changes in the developmental trajectory. Based on the results of the literature search, a further category of unphonated larynges was added. RESULTS Potential differences in the laryngeal framework (e.g., the development of the cricoid cartilage and the shape of the glottis) and vocal fold histology, depending on gestational age and post-natal phonation were identified. Much literature focused on the macula flavae, however, the layers of the lamina propria were also discussed. DISCUSSION It is unclear whether the process of differentiation of the layers of the lamina propria, which commences in the second to third months of life in term-born infants, is disrupted by prematurity. Further, development of the macula flavae continues until at least 28 weeks' gestation. Preterm children may not phonate immediately after birth, which may also affect laryngeal development.
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Affiliation(s)
| | - Shayla K Madden
- State University New York College at Plattsburgh, United States
| | - Amy B Ryan
- State University New York College at Plattsburgh, United States
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Jang M, Basa K, Levi J. Risk factors for laryngeal trauma and granuloma formation in pediatric intubations. Int J Pediatr Otorhinolaryngol 2018; 107:45-52. [PMID: 29501310 DOI: 10.1016/j.ijporl.2018.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Intubation has been associated with laryngeal injury that often resolves spontaneously without complication. We present a case of a child intubated for less than 48 hours, who presented with dysphonia and intermittent dyspnea two months after intubation due to epiglottic and vocal process granulomas. This is unusual in that multiple granulomas were found in the posterior glottis and supraglottis after short-term intubation. Our objective was to determine if there are risk factors for developing persistent post-intubation sequelae, including the delayed presentation and unusual location of post-intubation granulomas in our case. STUDY DESIGN Case report and systematic literature review. METHODS Pubmed database, which is inclusive of MEDLINE, was used to perform a literature review with the search terms ((pediatric OR children OR neonatal OR infant) AND (laryngeal OR supraglottic) AND intubation AND (granuloma OR injury OR complication)). Only English language results were reviewed. Titles and abstracts from 379 results were reviewed. Full text was reviewed from all original studies which included human pediatric subjects and endoscopic examinations after endotracheal intubation. RESULTS In our case, laryngeal granuloma size reduced significantly after starting anti-reflux medications. The remainder was removed with laryngeal microdebrider with no recurrence at 3 weeks and 2.5 years post-operatively. Overall, 28 of the 379 studies reviewed identified evidence of laryngeal trauma due to intubation, however only 6 studies documented any type of supraglottic injury. Risk factors identified for developing post-intubation sequelae included intubation duration greater than 24 h; trauma to the larynx via various mechanisms including traumatic intubation, need for reintubation and tube changes, and increased movement while intubated; and presence of respiratory tract infection during intubation. CONCLUSION Trauma to the larynx during intubation should be avoided to minimize post-intubation injury in pediatric patients, by using appropriate intubation protocols, endotracheal tube size, and adequate sedation.
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Affiliation(s)
- Minyoung Jang
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Krystyne Basa
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jessica Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. A Randomized, Controlled Trial of Behavioral Voice Therapy for Dysphonia Related to Prematurity of Birth. J Voice 2017; 31:247.e9-247.e17. [DOI: 10.1016/j.jvoice.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Voice problems in school-aged children following very preterm birth. Arch Dis Child 2016; 101:556-560. [PMID: 26906071 DOI: 10.1136/archdischild-2015-309441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/02/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Very preterm children may be at risk of voice abnormalities (dysphonia). Risk factors previously identified in extremely preterm children include female gender, multiple intubations, complicated intubation and very low birth weight. This study sought to identify the prevalence of dysphonia in very preterm children, at school age. METHODS Children born between 23 and 32 weeks' gestation were included in this prospective observational study. Participants were randomly selected from a sample stratified by gestational age and number of intubations, and were aged between 5 and 12 years at the time of assessment. Clinical voice assessments were conducted by a speech pathologist, and a diagnosis of dysphonia was made based on the presence and severity of disturbance to the voice. Retrospective chart review identified medical and demographic characteristics. RESULTS 178 participants were assessed. The prevalence of dysphonia in this cohort was 61%. 31% presenting with significant dysphonia, that is, voice disturbance of greater than mild in severity. Female gender (p=0.009), gestational age (p=0.031) and duration of intubation (p=0.021) were significantly associated with dysphonia although some preterm children with dysphonia were never intubated. CONCLUSIONS Significant voice abnormalities were observed in children born at up to 32 weeks' gestation, with intubation a major contributing factor. TRIAL REGISTRATION NUMBER ACTRN12613001015730.
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Affiliation(s)
- Victoria Reynolds
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Suzanne Meldrum
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,School of Psychology and Social Science, Faculty of Health, Engineering and Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Karen Simmer
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Shyan Vijayasekaran
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Department of Otolaryngology and Head and Neck Surgery, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia.,School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Noel French
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia.,Health Department of Western Australia, State Child Development Centre, Perth, Western Australia, Australia
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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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