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Callaghan A, El-Hakim H, Isaac A. Iatrogenic pediatric unilateral vocal cord paralysis after cardiac surgery: a review. Front Pediatr 2024; 12:1460342. [PMID: 39290595 PMCID: PMC11405229 DOI: 10.3389/fped.2024.1460342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 08/19/2024] [Indexed: 09/19/2024] Open
Abstract
Unilateral vocal cord paralysis (UVCP) is a growing area of research in pediatrics as it spans across many specialties including otolaryngology, cardiology, general surgery, respirology, and speech language pathology. Iatrogenic injury is the most common cause of UVCP, however there is a wide range of data reporting the prevalence, symptom burden, and best treatment practice for this condition. The literature included systematic reviews and meta-analyses, retrospective studies and limited prospective studies. Overall, the literature lacked consistency in the diagnosis, treatment, and long-term outcomes of patients with UVCP. Many articles conflated bilateral vocal cord paralysis (BVCP) with UVCP and had limited data on the natural history of the condition. There was no consensus on objective and subjective measurements to evaluate the condition or best indications for requiring surgical intervention. Thyroplasty, injection medialization (IM) and recurrent laryngeal nerve reinnervation (RLNR) were the reported surgical interventions used to treat UVCP, however there was limited data on short and long-term surgical outcomes in children. More research is needed to determine the true prevalence, natural history, indications for surgical intervention and long-term outcomes for pediatric patients with this condition.
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Affiliation(s)
- Amy Callaghan
- Division of Pediatric Surgery, Department of Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Hamdy El-Hakim
- Division of Pediatric Surgery, Department of Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Andre Isaac
- Division of Pediatric Surgery, Department of Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Šimkienė R, Šiupšinskienė N, Purlys P, Žvirblis T, Lesinskas E. Adaptation and Validation of the Lithuanian Version of the Pediatric Voice Handicap Index. J Voice 2024; 38:1247.e25-1247.e30. [PMID: 35361515 DOI: 10.1016/j.jvoice.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to develop the Lithuanian version of the Pediatric Voice Handicap Index (pVHI) and to assess its psychometric characteristics. METHODS The Lithuanian version of the pVHI was prepared according to the standard requirements for the questionnaire translation and adaptation procedure. It also included forward and backward translations of the original questionnaire, as well as a committee review and psychometric testing of the final version of the pVHI. A total of 126 children between 4 and 13 years of age were included in the study. Two study groups were formed: a group consisting of children with dysphonia (n = 70) and a control group of children without any alterations in their voice (n = 56). The questionnaire was always completed by their parents. The results were statistically analysed to assess the reliability, validity, sensitivity and specificity of the Lithuanian version of the pVHI. RESULTS High internal consistency of the Lithuanian version of the pVHI was determined (Cronbach's α = 0.938). The test-retest analysis also showed a high correlation between the two tests (r = 0.949) for both the dysphonic and control groups. The mean overall pVHI score was significantly higher (P < 0.001) in the dysphonic group than in the control group: 26.16 ± 11.84 and 2.43 ± 2.61, respectively. Similar results were obtained for all domains of pVHI. The most sensitive and specific limiting value for discrimination between the clinical and control groups was the sum of 8 points. CONCLUSIONS The Lithuanian version of the pVHI is a reliable and valid instrument for the evaluation of the Voice Handicap Index in the pediatric population and can be easily applied in daily clinical practice.
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Affiliation(s)
- Rita Šimkienė
- Vilnius University Hospital Santaros Klinikos Center for Ear, Nose and Throat Diseases, Vilnius, Lithuania.
| | - Nora Šiupšinskienė
- Lithuanian University of Health Sciences, Medicine Academy, Department of Otorhinolaryngology, Kaunas, Lithuania; Klaipeda University, Faculty of Health Sciences, Klaipeda, Lithuania
| | | | - Tadas Žvirblis
- Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Eugenijus Lesinskas
- Vilnius University Hospital Santaros Klinikos Center for Ear, Nose and Throat Diseases, Vilnius, Lithuania
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Fujiki RB, Thibeault SL. Voice Disorder Prevalence and Vocal Health Characteristics in Adolescents. JAMA Otolaryngol Head Neck Surg 2024; 150:800-810. [PMID: 39052255 PMCID: PMC11273279 DOI: 10.1001/jamaoto.2024.2081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/22/2024] [Indexed: 07/27/2024]
Abstract
Importance Voice disorders impede communication and detract from quality of life, yet little is known about how voice problems present in adolescents. This study characterized the prevalence of voice problems and vocal health characteristics of adolescents throughout the US. Objective To determine the prevalence of adolescent voice problems in the US as well as the symptoms, voice use patterns, and risk factors associated with these problems. Design, Setting, and Participants This prospectively performed, cross-sectional survey study conducted from March to June 2023 included a probability sample of adolescents (aged 13-17 years) who were located across the US. Main Outcome and Measures Adolescents were surveyed concerning voice use, voice symptoms, demographic information, and substance use patterns. The Vocal Fatigue Index (VFI) was also completed. Fisher exact tests, χ2 tests, and logistic regression were used to compare those with and without reported voice problems. Results Five-hundred and two adolescents participated (51.6% participation rate), including 248 female (49.4%), 7 nonbinary (1.3%), 254 male (50.6%), 4 transfemale (0.7%), and 3 transmale individuals (0.5%) (mean [SD] age, 15.2 [1.3] years). The lifetime prevalence of voice problems was 24.3%, and current prevalence was 7.4%. Voice-related diagnoses included dysphonia associated with acute illness, vocal hyperfunction, benign lesions, and muscle tension. The mean (SD) VFI score was 4.7 (8.09) for part 1, 1.6 (3.2) for part 2, and 2.1 (3.2) for part 3. Adolescents with voice complaints presented with significantly higher VFI scores than those without voice problems (Cohen d for part 1 = 0.78, part 2 = 0.59, and part 3 = 0.79). Voice problems interfered with daily tasks, prevented participation in extracurricular activities, limited the ability to sing, and were associated with school absences. Voice use patterns associated with voice problems included frequent loud voice use, coughing, and/or throat clearing. Risk factors for increased voice problem prevalence included part-time employment in childcare (odds ratio [OR], 6.4; 95% CI, 1.6-26.3), singing (OR, 2.08; 95% CI, 1.3-3.1), performance-related extracurricular activities (ie, musical theater [OR, 2.67; 95% CI, 1.1-6.6 ], karaoke [OR, 3.08; 95% CI, 1.3-6.9]), vaping (OR, 1.99; 95% CI, 1.1-3.5), and/or secondhand smoke exposure (OR, 1.83; 95% CI, 1.2-2.7). Adolescents identifying as transgender were more than 4 times (OR, 4.44; 95% CI, 0.63-31.2) as likely to report voice problems compared with cisgender adolescents. Conclusions The results of this survey study illuminate the nature of voice problems in adolescents and may guide clinicians in preventing and treating voice disorders in this population. Future work may define the mechanisms through which these factors are associated with the risk for voice disorders in adolescents and determine whether observed relationships are causal or associative.
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Xia W, Du M, Wu M, Chen Z, Yang R, Shi B, Huang H. Patient-reported outcomes measure for patients with cleft palate. Front Public Health 2024; 12:1469455. [PMID: 39281080 PMCID: PMC11393830 DOI: 10.3389/fpubh.2024.1469455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/14/2024] [Indexed: 09/18/2024] Open
Abstract
Cleft palate presents multifaceted challenges impacting speech, hearing, appearance, and cognition, significantly affecting patients' quality of life (QoL). While surgical advancements aim to restore function and improve appearance, traditional clinical measures often fail to comprehensively capture patients' experiences. Patient-reported outcomes measure (PROMs) have emerged as crucial tools in evaluating QoL, offering insights into various aspects such as esthetic results, speech function, and social integration. This review explores PROMs relevant to cleft palate complications, including velopharyngeal insufficiency, oronasal fistulas, maxillary hypoplasia, sleep-disordered breathing, and caregiver QoL. Additionally, the review highlights the need for cleft palate-specific scales to better address the unique challenges faced by patients. By incorporating PROMs, healthcare providers can achieve more personalized, patient-centered care, improve communication, and enhance treatment outcomes. Future research should focus on developing and validating specialized PROMs to further refine patient assessments and care strategies.
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Affiliation(s)
- Wenbo Xia
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Meijun Du
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Min Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zehua Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Renjie Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Eastern Clinic, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Doğan N, Eser MT, Yağcıoğlu D, Esen Aydınlı F. A Meta-Analytic Reliability Generalization Study of the Pediatric Voice Handicap Index. J Voice 2024:S0892-1997(24)00221-2. [PMID: 39179469 DOI: 10.1016/j.jvoice.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVES The pediatric voice handicap index (pVHI) is a widely used proxy-reported outcome measure. However, its reliability values are subject to variability across studies. Accordingly, the objective of this study is to analyze the mean reliability estimation and stratified alpha coefficient of the pVHI. Another aim of the study is to determine if differences in reliability values can be linked to the specific research characteristics. STUDY DESIGN This is a meta-analytic reliability generalization study. METHODS Two researchers used Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to review five databases (Scopus, Web of Science, YÖKTEZ, Ulakbim, and PUBMED) for publications published between 2007 and 2022 that used pVHI. A meta-analysis was then conducted on 12 papers that fit the predetermined inclusion criteria to ascertain the total effect size of the Cronbach's alpha coefficient of pVHI scores. The reliability coefficients of pVHI were computed utilizing Cochran Q, I2, and the lower and upper bounds of mean reliability. Additionally, moderator analyses were employed to examine the heterogeneity among studies. RESULTS The computed mean reliability value was approximately 0.916 [0.8840, 0.9401] which is within the acceptable range (>0.70). Furthermore, the mean stratified Cronbach's alpha coefficient was found to be roughly 0.95. The heterogeneity statistics indicated that the reliability estimations for each study varied significantly (Q ∼ (df = 11) ∼ = 163.6172, P < 0.0001; I2 = 93.90%). CONCLUSIONS Results indicate that pVHI yields sufficiently reliable outcomes. Furthermore, the reliability of the pVHI remained consistent regardless of index language, participant group (healthy, dysphonic, or both), or continent of origin. These results improve the clinical value and utility of pVHI by providing further evidence of its reliability.
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Affiliation(s)
- Nuri Doğan
- Department of Educational Sciences, Faculty of Education, Hacettepe University, Ankara, Turkey.
| | - Mehmet Taha Eser
- Department of Educational Sciences, Faculty of Education, Aydın Adnan Menderes University, Aydın, Turkey.
| | - Damlasu Yağcıoğlu
- Department of Speech and Language Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
| | - Fatma Esen Aydınlı
- Department of Speech and Language Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
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Fujiki RB, Thibeault SL. Voice Disorder Prevalence and Vocal Health Characteristics in Children. JAMA Otolaryngol Head Neck Surg 2024; 150:677-687. [PMID: 38900441 PMCID: PMC11190826 DOI: 10.1001/jamaoto.2024.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/23/2024] [Indexed: 06/21/2024]
Abstract
Importance Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children. Objective To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns. Design, Setting, and Participants This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023. Main Outcomes and Measures Caregivers were surveyed regarding their children's voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ2 tests, and logistic regression were used to compare children with and without voice problems. Results Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use-related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults. Conclusions The results of this survey study suggest that pediatric voice problems are relatively common and detract from quality of life. Specific environmental and behaviorial factors are associated with increased risk for voice disorders.
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Salderay ZE, Yılmaz M, Altınyay Ş, Gölaç H, Gökdoğan Ç. The Effect of An Indirect Voice Therapy Approach on the Voice of Children With Vocal Fold Nodules: A Prospective Cohort Study. J Voice 2024; 38:858-863. [PMID: 35082048 DOI: 10.1016/j.jvoice.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the effect of a combination indirect voice therapy approach on the management of vocal nodules in the pediatric population. METHODS A prospective cohort study with thirty children (24 males and 6 females; mean age 8.8 ± 2.2) with a diagnosis of vocal fold nodule (VFN) was conducted. All participants were included in an 8-week voice therapy program consisting of vocal hygiene education and parental rule-setting. Videolaryngoscopic examination, auditory-perceptual evaluation, and acoustic voice analysis were performed immediately before and after the intervention. RESULTS The comparison of videolaryngoscopic findings before and after the therapy revealed that the size of the nodules decreased significantly (P < 0.001). Findings from the laryngeal examination showed that the vast majority of children 73.3% (n = 22) had no VFN anymore after the intervention. The auditory-perceptual evaluation showed that overall severity of dysphonia decreased significantly [from 50 (40-70) to 38 (30-45), P < 0.001]. Jitter local (P = 0.031) and Jitter local abs (P = 0.043) parameters statistically differed after the therapy. There were not any statistically significant differences for mean F0, shimmer local (%), shimmer local (dB), and mean HNR. CONCLUSIONS The voice therapy method in this study has a clear benefit on the voice of children with VFN and can be used in clinical practice. Specifically, clinicians should consider the parents as a core component of voice therapies and pay attention to vocal hygiene education for optimal management of VFN related childhood dysphonia.
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Affiliation(s)
- Zehra Enhoş Salderay
- Department of Psychiatry, Gülhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Metin Yılmaz
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Şenay Altınyay
- Department of Audiology, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Hakan Gölaç
- Department of Speech and Language Therapy, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
| | - Çağıl Gökdoğan
- Department of Speech and Language Therapy, Faculty of Health Sciences, Gazi University, Emek mah. Bişkek Cad. 6. Cad. No:2 06490 Çankaya, Ankara, Turkey
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Rabelo ECDS, Dassie-Leite AP, Ribeiro VV, Madazio G, Behlau MS. Cepstral Peak Prominence Smoothed - CPPS and Acoustic Voice Quality Index - AVQI in healthy and altered children's voices: comparation, relationship with auditory-perceptual judgment and cut-off points. Codas 2024; 36:e20230047. [PMID: 38808777 PMCID: PMC11189156 DOI: 10.1590/2317-1782/20242023047pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 12/27/2023] [Indexed: 05/30/2024] Open
Abstract
PURPOSE To compare the acoustic measurements of Cepstral Peak Prominence Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) of children with normal and altered voices, to relationship with auditory-perceptual judgment (APJ) and to establish cut-off points. METHODS Vocal recordings of the sustained vowel and number counting tasks of 185 children were selected from a database and submitted to acoustic analysis with extraction of CPPS and AVQI measurements, and to APJ. The APJ was performed individually for each task, classified as normal or altered, and for the tasks together defining whether the child would pass or fail in a situation of vocal screening. RESULTS Children with altered APJ and who failed the screening had lower CPPS values and higher AVQI values, than those with normal APJ and who passed the screening. The APJ of the sustained vowel task was related to CPPS and AVQI, and APJ of the number counting task was related only to AVQI and CPPS numbers. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the vowel CPPS, 7.62 for the CPPS numbers and 2.01 for the AVQI. CONCLUSION Children with altered voices, have higher AVQI values and lower CPPS values, when detected in children with voices within the normal range. The acoustic measurements were related to the auditory perceptual judgment of vocal quality in the sustained vowel task, however, the number counting task was related only to the AVQI and CPPS. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the CPPS vowel, 7.62 for the CPPS numbers and 2.01 for the AVQI. The three measures were similar in identifying voices without deviation and dysphonic voices.
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Heller Murray E, Yucel R. Longitudinal Evaluation of Cepstral Peak Prominence in Children. J Voice 2024:S0892-1997(24)00138-3. [PMID: 38760251 DOI: 10.1016/j.jvoice.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES To evaluate whether the acoustic measure of cepstral peak prominence changes during typical development in children 2-7. METHODS Data were retrospectively analyzed from the Arizona Child Acoustic Database Repository in this longitudinal cohort study. The Repository contains longitudinal data recordings from 63 total children between 2 and 7 years of age. Thirty-one children met the inclusion criteria for the current analysis (at least five time points of usable speech data, no history of speech or language difficulties, no significant dysphonia, and were monolingual speakers of American English). Cepstral peak prominence measures were calculated in Praat for each child, at each timepoint. Additional acoustic measures of vocal fundamental frequency, vocal intensity, and stimuli length were also calculated. These measures were chosen as previous work has shown they may impact cepstral peak prominence values. RESULTS Linear mixed-effects regression models examined the relationship between cepstral peak prominence and age, after controlling for vocal fundamental frequency, vocal intensity, and stimuli length. Within-participant effects of age were found, indicating a trajectory change in which cepstral peak prominence increases with age in this population. This positive relationship between a cepstral peak prominence and age was nonlinear, with a steeper slope between age and cepstral peak prominence after 5 years of age. CONCLUSIONS This is the first study to examine the typical developmental trajectory of cepstral peak prominence children between 2 and 7 years, a critical period of vocal development. Cepstral peak prominence increased with age, suggesting an increase in periodicity of vocal fold vibration that coincides with the significant vocal fold structural changes occurring during this time. Outcomes present important normative information on vocal development, essential for effectively understanding the difference between what vocal changes are part of normative development and what changes indicate a voice disorder.
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Affiliation(s)
- Elizabeth Heller Murray
- Department of Communication Sciences and Disorders, College of Public Health, Temple University, Philadelphia, Pennsylvania.
| | - Recai Yucel
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania
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Deborah R, Samayan K. Cepstral Analysis of Voice in School-Aged Children. J Voice 2024:S0892-1997(24)00090-0. [PMID: 38677907 DOI: 10.1016/j.jvoice.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Dysphonia in school-aged children is attributed primarily to hyperfunctional use of voice. These can be identified through effective protocols using both acoustic and auditory-perceptual analyses. OBJECTIVE The current study aimed to investigate voice characteristics in school children aged 4-17 years using auditory-perceptual rating and cepstral measures of voice. STUDY DESIGN This is a descriptive cross-sectional observational study. METHOD Four hundred and fifty-seven recordings of sustained phonation of /a/ in children and adolescents obtained in a quiet room using Zoom h1 voice recorder were analyzed using auditory-perceptual evaluation by three speech-language pathologists using Grade of overall dysphonia, Roughness, Breathiness, Asthenia, and Strain(GRBAS) rating scale. The samples were classified based on age into five groups: 1) 4 to 6; 11 years 2) 7-8; 11 years, 3) 9-11; 11years 4) 12-13; 11years and 5) 14-16; 11 years. PRAAT software was used to extract Cepstral Peak Prominence (CPP) and Cepstral Peak Prominence Smoothed (CPPS). Inter-rater reliability was assessed for both auditory-perceptual and acoustic analysis. RESULTS Auditory-perceptual analysis revealed dysphonia in 7.8% of samples with higher rate in males than females. Inter-rater reliability for auditory-perceptual rating was found to be good (Intraclass Corelation Coefficient-0.83). Independent t test revealed statistically significant difference (P < 0.001) in both cepstral measures and mean values were lower in dysphonic than normal group. Gender effect was present for CPP in group 5(14-16;11 years) and CPPS in group 4 (12-13; 11 years). One-way analysis of variance within groups in males (P < 0.005) revealed statistical difference in both cepstral measures but not in females. Statistically significant difference was not found between ratings of both speech language pathologists for both CPP (P = 0.929) and CPPS (P = 0.965) values indicating the ratings to be reliable. CONCLUSION Pediatric dysphonia has received less attention when compared to adults. Assessing school-aged children for dysphonia using both auditory-perceptual and acoustic measures would aid in identifying those at risk to make appropriate referrals and plan further intervention.
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Affiliation(s)
- Ruth Deborah
- Department of Audiology and Speech Language Pathology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District 603203, Tamil Nadu, India.
| | - Kala Samayan
- Department of Audiology and Speech Language Pathology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District 603203, Tamil Nadu, India.
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Iliadou E, Fortune-Ely M, Melley LE, Garabet R, Sataloff RT, Rubin JS. Patients' Demographics and Risk Factors in Voice Disorders: An Umbrella Review of Systematic Reviews. J Voice 2024:S0892-1997(24)00080-8. [PMID: 38556378 DOI: 10.1016/j.jvoice.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES This study aimed to provide a comprehensive overview of the systematic reviews that focus on the prevalence of voice disorders (VDs), associated risk factors, and the demographic characteristics of patients with dysphonia. An umbrella review was conducted to identify general research themes in voice literature that might guide future research initiatives and contribute to the classification of VDs as a worldwide health concern. STUDY DESIGN Umbrella review of systematic reviews. METHODS Pubmed/Medline and Embase were searched for eligible systematic reviews by two authors independently. Extracted data items included the study publication details, study design, characteristics of the target population, sample size, region/country, and incidence and/or prevalence of the VD(s) of interest. RESULTS Forty systematic reviews were included. Sixteen reported a meta-analysis. Great heterogeneity in methods was found. A total of 277,035 patients across the included studies were included with a prevalence ranging from 0%-90%. The countries represented best were the United States and Brazil, with 13 studies each. Aging, occupational voice use, lifestyle choices, and specific comorbidities, such as obesity or hormonal disorders, seem to be associated with an increased prevalence of dysphonia. CONCLUSIONS This review underscores the influence of VDs on distinct patient groups and the general population. A variety of modifiable or non-modifiable risk factors, having varied degrees of impact on voice qualities, have been identified. The overall effect of VDs is probably underestimated due to factors, such as sample size, patient selection, underreporting of symptoms, and asymptomatic cases. Employing systematic reviews with consistent methodologies and criteria for diagnosing VDs would enhance the ability to determine the prevalence of VDs and their impact.
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Affiliation(s)
| | | | - Lauren E Melley
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia
| | - Razmig Garabet
- Department of Otolaryngology, Drexel University College of Medicine, Philadelphia
| | - Robert T Sataloff
- Department of Otolaryngology, Drexel University College of Medicine, Philadelphia
| | - John S Rubin
- University College London Hospital Trust, London, United Kingdom
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Ma EPM, Cheung YC, Siu AKY, Lo JFW. The Effectiveness of Vocal Hygiene Education With Resonant Voice Therapy for School-Aged Children With Vocal Nodules. J Voice 2024; 38:538.e23-538.e30. [PMID: 34785116 DOI: 10.1016/j.jvoice.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study evaluated the effectiveness of vocal hygiene education with resonant voice therapy for school-aged children with vocal nodules. STUDY DESIGN A pre-test/post-test control group design was employed. METHODS Seventeen children aged between 6 and 9 years old with vocal nodules were randomly assigned to three groups: a treatment group, a placebo group and a control group. Children in the treatment group (n = 7) received six consecutive, weekly, one-hour sessions of vocal hygiene education with resonant voice therapy. Children in the placebo group (n = 5) received six consecutive, weekly, one-hour sessions on presentation skills training. Children in the control group (n = 5) did not receive any form of treatment. Subjective outcome measures included auditory-perceptual evaluation of overall dysphonia severity, the Pediatric Voice Handicap Index (pVHI) and the Children's Voice Handicap Index-10 (CVHI-10). Objective outcome measures included acoustic analysis of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio. RESULTS AND CONCLUSIONS Significant improvements in perceptual ratings of overall dysphonia severity levels and pVHI scores were found in the treatment group. No significant changes in acoustic measures and CVHI-10 scores were noted in any of the three groups. Interestingly, an improvement in perceptual overall dysphonia severity levels at post-evaluation was observed in the no treatment control group.
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Affiliation(s)
- Estella P-M Ma
- Voice Research Laboratory, Unit of Human Communication, Development and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong.
| | - Yan-Chi Cheung
- Voice Research Laboratory, Unit of Human Communication, Development and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong
| | - Alice K-Y Siu
- Department of Otorhinolaryngology Head-and-Neck Surgery, Kowloon East Cluster, affiliated academic unit of Department of Otorhinolaryngology Head-and-Neck Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Jacky F-W Lo
- Department of Otorhinolaryngology Head-and-Neck Surgery, Kowloon East Cluster, affiliated academic unit of Department of Otorhinolaryngology Head-and-Neck Surgery, The Chinese University of Hong Kong, Hong Kong
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13
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Feinstein H, Daşdöğen Ü, Libertus ME, Awan SN, Galera RI, Dohar JE, Abbott KV. Cognitive Mechanisms in Pediatric Voice Therapy - An Initial Examination. J Voice 2024; 38:538.e11-538.e22. [PMID: 34750034 PMCID: PMC9068827 DOI: 10.1016/j.jvoice.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Voice disorders are a common communication disorder in children. Behavioral voice therapy is recommended by both Otolaryngologists and Speech-Language Pathologists as a first-line approach for treatment of benign vocal fold lesions that affect children in large numbers. However, the role of cognitive mechanisms critical to voice therapy have not yet been explored. OBJECTIVE This proof-of-concept study aims to provide preliminary data on the potential relation between cognitive abilities and behavioral results of voice therapy for children with benign phonotraumatic vocal fold lesions. METHODS Six children (4;05 -9;02 years) diagnosed with vocal fold nodules completed a battery of cognitive tests from the NEuroPSYchological (NEPSY-II) Assessment and a standard course of "Adventures in Voice" therapy. Recordings pre and post intervention were analyzed acoustically using the Cepstral Spectral Index of Dysphonia (CSID) and perceptually using visual analog scales (VAS) for severity and resonance separately. Raw and age-corrected scaled scores from the NEPSY-II were then examined for their possible relation to voice outcomes. RESULTS Multiple cognitive functions correlated with voice outcomes. Raw score measures for Design Fluency, Inhibition, Fingertip Tapping, and Narrative Memory correlated favorably with all voice outcome measures. Age correlated with all NEPSY-II raw scores and perceptual voice outcome measures. Scaled scores for Auditory Attention, Design Fluency, Fingertip Tapping (Dominant hand), and Narrative Memory correlated with all voice outcome measures. CONCLUSION Results suggest that there is merit to further investigation of the relation between cognitive skills and their development and voice treatment outcomes in children with benign phonotraumatic lesions. Future studies with larger samples will build on present findings.
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Affiliation(s)
- Hagar Feinstein
- Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware, USA.
| | - Ümit Daşdöğen
- Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware, USA
| | - Melissa E Libertus
- Department of Psychology and Learning Research and Development Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shaheen N Awan
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida, USA
| | - Rhona I Galera
- Department of Rehabilitation Services, Lucile Packard Children's Hospital Stanford University, Palo Alto, California, USA
| | - Joseph E Dohar
- Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh - UPMC, Pittsburgh, Pennsylvania, USA; Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Communication Science and Disorders, University of Pittsburgh School of Health and Rehabilitation, Pittsburgh, Pennsylvania, USA
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14
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Dahan Z, Pincivy A, Nhan C, Bergeron M. Characterizing Dysphonia After Pediatric Open Airway Reconstruction: Systematic Review and Meta-Analysis. J Otolaryngol Head Neck Surg 2024; 53:19160216241266570. [PMID: 39138869 PMCID: PMC11325326 DOI: 10.1177/19160216241266570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Pediatric laryngotracheal stenosis often requires open airway reconstruction. While these surgeries establish an airway for adequate ventilation, many patients develop subsequent dysphonia. Numerous studies have reported outcomes related to voice. OBJECTIVE This study aims to evaluate dysphonia in pediatric patients following open airway reconstruction, focusing on acoustic parameters, perceptual voice quality, and voice-related quality of life. METHODS A comprehensive search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across 6 databases identified articles involving pediatric patients who underwent open airway reconstruction and reported postoperative vocal acoustic parameters, perceptual voice quality, voice-related quality of life, or vocal mechanics. Articles were assessed for bias risk, and common outcomes were synthesized qualitatively and quantitatively using meta-analyses. RESULTS Among 4089 articles, 21 were included, involving 497 pediatric patients. Laryngotracheoplasty was the most common procedure followed by cricotracheal resection. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scale was frequently used to assess voice quality, with a mean score of 55.6 [95% confidence intervals (CIs): 47.9-63.3]. Voice-related quality of life was measured using the pediatric Voice Handicap Index (pVHI) and Pediatric Voice-Related Quality of Life Survey, with mean scores of 35.6 (95% CI: 21.4-49.7) and 83.7 (95% CI: 74.1-93.2), respectively. The fundamental frequency was 210.5 (95% CI: 174.6-246.3). Other common findings included supraglottic phonation, anterior commissure blunting, posterior glottic diastasis, and abnormal vocal cord mobility. CONCLUSION Pediatric patients experiencing dysphonia after open airway reconstruction exhibited moderately decreased voice quality and reduced voice-related quality of life. However, there was inconsistency in study protocols and outcome measures used. Preserving voice quality during airway reconstruction is crucial to avoid negative impacts on quality of life.
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Affiliation(s)
- Zachary Dahan
- Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Alix Pincivy
- Medical library, CHU Sainte Justine, Montreal, QC, Canada
| | - Carol Nhan
- Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Ste-Justine, Montreal, QC, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, QC, Canada
| | - Mathieu Bergeron
- Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Ste-Justine, Montreal, QC, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, QC, Canada
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15
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Fujiki RB, Thibeault SL. Are Children with Cleft Palate at Increased Risk for Laryngeal Pathology? Cleft Palate Craniofac J 2023; 60:1385-1394. [PMID: 35912443 DOI: 10.1177/10556656221104027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To determine the prevalence of laryngeal pathology in children presenting with cleft palate with or without cleft lip (CP ± L) who underwent nasoendoscopy to assess palatal function. A secondary aim was to determine the relationship between patient demographics, resonance, articulation, and prevalence of laryngeal pathology in this population. Retrospective, observational cohort study. Outpatient pediatric cranio-facial anomalies clinic. Children ≤18 years of age presenting with CP ± L (N = 215) who underwent nasoendoscopy, speech language pathology, plastic surgery, and otolaryngological evaluations between 2009 and 2020. Laryngeal diagnosis by pediatric otolaryngologists. 21.9% of children presented with laryngeal pathology. Diagnoses included benign vocal fold lesions and laryngeal edema sufficiently severe to alter vocal fold edge contour. Likelihood of laryngeal pathology increased by approximately 12% with every increase of 1 year in age (P = .001, OR = 1.12). Children with laryngeal pathology were 50% more likely to have undergone palatal repair (P < .001, OR = 1.50). In addition, children with severely hypernasal resonance were 78% less likely to present with laryngeal pathology (P =.046, OR = 0.22). This population is at increased risk for laryngeal pathologies as determined by nasoendoscopy. This finding underscores the importance of careful laryngeal imaging in assessing these children. Additional research is warranted to identify the mechanisms underlying the increased risk for morphological vocal fold changes.
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Affiliation(s)
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin Madison, Madison, WI, USA
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16
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Heller Murray ES, Chao A. The Relationships Among Vocal Variability, Vocal-Articulatory Coordination, and Dysphonia in Children. J Voice 2023; 37:969.e43-969.e49. [PMID: 34272144 DOI: 10.1016/j.jvoice.2021.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the relationship between vocal variability and variability of vocal-articulatory coordination in children. Furthermore, this study examined if this relationship was impacted by pediatric dysphonia. STUDY DESIGN Retrospective analysis of speech samples in the Arizona Child Acoustic Database. METHODS Speech samples from children 2-7 years of age were selected for analysis. Vocal variability was defined as the coefficient of variation (CoV) of fundamental frequency, taken from the center of sustained vowels. Variability of vocal-articulatory coordination was defined as the CoV of voice onset time (VOT) of voiceless stop consonants. Both objective and subjective measures of dysphonia were completed for each participant. RESULTS Children had a negative correlation between VOT variability and vocal variability. Further analysis indicated that this relationship was present in children with typical developmental levels of dysphonia but absent for children with moderate to severe dysphonia. Increased dysphonia severity was associated with increased vocal variability. CONCLUSION Increased VOT variability was associated with decreased vocal variability in children with dysphonia severities consistent with typical vocal development. However, this relationship was not present in children with moderate to severe dysphonia. This study suggests that future work is needed to examine the relationships between the vocal system and vocal-articulatory coordination in children with and without diagnosed voice disorders.
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Affiliation(s)
| | - Andie Chao
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, Pennsylvania
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17
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Amir O, Yagev Bar-David O, Goldstein S, Epstein R, Alston M, Roziner I, Primov-Fever A. Development and Validation of the Children's Voice Questionnaire (CVQ). J Voice 2023:S0892-1997(23)00306-5. [PMID: 37919108 DOI: 10.1016/j.jvoice.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES This study developed and validated the children's voice questionnaire (CVQ), a new self-administered instrument for children, and evaluated its internal consistency and reliability. STUDY DESIGN Observational, prospective, cross-sectional study. METHODS The initial preparation of the CVQ was conducted in four steps. First, individual interviews were conducted with dysphonic and non-dysphonic children and their parents, teachers, and speech pathologists. Second, the responses collected from the interviews were arranged into a comprehensive list of 175 items. Third, this list was reduced to a preliminary 21-item version of the questionnaire, which was tested as a pilot with 254 children. Fourth, a further reduction to 18 items was performed to construct the final version of the CVQ. The questionnaire was then administered to 342 children (73 dysphonic, 269 non-dysphonic) aged 6-18. Simultaneously, the parents of these children completed the pediatric voice handicap index (pVHI). Finally, after 2 weeks, 30 randomly selected children (nine dysphonic, 21 non-dysphonic) completed the CVQ again to evaluate test-retest reliability. RESULTS High reliability was found for the CVQ (Cronbach's α = 0.94). Test-retest revealed strong and statistically significant reliability (r = 0.79, P < 0.001). A highly significant group difference was found between the CVQ scores obtained for the dysphonic and non-dysphonic groups (t[78.25] = 6.22, P < 0.001). In addition, significant medium-to-strong positive correlations were found between the children's evaluations using the CVQ and their parents' evaluations using the pVHI (0.59 < r < 0.66, P < 0.01). CONCLUSIONS The newly developed CVQ is a valid and reliable instrument. Findings reveal general agreement between children and their parents, but also show that children's perspective on their dysphonia is not equivalent to the parent's perspective. This demonstrates that combining both perspectives provides a more holistic and complete overview of dysphonic children's voice-related quality of life. The self-administered CVQ reliably differentiates dysphonic from non-dysphonic children and may serve as a valuable tool for the initial or ongoing evaluation of children with voice disorders in clinical and research settings.
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Affiliation(s)
- Ofer Amir
- Department of Communication Disorders, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Hearing, Speech, and Language, Sheba Medical Center, Tel Hashomer, Israel.
| | - Orr Yagev Bar-David
- Department of Communication Disorders, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shay Goldstein
- Department of Communication Disorders, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ruth Epstein
- Speech and Language Therapy (ENT), University College London Hospitals NHS Foundation Trust, London, England, UK
| | - Marion Alston
- Speech and Language Therapy (ENT), University College London Hospitals NHS Foundation Trust, London, England, UK
| | - Ilan Roziner
- Department of Communication Disorders, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Primov-Fever
- Department of Otolaryngology, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Otorhinolaryngology, Head & Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel
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18
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Hseu AF, Spencer GP, Jo S, Kawai K, Nuss RC. Pediatric Dysphonia: When to Refer. Clin Pediatr (Phila) 2023; 62:1261-1268. [PMID: 36856137 DOI: 10.1177/00099228231157957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The reported prevalence of voice disorders in the pediatric population varies widely between studies, ranging from 3.9% to 23%. Despite this, not all children with dysphonia are referred to a voice specialist for further evaluation. The objective of this study is to examine the relationship between dysphonia history, voice assessment, and laryngeal findings to help guide referrals of dysphonic children. A retrospective review was conducted of pediatric patients at a tertiary voice clinic between January 2014 and December 2017. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, laryngeal exam findings, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed. Of 475 patients initially identified, 459 met inclusion criteria and were reviewed. In all, 272 (59.3%) were male and 187 (40.7%) were female. Mean age at first presentation was 8.6 years old (range: 2-18). Males were more likely to present at a younger age than females. CAPE-V data were available for 439 patients, and pVHI data were available for 109 patients. The mean CAPE-V Overall Severity score was 38.2. The mean total pVHI score was 25.4. Males had higher CAPE-V Overall Severity (40.0 vs. 35.4), Roughness (32.2 vs. 27.6), and Strain scores (37.2 vs. 32.4) than females. Patient pVHI scores did not differ by gender. In all, 283 patients self-reported a length of symptoms prior to evaluation. Children with a longer duration of symptoms prior to evaluation had higher CAPE-V Overall Severity scores. Diagnoses of vocal fold movement impairment and benign vocal fold lesions that were not nodules were associated with higher average CAPE-V Overall Severity scores. Overall, 310 patients (67.5%) were recommended intervention for their dysphonia. These patients had higher CAPE-V Overall Severity scores than those who were solely recommended observation (42.8 vs. 28.0). Males were more likely than females to present with dysphonia and presented with more severe perceptual dysphonia scores on average. The length of symptoms and certain diagnoses correlated with higher CAPE-V Scores. Referrals to a pediatric voice clinic should be considered in patients with a dysphonia history lasting greater than 3 months and in patients with more severe symptoms.
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Affiliation(s)
- Anne F Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Grant P Spencer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Stacy Jo
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roger C Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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19
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Gale V, Carlton J. Including Young Children in the Development and Testing of Patient Reported Outcome (PRO) Instruments: A Scoping Review of Children's Involvement and Qualitative Methods. THE PATIENT 2023; 16:425-456. [PMID: 37402059 DOI: 10.1007/s40271-023-00637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Qualitative research during the development/testing of Patient Reported Outcome Measures (PROMs) is recommended to support content validity. However, it is unclear if and how young children (≤ 7 years) can be involved in this research because of their unique cognitive needs. OBJECTIVES Here we investigate the involvement of children (≤ 7 years) in qualitative research for PROM development/testing. This review aimed to identify (1) which stages of qualitative PROM development children ≤ 7 years had been involved in, (2) which subjective health concepts had been explored within qualitative PROM development with this age group, and (3) which qualitative methods had been reported and how these compared with existing methodological recommendations. METHODS This scoping review systematically searched three electronic databases (searches re-run prior to final analysis on 29 June 2022) with no date restrictions. Included studies had samples of at least 75% aged ≤ 7 years or reported distinct qualitative methods for children ≤ 7 years in primary qualitative research to support concept elicitation or PROM development/testing. Articles not in English and PROMs that did not enable children ≤ 7 years to self-report were excluded. Data on study type, subjective health and qualitative methods were extracted and synthesised descriptively. Methods were compared with recommendations from guidance. RESULTS Of 19 included studies, 15 reported concept elicitation research and 4 reported cognitive interviewing. Most explored quality of life (QoL)/health-related quality of life (HRQoL). Some concept elicitation studies reported that creative/participatory activities had supported children's engagement, but results and reporting detail varied considerably across studies. Cognitive interviewing studies reported less methodological detail and fewer methods adapted for young children compared with concept elicitation studies. They were limited in scope regarding assessments of content validity, mostly focussing on clarity while relevance and comprehensiveness were explored less. DISCUSSION Creative/participatory activities may be beneficial in concept elicitation research with children ≤ 7 years, but future research needs to explore what contributes to the success of young children's involvement and how researchers can adopt flexible methods. Cognitive interviews with young children are limited in frequency, scope and reported methodological detail, potentially impacting PROM content validity for this age group. Without detailed reporting, it is not possible to determine the feasibility and usefulness of children's (≤ 7 years) involvement in qualitative research to support PROM development and assessment.
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Affiliation(s)
- Victoria Gale
- School of Health and Related Research, The University of Sheffield, Sheffield, UK.
| | - Jill Carlton
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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20
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Guimarães I, Almeida L, Quintal A, Batista AP, Teixeira A, Romeiro C, Ferreira DB, Fernandes IS, Saraiva M, Bom R, Almeida S, Freitas SV. Pediatric Voice Handicap Index (pVHI): Validation in European Portuguese Children. J Voice 2023; 37:804.e11-804.e19. [PMID: 34183214 DOI: 10.1016/j.jvoice.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine reliability and validity of the European Portuguese pVHI version (pVHI-EP). STUDY DESIGN Cross-sectional design. METHODS The pVHI-EP and the talkative and global voice assessment scales were administered to the caregivers of children aged from 3 to 16 years old with and without dysphonia. Reliability (internal consistency and test-retest) was analyzed. The validity analyses performed were: (1) content validity by analyzing the percentage of missing data; (2) construct validity with intraclass correlation coefficients among pVHI-EP domains and overall score; (3) concurrent validity was conducted between pVHI-EP, the caregivers' judgment of the child's voice severity on a visual analog scale and the Speech-Language Pathologist perceptual voice assessment; (4) known-groups validity between children with and without dysphonia, and (5) predictive validity by calculating receiver operating characteristics, sensitivity and specificity and determining cut-off points. RESULTS A total of 283 children (61.5% boys, mean age 8.3 years) participated in the study. The pVHI-EP showed an excellent internal consistency for the pVHI-EP total data. Strong to moderate test-retest reliability confirms pVHI-EP reproducibility. Excellent to good intraclass correlation coefficients between the pVHI-EP overall and the domains confirms its construct validity. Weak to moderate concurrent validity with visual analog scale and Speech-Language Pathologist perceptual voice assessment was confirmed. The pVHI-EP significantly distinguished two groups of different voice conditions. A cut-off point of 10.5 with 95.9% sensitivity and 92.5% specificity was determined for the overall score of the pVHI-EP. CONCLUSIONS The pVHI-EP is a reliable and valid caregiver voice outcome tool for EP children with dysphonia.
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Affiliation(s)
- Isabel Guimarães
- Speech and Language Pathologist (SLP), Speech Therapy Department, Alcoitão Health School of Sciences, Clinical and Therapeutics Pharmacological Unit, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Lina Almeida
- SLP, ENT Department, Hospital dos Lusíadas, Lisboa, Portugal.
| | - Aldora Quintal
- SLP, MSc, ENT Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Paula Batista
- SLP, MSc, ENT Department, Centro Hospitalar e Universitário do Algarve, Portimão, Portugal
| | - Ana Teixeira
- SLP, Physical Medicine and Rehabilitation, Hospital São João de Deus, Montemor-o-Novo, Portugal
| | - Cláudia Romeiro
- SLP, ENT Department, Hospital de Ponta Delgada-Hospital do Divino Espírito Santo de Ponta Delgada, EPE, São Miguel, Açores, Portugal
| | - Daniela Brás Ferreira
- SLP, ENT Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | | | - Madalena Saraiva
- SLP, ENT Department, Hospital de Ponta Delgada-Hospital do Divino Espírito Santo de Ponta Delgada, EPE, São Miguel, Açores, Portugal
| | - Rita Bom
- SLP, ENT Department, Hospital do Espírito Santo de Évora, EPE, Évora, Portugal
| | - Sancha Almeida
- SLP, MSc, ENT Department, Hospital da Luz, Lisboa, Portugal
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21
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Colletti L, Heller Murray E. Voice Onset Time in Children With and Without Vocal Fold Nodules. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1467-1478. [PMID: 36940476 PMCID: PMC10457081 DOI: 10.1044/2023_jslhr-22-00463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/21/2022] [Accepted: 01/16/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Voice onset time (VOT) of voiceless consonants provides information on the coordination of the vocal and articulatory systems. This study examined whether vocal-articulatory coordination is affected by the presence of vocal fold nodules (VFNs) in children. METHOD The voices of children with VFNs (6-12 years) and age- and gender-matched vocally healthy controls were examined. VOT was calculated as the time between the voiceless stop consonant burst and the vocal onset of the vowel. Measures of the average VOT and VOT variability, defined as the coefficient of variation, were calculated. The acoustic measure of dysphonia, cepstral peak prominence (CPP), was also calculated. CPP provides information about the overall periodicity of the signal, with more dysphonic voices having lower CPP values. RESULTS There were no significant differences in either average VOT or VOT variability between the VFN and control groups. VOT variability and average VOT were both significantly predicted by the interaction between Group and CPP. There was a significant negative correlation between CPP and VOT variability in the VFN group, but no significant relationship was found in the control group. CONCLUSIONS Unlike previous studies with adults, there were no group differences in average VOT or VOT variability in this study. However, children with VFNs who were more dysphonic had increased VOT variability, suggestive of a relationship between dysphonia severity and control of vocal onset during speech production.
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Affiliation(s)
- Lauren Colletti
- Department of Communication Sciences and Disorders, College of Public Health, Temple University, Philadelphia, PA
| | - Elizabeth Heller Murray
- Department of Communication Sciences and Disorders, College of Public Health, Temple University, Philadelphia, PA
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22
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Fujiki RB, Thibeault SL. Examining Relationships Between GRBAS Ratings and Acoustic, Aerodynamic and Patient-Reported Voice Measures in Adults With Voice Disorders. J Voice 2023; 37:390-397. [PMID: 33750626 PMCID: PMC8419204 DOI: 10.1016/j.jvoice.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if auditory-perceptual voice ratings performed using the GRBAS scale correlate with acoustic and aerodynamic measures of voice. A secondary aim was to examine the relationship between GRBAS ratings and patient-reported quality of life scales. METHODS GRBAS ratings, acoustic, aerodynamic and patient-reported quality of life ratings were collected from the University of Wisconsin Madison Voice and Swallow Outcomes Database for 508 adults with voice disorders. Acoustic measures included noise to harmonic ratio, jitter%, shimmer%, highest fundamental frequency (F0) of vocal range, lowest F0 of vocal range, maximum phonation time and dysphonia severity index. Aerodynamic measures included phonation threshold pressure, subglottal pressure, mean transglottal airflow and laryngeal airway resistance. Patient-reported quality of life measures included the Vocal Handicap Index (VHI) and Glottal Function Index (GFI). RESULTS GRBAS ratings were significantly correlated with several acoustic and aerodynamic measures, VHI and GFI. The strongest significant correlations for acoustic measures were observed between GRBAS ratings of overall voice quality and perturbation measures (jitter% r = 0.58, shimmer% r = 0.45, noise to harmonic ratio r = 0.36, Dysphonia Severity Index r = -0.56). The strongest significant correlation for aerodynamic voice measures was observed between GRBAS ratings of breathiness and transglottal airflow (r = 0.23), subglottal pressure (r = 0.49), and phonation threshold pressure (r = 0.26). GRBAS ratings were also significantly correlated with both VHI and the GFI scales. R values were higher for the VHI, but remained largely in low range for both scales. CONCLUSIONS Although GRBAS ratings were significantly correlated with multiple objective voice and patient related quality of life ratings, r values were low. These findings support the need for multiple voice measures when performing voice evaluations as no single voice measure was highly correlated with voice quality as measured by the GRBAS scale.
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Affiliation(s)
- Robert Brinton Fujiki
- Department of Surgery, University of Wisconsin Madison, Wisconsin Institutes for Medical Research (WIMR) BLDG. 1485, Madison, Wisconsin
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin Madison, Wisconsin Institutes for Medical Research (WIMR) BLDG. 1485, Madison, Wisconsin.
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Fujiki RB, Braden M, Thibeault SL. Voice Therapy Improves Acoustic and Auditory-Perceptual Outcomes in Children. Laryngoscope 2023; 133:977-983. [PMID: 35754165 PMCID: PMC9790974 DOI: 10.1002/lary.30263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE This study employed acoustic measures as well as auditory-perceptual assessments to examine the effects of voice therapy in children presenting with benign vocal fold lesions. METHODS A retrospective, observational cohort design was employed. Sustained vowels produced by 129 children diagnosed with benign vocal fold lesions were analyzed, as well as connected speech samples produced by 47 children. Treatment outcome measures included Consensus of Auditory-Perceptual Evaluation of Voice (CAPE-V), jitter, shimmer, Noise-to-Harmonic Ratio (NHR), cepstral peak prominence (CPP), and Low-to-High Ratio (LHR) on sustained vowels, and CPP and LHR on connected speech. RESULTS Following voice therapy, significant improvements in CAPE-V ratings (p < 0.001) were observed. Additionally, jitter (p = 0.041), NHR (p = 0.019), and CPP (p < 0.01) on sustained vowels, and CPP (p = 0.002), and LHR (p = 0.008) on connected speech significantly improved following voice therapy. CPP increased with age in males but did not change in females. CAPE-V ratings and perturbation measures indicated that dysphonia was more severe in younger children pre and post-therapy. CONCLUSIONS Auditory-perceptual and acoustic measures demonstrated improved voice quality following voice therapy in children with dysphonia. CPP effectively quantified voice therapy gains and allowed for analysis of connected speech, in addition to sustained vowels. These findings demonstrate the value of CPP as a tool in assessing therapy outcomes and support the efficacy of voice therapy for children presenting with vocal fold lesions. LEVEL OF EVIDENCE 4 Laryngoscope, 133:977-983, 2023.
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Affiliation(s)
| | - Maia Braden
- Department of Communication Sciences and Disorders, University of Wisconsin Madison, Madison, Wisconsin, U.S.A
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin Madison, Madison, Wisconsin, U.S.A
- Department of Communication Sciences and Disorders, University of Wisconsin Madison, Madison, Wisconsin, U.S.A
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A Review of Voice Disorders in School-Aged Children. J Voice 2023; 37:301.e1-301.e7. [PMID: 33500199 DOI: 10.1016/j.jvoice.2020.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to review literature concerning voice disorders in school-aged children. STUDY DESIGN Integrative review. MATERIALS AND METHODS A database search was conducted using PubMed, Web of Science, Academic Search Complete, CINAHL Complete, and Medline. All records included in this review were peer-reviewed journal articles that discussed voice disorders in children, conducted in the United States or Canada, written in English, and published between 2009 and 2019. RESULTS Database searching identified 1,771 records and 551 duplicates were removed. A total of 1,220 records were screened and 949 records were excluded. Two hundred and seventy-one full-text records were screened and 12 records met inclusion criteria. Vocal fold nodules were the most commonly reported vocal fold pathology. The Consensus Auditory Perceptual Evaluation of Voice and endoscopy were the most commonly reported assessments. However, variations in practice patterns and access to voice services may exist. CONCLUSIONS The findings highlight that school-aged children may face barriers in accessing voice services. As a result, continued analyses of the potential barriers that hinder identification and treatment of voice disorders in this population appear warranted.
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Wu SS, Ongkasuwan J, Anne S, Appachi S. Voice outcomes following surgical treatment for pediatric vocal fold nodules: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2023; 166:111461. [PMID: 36758441 DOI: 10.1016/j.ijporl.2023.111461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study aimed to systematically review the literature to determine outcomes following surgical treatment of pediatric vocal fold nodules. METHODS Studies with patients ≤18 years with nodules who underwent surgery were reviewed for dysphonia improvement and recurrence in PubMed, EMBASE, Medline, CINAHL, Cochrane, Scopus, and Web of Science databases, searched from inception to November 1, 2022 using PRISMA guidelines. Non-English studies and case reports were excluded. Two evaluators independently reviewed each abstract and article. Heterogeneity and bias across studies were evaluated and meta-analysis was performed. RESULTS The literature search yielded 655 articles; 145 underwent full-text screening and eight were selected for systematic review and meta-analysis. There were 311 children with nodules, aged 2-18 years, with male-to-female ratio of 3.6:1. There were no surgical complications. Voice therapy was inconsistently reported. Follow-up time ranged from 1 month to 10 years. One study concluded that neither surgery nor voice therapy was effective, while five studies concluded that dysphonia improved with surgery. Voice grading by GRBAS, objective voice measures, and lesion size were improved following surgery, when reported. Meta-analysis of six studies demonstrated improvement in dysphonia in 90% of children post-operatively (95% CI: 74-99%). Meta-analysis of four studies showed that recurrence occurred in 19% of children (95% CI: 13-23%). CONCLUSION This systematic review suggests possible post-operative improvement in dysphonia for pediatric patients with vocal fold nodules; however, study measures, methods, and surgery utilized were heterogeneous and results should be interpreted cautiously. In order to better understand surgical outcomes, future studies should include standardized definition of nodules and objective measures of voice.
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Affiliation(s)
- Shannon S Wu
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Samantha Anne
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Swathi Appachi
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA.
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Kwong E. Cross-cultural Adaptation and Validation of the Hong Kong-Chinese version of Children's Voice Handicap Index-10 for Parents (CVHI-10-P(HK)). J Voice 2023; 37:299.e9-299.e14. [PMID: 33384249 DOI: 10.1016/j.jvoice.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to cross-culturally adapt and validate the Hong Kong Chinese version of the Children's Voice Handicap Index-10 for Parents (CVHI-10-P(HK)), a parent-proxied quality of life (QOL) questionnaire that pairs with the Children's Voice Handicap Index-10 (CVHI-10(HK)). METHOD The English version of the (CVHI-10-P(HK)) underwent forward-backward translation and pretesting. Content validity was computed from an expert panel rating on relevance and test-retest reliability was obtained from parents and/or guardians of six dysphonic and five vocally-healthy children. Other validity and reliability measures were analyzed from CVHI-10-P(HK) completed by parents and/or guardians of 28 dysphonic and 35 vocally-healthy children who had completed CVHI-10(HK). RESULTS The CVHI-10-P(HK) demonstrated excellent internal consistency (α = 0.091), excellent content validity (item- and scale-level content validity indices = 1.00), good construct validity (between group difference in total CVHI-10-P(HK) score: t(30.904) = -6.449, P < 0.001, Cohen's d = 1.709) and excellent test-retest reliability (r = 0.966, P < 0.001). Criterion validity analysis showed a moderate correlation between the total CVHI-10-P(HK) score and auditory-perceptual ratings on overall severity (r = 0.515, P < 0.001). Area under the curve of the receiver operating characteristic plot was found to be 0.855. The CVHI-10-P(HK) has excellent intrinsic accuracy. A cutoff of score of four may be adopted for the optimal sensitivity and specificity match. A moderate correlation was found between the total scores of CVHI-10-P(HK) and CVHI-10(HK) (r = 0.684, P < 0.001). CONCLUSION The CVHI-10-P(HK) is a valid tool that measures QOL of dysphonic children from the parents' perspective. It is recommended to be used in parallel to the CVHI-10(HK) as part of a comprehensive voice assessment for children in Hong Kong.
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Affiliation(s)
- Elaine Kwong
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
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Hazkani I, Farje D, Alden T, DiPatri A, Tennant A, Ghadersohi S, Thompson DM, Rastatter J. The Clinical Impact of Vagal Nerve Stimulator Implantation on Laryngopharyngeal Function in Children: A Single-Center Experience. Otolaryngol Head Neck Surg 2023; 168:1521-1528. [PMID: 36939431 DOI: 10.1002/ohn.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/01/2022] [Accepted: 10/14/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE A vagal nerve stimulator (VNS) has been established as the treatment of choice for children with refractory epilepsy. The outcomes of the procedure have been well documented in adults but are less clear in children. The goal of our study was to review laryngopharyngeal (LP) function following VNS implantation in children. STUDY DESIGN Case series with chart review. SETTING Tertiary-care children's hospital. METHODS Voice, swallowing, and sleep apnea symptoms were extracted from the charts of children who underwent VNS implantation between 2013 and 2021. A questionnaire was sent to parents of implanted children to ascertain the degree of the social and functional impact of the implant. RESULTS There were 69 patients, aged 2.3 to 21.4 years old, who met the inclusion criteria. LP symptoms were most common during the first year following implantation; 26 patients (37.6%) demonstrated at least 1 symptom (voice alteration, chronic cough, sleep-disordered breathing, or dysphagia), and 15 patients required adjustments to their implant settings. The incidence of symptoms and the need to adjust VNS settings significantly dropped during years 2 to 5 and 6 to 8 (22% vs 7% and 5%, respectively, p = .0002). The mean score of the Pediatric Voice Handicap Index differed greatly from a normal control group on each subscale and the total score. CONCLUSION LP dysfunction in children following VNS implantation is comparable to adults, with the most burden noticed during the first year after implantation. The presence of voice alterations did not correlate with the presence of dysphagia and sleep-disordered breathing. Thorough evaluation, preferably by a multidisciplinary team, is required to assess LP dysfunction postoperatively.
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Affiliation(s)
- Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Doris Farje
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tord Alden
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Arthur DiPatri
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Amy Tennant
- Division of Pediatric Neurology-Epilepsy Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Saied Ghadersohi
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dana M Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey Rastatter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Assessment of Life Quality in Children with Dysphonia Using Modified Pediatric Voice-Related Quality of Life Questionnaire in Serbia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010125. [PMID: 36670675 PMCID: PMC9856427 DOI: 10.3390/children10010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
(1) Background: Hoarseness is not uncommon in children, especially at school age, as communication with peers is intensified. It is caused by improper use or overuse of the vocal apparatus. (2) Methods: The study included 85 hoarse children aged 6-12 (study group) and 240 healthy children (control group) of the same age. The study group underwent a detailed medical history, phoniatric examination, larynx fiber endoscopy, allergy treatment and the Pediatric Voice-Related Quality of Life questionnaire, modified by Jasmina Stojanovic. (3) Results: Our modified questionnaire revealed the significance of parental perception of a voice disorder in a child after organized activities. Using our modified questionnaire, we were able to determine the most frequent form of a voice disorder in children-speaking too loudly-is often neglected by the environment and can lead to an overall lower life quality. (4) Conclusions: As the presence of hoarseness impairs the quality of life in the pediatric population, awareness of a voice disorder must be recognized and treated on time to overcome the possible side effects on a child's psychological and emotional development.
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Costa CC, Leite APD, Madazio G, Behlau M. Auditory-perceptual evaluation of voice: comparing different speech tasks to identify children with and without laryngeal lesions. Codas 2023; 35:e20210198. [PMID: 36888744 PMCID: PMC10010427 DOI: 10.1590/2317-1782/20212021198pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/03/2022] [Indexed: 03/08/2023] Open
Abstract
PURPOSE To compare the vowel emission and number counting tasks in perceptual-auditory differentiation among children with and without laryngeal lesions. METHODS Observational, analytical, and cross-sectional methods were used. Medical records of 44 children were selected from a database of an otorhinolaryngology service at a University Hospital and they were divided into groups: without laryngeal lesion (WOLL), and with laryngeal lesion (WLL), with 33 and 11 children. For the auditory-perceptual evaluation, the vocal samples were separated according to the type of task. They were analyzed separately by a judge who analyzed the general degree of vocal deviation and assessed whether the child would pass or fail in the face of a screening situation. RESULTS There was a difference between the WOLL and WLL groups in terms of the overall degree of vocal deviation for the task of number counting, with a predominance of mild deviations in WOLL and moderate in WLL. In the screening, there was a difference between the groups during the number counting task, with more failures in the WLL. The groups were similar in the sustained vowel task, both in terms of the overall degree of vocal deviation and the vocal screening. Most children in the WLL failed in both tasks during vocal screening compared to the children in the WOLL who, in general, failed in only one task. CONCLUSION The task of number counting contributes to the auditory differentiation in children with and without laryngeal lesion, by identifying deviations of greater intensity in children with laryngeal lesion.
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Affiliation(s)
- Cintia Conceição Costa
- Departamento de Fonoaudiologia, Universidade Estadual do Centro-Oeste - UNICENTRO - Irati (PR), Brasil
| | - Ana Paula Dassie Leite
- Departamento de Fonoaudiologia, Universidade Estadual do Centro-Oeste - UNICENTRO - Irati (PR), Brasil
| | | | - Mara Behlau
- Centro de Estudos da Voz - CEV - São Paulo (SP), Brasil
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Foster ME, Choo AL, Smith SA. Speech-language disorder severity, academic success, and socioemotional functioning among multilingual and English children in the United States: The National Survey of Children's Health. Front Psychol 2023; 14:1096145. [PMID: 36891210 PMCID: PMC9987562 DOI: 10.3389/fpsyg.2023.1096145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/23/2023] [Indexed: 02/22/2023] Open
Abstract
Research points to negative associations between educational success, socioemotional functioning, and the severity of symptoms in some speech-language disorders (SLDs). Nonetheless, the majority of studies examining SLDs in children have focused on monolinguals. More research is needed to determine whether the scant findings among multilinguals are robust. The present study used parent report data from the U.S. National Survey of Children's Health (2018 to 2020) to gain a better understanding of the impacts of SLD severity on indicators of academic success and socioemotional functioning among multilingual (n = 255) and English monolingual (n = 5,952) children with SLDs. Tests of between-group differences indicated that multilingual children evidenced more severe SLDs, had lower school engagement, and had lower reports of flourishing than English monolingual children with SLDs. Further, a greater proportion of multilingual children with SLDs missed more school days than English monolinguals. However, multilinguals were less likely to bully others or have been bullied than monolinguals. While the previous between-group differences were statistically significant, they were small (vs ≤ 0.08). Increased SLD severity predicted an increased number of repeated school grades, increased absenteeism, and decreased school engagement, when age and socioeconomic status were controlled. Increased SLD severity also predicted greater difficulty making and keeping friends and decreased flourishing. The effect of SLD severity on being bullied was statistically significant for the monolinguals but not multilinguals. There was a statistically significant interaction for SLD severity and sex for school engagement and difficulty making and keeping friends for monolinguals but not multilinguals. The interactions indicated that school engagement decreased more for females than for males while difficulties making and keeping friends increased more for males than females as one's SLD severity increased. While some findings were specific to monolinguals, tests of measurement invariance indicated that the same general pattern of relations among the variables were evident across the groups of multilinguals and monolinguals. These final findings can inform the interpretation of the results from both the current and future studies, while the overall findings can inform the development of intervention programs, thereby improving the long-term academic and socioemotional outcomes of children with SLDs.
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Affiliation(s)
- Matthew E Foster
- Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Ai Leen Choo
- Communication Sciences and Disorders, College of Education and Human Development, Georgia State University, Atlanta, GA, United States
| | - Sara A Smith
- Technology in Education and Second Language Acquisition, College of Education, University of South Florida, Tampa, FL, United States
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Costa CC, Leite APD, Madazio G, Behlau M. Auditory-perceptual evaluation of voice: comparing different speech tasks to identify children with and without laryngeal lesions. Codas 2023. [DOI: 10.1590/2317-1782/20212021198en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
ABSTRACT Purpose To compare the vowel emission and number counting tasks in perceptual-auditory differentiation among children with and without laryngeal lesions. Methods Observational, analytical, and cross-sectional methods were used. Medical records of 44 children were selected from a database of an otorhinolaryngology service at a University Hospital and they were divided into groups: without laryngeal lesion (WOLL), and with laryngeal lesion (WLL), with 33 and 11 children. For the auditory-perceptual evaluation, the vocal samples were separated according to the type of task. They were analyzed separately by a judge who analyzed the general degree of vocal deviation and assessed whether the child would pass or fail in the face of a screening situation. Results There was a difference between the WOLL and WLL groups in terms of the overall degree of vocal deviation for the task of number counting, with a predominance of mild deviations in WOLL and moderate in WLL. In the screening, there was a difference between the groups during the number counting task, with more failures in the WLL. The groups were similar in the sustained vowel task, both in terms of the overall degree of vocal deviation and the vocal screening. Most children in the WLL failed in both tasks during vocal screening compared to the children in the WOLL who, in general, failed in only one task. Conclusion The task of number counting contributes to the auditory differentiation in children with and without laryngeal lesion, by identifying deviations of greater intensity in children with laryngeal lesion.
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Lee JM, Roy N, Park A, Muntz H, Smith M. Emotional Adjustment in Children with Vocal Fold Nodules. J Voice 2022:S0892-1997(22)00346-0. [PMID: 36509581 DOI: 10.1016/j.jvoice.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Vocal fold nodules (VNs) in children are benign, bilateral, callous-like lesions at the junction of the anterior third and posterior two-thirds of the true vocal folds. Chronic, repetitive, and intense vocal behavior is often cited as the primary etiology; however, difficulties with emotional adjustment may predispose some children towards extreme and possibly phonotraumatic vocal activity, thereby contributing secondarily to the development of VNs. OBJECTIVES This case-control study examined the association between features of emotional adjustment and VNs in children. METHODS Parents of children with VNs (N = 40, Mage = 7.5, SDage = 2.03) and two medical control groups [ie, voice disordered, but not VNs (VDCs; N = 40, Mage= 7.09, SDage = 2.01) and vocally normal controls (VNCs; N = 40, Mage = 7.6, SDage = 1.54)] participated in the study. Features of emotional adjustment were assessed using two inventories: the Parent Rating scale for Reactive and Proactive Aggression and the Revised Child Anxiety and Depression Scale - Parent version. RESULTS As compared with the VNCs, children with VNs were significantly more aggressive (P = 0.042, Cohen's d = 0.47) whereas the VDCs were more depressed (P = 0.013, Cohen's d = 0.60). Furthermore, VDCs experienced more separation anxiety than VNs (P = 0.038, Cohen's d = 0.45) and VNCs (P = 0.021, Cohen's d = 0.55). No other significant between-group differences were identified between the VNs and VDCs. CONCLUSIONS When present, elevated aggression may represent a risk factor for VNs formation in children, and possibly influence treatment outcomes. Therefore, the current results highlight the importance of understanding the role of emotional adjustment in the evaluation and treatment of dysphonia in children.
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Affiliation(s)
- Jeong Min Lee
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah.
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah
| | - Albert Park
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, Utah; Division of Otolaryngology - Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, Utah
| | - Harlan Muntz
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, Utah; Division of Otolaryngology - Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, Utah
| | - Marshall Smith
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, Utah; Division of Otolaryngology - Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, Utah
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Fujiki RB, Thibeault SL. Pediatric Voice Therapy: How Many Sessions to Discharge? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2663-2674. [PMID: 36198045 PMCID: PMC9911102 DOI: 10.1044/2022_ajslp-22-00111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/14/2022] [Accepted: 07/11/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE Voice therapy is the primary treatment for children presenting with benign morphological vocal fold changes. This study examined the number of voice therapy sessions required to meet treatment goals and identified factors that predicted treatment length for pediatric voice patients. METHOD An observational cohort design was employed. Data were extracted from the University of Wisconsin-Madison Voice and Swallow Outcome Database. This study examined 62 children who completed a course of voice therapy with a speech-language pathologist (SLP) addressing dysphonia caused by benign vocal fold lesions. Extracted data included patient demographics, auditory-perceptual assessments, acoustic and aerodynamic voice measures, videostroboscopy ratings, and medical comorbidities. Linear regression was used to identify predictors of number of therapy sessions. RESULTS Patients received an average of 7.5 sessions of voice therapy prior to discharge. Baseline auditory-perceptual assessment of dysphonia (p = .032), phonation threshold pressure (PTP, p = .005), Glottal Function Index (GFI) score (p = .006), and glottic closure pattern (p = .023) were significant predictors of number of voice therapy sessions. These measures, as well as hourglass glottic closure, predicted longer intervention duration. The regression model had an overall r 2 of .62. CONCLUSIONS Pediatric voice therapy addressing benign vocal fold lesions and/or laryngeal edema required an average of 7.54 sessions before voice outcomes were sufficiently improved for discharge. More severe overall SLP ratings of dysphonia, GFI scores, PTP, or hourglass glottic closure pattern significantly predicted increased number of therapy sessions prior to discharge. Future work should determine what other factors affect treatment duration and how the efficiency of pediatric voice therapy can be maximized.
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Ma EPM, Chow AYT, Lam VWY. Management of Pediatric Voice Disorders: Perceived Knowledge, Confidence, Attitude and Practice Patterns Among School-based Speech-language Pathologists in Hong Kong. J Voice 2022:S0892-1997(22)00316-2. [PMID: 36400633 DOI: 10.1016/j.jvoice.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This survey evaluated the levels of self-perceived knowledge, confidence, attitude and practice patterns of school-based speech-language pathologists (SLPs) in Hong Kong regarding their management of pediatric voice disorders. METHODS SLPs with experience working in school settings in Hong Kong were invited to complete an anonymous online survey. The survey ascertained SLPs' perception of their knowledge, confidence, attitude and practice patterns regarding their management of pediatric voice disorders. It also explored the barriers and facilitators to effective service provision for children with voice problems in schools. RESULTS A total of 85 responses were received, of which 56 respondents with complete responses were selected for analysis. Results showed that respondents in general did not consider themselves having sufficient knowledge on pediatric voice. They did not feel fully confident in managing pediatric voice cases. Even though they exhibited a positive attitude and agreed that pediatric voice management was important, discrepancies were noted between their attitude and practice. Barriers that hinder practice include the lack of professional guidelines, insufficient time and resource as well as difficulties to conduct comprehensive voice assessments with children. CONCLUSION The study findings urge the needs of enhancing school-based SLPs' perceived knowledge and competence in managing pediatric voice disorders. The study also identifies strategic directions to improve service provision for children with voice disorders in schools.
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Affiliation(s)
- Estella P-M Ma
- Voice Research Laboratory, Academic Unit of Human Communication, Development & Information Sciences, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Amy Y-T Chow
- Voice Research Laboratory, Academic Unit of Human Communication, Development & Information Sciences, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong
| | - Verna W-Y Lam
- Voice Research Laboratory, Academic Unit of Human Communication, Development & Information Sciences, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong
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Adriaansen A, Meerschman I, Van Lierde K, D'haeseleer E. Effects of voice therapy in children with vocal fold nodules: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1160-1193. [PMID: 35758272 DOI: 10.1111/1460-6984.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Vocal fold nodules (VFNs) are the main cause of paediatric dysphonia. Voice therapy is recommended as the preferable treatment option for VFNs in children. AIM The aim of this systematic review is to provide an overview of the existing literature concerning the effects of voice therapy in children with VFNs. METHODS & PROCEDURES This systematic literature review was developed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed) and Embase were searched and the grey literature was checked. The search strategy was based on three concepts: VFNs, voice therapy and children. Two examiners independently determined article eligibility and extracted all relevant data from the included studies. The methodological quality of the included study was assessed using the QualSyst tool. MAIN CONTRIBUTIONS By identifying, evaluating and summarizing the results of all relevant studies about voice therapy in paediatric VFNs, this systematic review makes the available evidence more accessible to voice therapists, otolaryngologists and other relevant stakeholders. CONCLUSIONS & IMPLICATIONS 24 studies were included in this systematic review. Eight studies (8/24) reported a significant improvement for at least one outcome parameter after voice therapy. However, five papers (5/24) could not demonstrate significant changes after voice therapy. All studies that did not test for significance (11/24) found improvements for one or more outcome parameters. The overall quality of the included studies is adequate (55%). In sum, there is some evidence that voice therapy is effective in children with VFNs, but further well-designed research, especially randomized controlled trials, is necessary to confirm these results. WHAT THIS PAPER ADDS What is already known on the subject Voice therapy is preferable in children with VFNs because of the phonotraumatic nature of the nodules and the associated high recurrence rate after phonosurgery. Most voice therapists in clinical practice offer an eclectic voice therapy programme, consisting of direct and indirect voice therapy techniques. What this study adds to existing knowledge This systematic review provides a clear overview of the available evidence concerning the effects of voice therapy in paediatric VFNs. There is some evidence that voice therapy is an effective treatment option in children with VFNs, but well-designed research is scarce on this subject. What are the potential or actual clinical implications of this work? This review shows that effectiveness studies with strong designs are very scarce in children with VFNs. Clinicians should be aware that few therapy techniques have been thoroughly investigated in this population. However, this review may guide voice therapists when creating a treatment plan for a child with VFNs because it identifies, evaluates and summarizes the results of all relevant individual studies about voice therapy in paediatric VFNs. Voice therapy seems to be effective in treating paediatric patients with VFNs, given the fact that a considerable number of included studies report significant improvements after voice therapy. Both direct and indirect therapy approaches appear to have a positive effect on the phonation of children with VFNs.
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Affiliation(s)
- Anke Adriaansen
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Iris Meerschman
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Behlau M, Almeida AA, Amorim G, Balata P, Bastos S, Cassol M, Constantini AC, Eckley C, Englert M, Gama ACC, Gielow I, Guimarães B, Lima LR, Lopes L, Madazio G, Moreti F, Mouffron V, Nemr K, Oliveira P, Padovani M, Ribeiro VV, Silverio K, Vaiano T, Yamasaki R. Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment. Codas 2022; 34:e20210240. [PMID: 35920467 PMCID: PMC9886186 DOI: 10.1590/2317-1782/20212021240pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023] Open
Abstract
During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part "a" of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.
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Affiliation(s)
- Mara Behlau
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Escola Paulista de Medicina – EPM, Universidade Federal de São Paulo – UNIFESP - São Paulo (SP), Brasil.
| | - Anna Alice Almeida
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.
| | - Geová Amorim
- Universidade Federal de Alagoas – UFAL - Maceió, AL, Brasil.
| | - Patrícia Balata
- APTA COMUNICAÇÃO - Recife (PE), Brasil.
- Universidade Federal de Pernambuco – UFPE - Recife (PE), Brasil.
| | - Sávio Bastos
- Centro de Fotobiomodulação e Saúde – CFOTOBIOS - Belém (PA), Brasil.
| | - Mauricéia Cassol
- Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA - Porto Alegre (RS), Brasil.
| | | | - Claudia Eckley
- Faculdade de Ciências Médicas da Santa Casa de São Paulo – FCMSCSP - São Paulo (SP), Brasil.
| | - Marina Englert
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
| | | | - Ingrid Gielow
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
| | - Bruno Guimarães
- Clínica Bruno Guimarães Serviços de Fonoaudiologia e Fisioterapia - Fortaleza (CE), Brasil.
| | | | - Leonardo Lopes
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.
| | | | - Felipe Moreti
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Centro Universitário da Faculdade de Medicina do ABC – FMABC - Santo André (SP), Brasil.
- Complexo Hospitalar Municipal de São Bernardo do Campo – CHMSBC - São Bernardo do Campo (SP), Brasil.
| | - Vanessa Mouffron
- Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Katia Nemr
- Universidade de São Paulo – USP - São Paulo (SP), Brasil.
| | | | - Marina Padovani
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Faculdade de Ciências Médicas da Santa Casa de São Paulo – FCMSCSP - São Paulo (SP), Brasil.
| | - Vanessa Veis Ribeiro
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.
| | - Kelly Silverio
- Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.
| | - Thays Vaiano
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
| | - Rosiane Yamasaki
- Centro de Estudos da Voz – CEV - São Paulo (SP), Brasil.
- Escola Paulista de Medicina – EPM, Universidade Federal de São Paulo – UNIFESP - São Paulo (SP), Brasil.
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Alonso LAR, Fabbron EMG, Giacheti CM. Voice and Behavior of Children and Adolescents With Obesity: Integrative Literature Review. J Voice 2022:S0892-1997(22)00152-7. [PMID: 35810046 DOI: 10.1016/j.jvoice.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To verify the relationship between obesity, voice and behavior in childhood and adolescence, through an integrative review. METHODS The researchers surveyed the articles indexed in the following databases: Embase, Web of Science, Scopus and Pubmed, using uniterms found in the Medical Subject Headings, related to the subject of the study, combined by the Boolean operators "and" and "or", published until January 2022. In the end, three reviewers selected the articles. RESULTS When searching for studies related to voice, obesity and behavior, 62 articles were found that did not meet the selection criteria and were excluded. Given this result, new searches were carried out with the following crossing strategies: voice and obesity and; Voice, Behavior and Child Behavior Checklist (CBCL). After the evaluation of the reviewers, two articles were selected referring to the intersection "voice and obesity in children and adolescents" and, two studies, in the intersection between "voice, behavior and CBCL". The first study on voice and obesity showed that the greater the abdominal circumference, the greater the maximum expiratory force and sound pressure found. The second study showed high Jitter and NHR values in obese children. Furthermore, studies on voice, behavior and CBCL showed that children with vocal nodules were more sociable than children without vocal nodules, and had behaviors described as "screams a lot" and "teases a lot". On the other hand, another study found potential risks of behavioral changes in the face of vocal complaints. CONCLUSIONS Although this literature review did not find studies associating obesity with vocal and behavioral disorders, the literature found showed the presence of vocal alteration in some acoustic parameters in obese children. Regarding voice, behavior and CBCL, two studies were found reporting the presence of behavioral changes in children with voice-related complaints, according to the opinion of their parents.
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Affiliation(s)
- Letícia Alvieri Riato Alonso
- Speech Language Pathology department, São Paulo State University (UNESP), Marília (SP), Brazil; São Paulo State University (UNESP), School of Philosophy and Sciences, Marília, Brazil.
| | - Eliana Maria Gradim Fabbron
- Speech Language Pathology department, São Paulo State University (UNESP), Marília (SP), Brazil; São Paulo State University (UNESP), School of Philosophy and Sciences, Marília, Brazil
| | - Célia Maria Giacheti
- Speech Language Pathology department, São Paulo State University (UNESP), Marília (SP), Brazil; São Paulo State University (UNESP), School of Philosophy and Sciences, Marília, Brazil
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Adriaansen A, Van Lierde K, Meerschman I, Everaert C, D'haeseleer E. Validity and Reliability of the Dutch Children's Voice Handicap Index-10. J Voice 2022:S0892-1997(22)00131-X. [PMID: 35641381 DOI: 10.1016/j.jvoice.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Voice-related quality of life (Qol) questionnaires provide the clinician with information regarding the impact of voice disorders on the patient's well-being. The available voice-related QoL tools for Dutch-speaking children are parent-proxy in nature. However, the use of proxy measurements has been debated in the literature. The Children's Voice Handicap Index-10 (CVHI-10) is a self-reported QoL tool for dysphonic children. Therefore, the aim of this study is to develop and validate a Dutch version of the CVHI-10. STUDY DESIGN Observational, prospective, cross-sectional study. METHODS The original version of the CVHI-10 was translated and adapted to Dutch according to the recommendations of the Quality of Life Special Interest Group - Translation and Cultural Adaptation group. Subsequently, the questionnaire was individually completed by 77 children (dysphonic group: n = 30, control group: n = 47) between eight and 14 years. In order to investigate test-retest reliability, 50% of the participants were asked to complete the questionnaire twice with an interval of 2 weeks. Internal consistency, test-retest reliability and construct validity were calculated. A receiver operating characteristic (ROC) analysis was conducted to check the sensitivity and specificity levels of the instrument. RESULTS Internal consistency measured with Cronbach's alpha coefficient was 0.745. Test-retest reliability measured with intraclass correlation coefficients was 0.718. Mean total CVHI-10 score was 6.17 ± 2.7 in the dysphonic group and 2.68 ± 2.6 in the control group. The difference in total score between the groups was statistically significant (P < 0.001), suggesting that the tool has good construct validity. ROC analysis demonstrated moderate diagnostic accuracy (area under the curve = 0.869) and suggested a cut-off score of 3.5. CONCLUSIONS The Dutch CVHI-10 is the first self-reported voice-related QoL tool for dysphonic Dutch-speaking children. It is a valid, reliable and sensitive tool to assess the impact of a voice disorder on the child's well-being.
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Affiliation(s)
- Anke Adriaansen
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Kristiane Van Lierde
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South-Africa
| | - Iris Meerschman
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Charlot Everaert
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Pan Z, Ma T, Gao B, Ma EPM, Yu L, Qiu Z, Lu D. Survey of Referral Patterns in Southwestern Mainland China: How Do Pediatricians Manage Children with Dysphonia. J Voice 2022:S0892-1997(22)00128-X. [PMID: 35623982 DOI: 10.1016/j.jvoice.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Voice disorders are common in children and have a negative impact on their quality of life. However, presently, voice assessment and therapy are inaccessible in most pediatric departments of Mainland China. Thus, referring pediatric patients with voice disorders to otolaryngology is warranted for prompt and appropriate treatment. The purpose of this study is to investigate referral patterns and their influencing factors for pediatricians' managing children with dysphonia in Southwestern Mainland China. STUDY DESIGN Observational study. METHODS A 28-item questionnaire was designed by multidisciplinary experts, and an anonymous survey was performed online via Wenjuanxing between September 8, 2021 and October 8, 2021. The statistical analyses were performed using the independent sample median test, the linear/logistic regression model, the Kruskal-Wallis test, and Spearman's correlation test to determine any statistically significant relationships between the variables of interest. RESULTS Predominantly recruited from institutions in Southwestern China, 368 pediatricians were surveyed. (1) The majority of the pediatricians reported that ≤10% of children sought medical help for voice disorders; (2) only 22.1% of the pediatricians' hospitals had equipment for evaluating voice disorders; (3) 74.6% of the pediatricians would refer children with dysphonia to otolaryngology, and the older pediatricians were more likely to refer their patients than were the younger pediatricians (P = 0.022); (4) in the group that would make a referral (n = 250), the pediatricians who had worked longer (P = 0.037) and practised in the Grade-A tertiary hospitals (P = 0.044) were more likely to trust their experience as a reason for making a referral. For each year worked the probability of referring children with dysphonia depending on the pediatrician's experience increased by 3.4%. CONCLUSION Although the pediatricians encountered some barriers to diagnosing voice disorders, their attitude towards making referrals was positive. The age and work duration of the pediatricians and the hospital grade were the influencing factors in the referral patterns. Further publicity of vocal hygiene, ongoing education among Chinese pediatricians and the improvement of referral systems may be most useful for better managing children with dysphonia.
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Affiliation(s)
- Zhongjing Pan
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianpei Ma
- Laboratory for Aging and Cancer Research, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Gao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Estella P-M Ma
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lingyu Yu
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zijun Qiu
- West China Clinical Medical School, Sichuan University, Chengdu Sichuan,China
| | - Dan Lu
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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40
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Lee JM, Roy N, Park A, Muntz H, Redmond SM, Smith M. Self-regulation in children with vocal fold nodules: A multilevel analysis. JOURNAL OF COMMUNICATION DISORDERS 2022; 97:106203. [PMID: 35272152 DOI: 10.1016/j.jcomdis.2022.106203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Vocal fold nodules (VNs) represent the most common cause of voice disorders in children. Phonotrauma related to chronic, repetitive, intense vocal activity is often cited as the proximate cause of VNs. However, diminished self-regulation (SR) may predispose some children toward extreme phonotraumatic voice use, thereby contributing secondarily to their development. This case-control study examined the association between features of SR and VNs in children. METHOD Parents of children with VNs (N = 40, Age Mean = 7.5, SD = 2.03 years) and vocally normal, medical controls (VNCs; N = 40, Age Mean = 7.6, SD = 1.54 years) completed the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2; Gioia, Isquith, Guy & Kenworthy, 2015), an inventory that evaluates components of SR in children. RESULTS Children with VNs, as compared with the vocally normal control group, were described as (i) impulsive (i.e., scoring significantly worse on the Behavior Regulation Index, BRI; P < 0.001, Cohen's d = 0.86), and (ii) emotionally dysregulated (i.e., scoring significantly worse on the Emotional Regulation Index, ERI; P < 0.001, Cohen's d = 0.81). CONCLUSIONS Diminished SR in some children with VNs may contribute to phonotraumatic vocal behaviors and potentially attenuate the effectiveness of voice therapy.
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Affiliation(s)
- Jeong Min Lee
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, United States.
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, United States
| | - Albert Park
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, UT, United States; Division of Otolaryngology, Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Harlan Muntz
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, UT, United States; Division of Otolaryngology, Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Sean M Redmond
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, United States
| | - Marshall Smith
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, UT, United States; Division of Otolaryngology, Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, UT, United States
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Watson NA, Orton KA, Hall A. Fifteen-minute consultation: Guide to paediatric voice disorders. Arch Dis Child Educ Pract Ed 2022; 107:101-104. [PMID: 33579744 DOI: 10.1136/archdischild-2020-321134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/04/2022]
Abstract
Paediatric voice disorders in the normal paediatric population ranges from 6% to 20%. We outline the important features in the initial evaluation of a persistent altered cry or voice in children and highlight the subsequent management currently used by ear, nose and throat (ENT) surgeons and speech and language therapists (SLTs). It is important to appreciate that there are stark differences between a child and adult larynx due to anatomical and physiological changes during development. The voice history elicited from both child and parent includes birth and developmental history, hearing, early feeding and respiratory function. Red flag symptoms or signs presenting with dysphonia include stridor, dysphagia, failure to thrive and recurrent chest infections. The most likely cause for dysphonia in children presenting to general paediatric practice and primary care will be secondary to laryngitis, hyperfunction and vocal cord nodules, and laryngopharyngeal reflux. Regarding treatment, in most cases a non-surgical option is preferred with voice therapy preferably delivered by a specialist paediatric voice SLT. The maximum effectiveness of behavioural or direct therapy is to children over 7 years, for in excess of 8 weeks with additional rigorous home rehearsal.
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Affiliation(s)
- Natalie Anne Watson
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Andrew Hall
- Department of Paediatric ENT, Noah's Ark Children's Hospital for Wales, Cardiff, UK
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Behlau M, Almeida AA, Amorim G, Balata P, Bastos S, Cassol M, Constantini AC, Eckley C, Englert M, Gama ACC, Gielow I, Guimarães B, Lima LR, Lopes L, Madazio G, Moreti F, Mouffron V, Nemr K, Oliveira P, Padovani M, Ribeiro VV, Silverio K, Vaiano T, Yamasaki R. Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment. Codas 2022. [DOI: 10.1590/2317-1782/20212021240en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
ABSTRACT During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part “a” of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.
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Affiliation(s)
- Mara Behlau
- Centro de Estudos da Voz, Brasil; Universidade Federal de São Paulo, Brasil
| | - Anna Alice Almeida
- Centro de Estudos da Voz, Brasil; Universidade Federal da Paraíba, Brasil
| | | | - Patrícia Balata
- APTA COMUNICAÇÃO, Brasil; Universidade Federal de Pernambuco, Brasil
| | | | - Mauricéia Cassol
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
| | | | - Claudia Eckley
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil
| | | | | | | | - Bruno Guimarães
- Clínica Bruno Guimarães Serviços de Fonoaudiologia e Fisioterapia, Brasil
| | | | - Leonardo Lopes
- Centro de Estudos da Voz, Brasil; Universidade Federal da Paraíba, Brasil
| | | | - Felipe Moreti
- Centro de Estudos da Voz, Brasil; Centro Universitário da Faculdade de Medicina do ABC, Brasil; Complexo Hospitalar Municipal de São Bernardo do Campo, Brasil
| | | | | | | | - Marina Padovani
- Centro de Estudos da Voz, Brasil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil
| | | | | | | | - Rosiane Yamasaki
- Centro de Estudos da Voz, Brasil; Universidade Federal de São Paulo, Brasil
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Liu J, Cao W, Sun DH, Wu L, Sun J, Xu B, Fu Y. Vocal nodules in children: Laryngoscopic morphological classification aids prognostic judgment. Front Pediatr 2022; 10:941483. [PMID: 36147819 PMCID: PMC9488521 DOI: 10.3389/fped.2022.941483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Vocal fold nodules (VFNs) are benign lesions, occurring at the junction of the anterior and middle thirds of bilateral vocal cords, for which pediatric prognosis and treatment remains controversial. There is a requirement for a correlation indicator to assess the prognosis by pediatric otolaryngologists. MATERIALS AND METHODS Patients with VFNs, who were admitted to the department of otolaryngology, were enrolled. The patient's gender, age, duration of dysphonia, laryngoscopy results and related diseases [allergic rhinitis, sinusitis, laryngopharyngeal reflux (LPR)] were collected and recovery from dysphonia followed up. Correlations between clinical factors and type of laryngoscopic morphology of VFNs were analyzed. RESULTS A total of 432 patients with dysphonia were identified, 208 agreed to undergo laryngoscopy and 194 were diagnosed with VFNs as a result. The modal age of patients with dysphonia was between 3 and 7 years with a male: female ratio of 2.1:1 (294:138) and 116 (26.85%; 116/432) had symptoms of allergic rhinitis. The boy to girl ratio among the 194 children with VFNs was about 2.6:1 (140:54) and modal age was consistent with dysphonia. Vocal nodules were the cause of most phonation disorders (93.27%; 194/208) and those with long duration of dysphonia presented more mature (p = 0.026) and discrete types (p = 0.022). Boys were more likely to have mature (p = 0.050) and discrete nodules (p = 0.008). Dysphonia recovery time was closely related to age (p = 0.000), duration of dysphonia (p = 0.000) and morphology of vocal nodules under laryngoscopy (p = 0.000). CONCLUSION Vocal nodules are the most frequent cause of phonation disorders in children. The morphological classification by endoscopy may help with clinical diagnosis and therapy choice. In the case of the older child with longer duration of dysphonia and the appearance of mature, large, discrete nodules by laryngoscopy, active treatment is recommended, such as drug therapy, voice therapy or surgical treatment.
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Affiliation(s)
- Jia Liu
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Department of Endoscopy Center, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Cao
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Dan-Hua Sun
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lei Wu
- Department of Endoscopy Center, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Sun
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Xu
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Fu
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Yağcıoğlu D, Aydınlı FE, Aslan G, Kirazlı MÇ, Köse A, Doğan N, Akbulut S, Yılmaz T, Özcebe E. Development, Validation, and Reliability of the Teacher-Reported Pediatric Voice Handicap Index. Lang Speech Hear Serv Sch 2021; 53:69-87. [PMID: 34762816 DOI: 10.1044/2021_lshss-21-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to develop a novel teacher-reported pediatric voice outcome measure and to investigate its psychometric properties. METHOD In the first stage, a new instrument, the Teacher-Reported Pediatric Voice Handicap Index (TRPVHI), was developed. After item generation, a panel of experts evaluated the items to assess the content validity. Subsequently, the final version of the preliminary instrument was applied to teachers of 306 children (57 dysphonic and 249 vocally healthy) between the ages of 4 and 11 years. Eventually, the construct validity, criterion-related validity, test-retest reliability, and internal consistency of the developed instrument were examined. RESULTS The items with a content validity ratio less than .8 were modified or removed, and accordingly, the preliminary version of the index was finalized. After the application of the preliminary version, item reduction was made based on the factor analysis. The index is composed of 27 questions and three subscales: Functional, Physical, and Emotional. A significant difference was observed between the dysphonic and vocally healthy children for the TRPVHI scores (p < .001). A positive moderate correlation was determined between the Pediatric Voice Handicap Index and TRPVHI scores. Correlation coefficients between the test and retest scores of the TRPVHI were in the range of .92-.98. Cronbach's alpha values computed to assess the internal consistency were in the range of .94-.98. CONCLUSIONS The TRPVHI is the only valid and reliable teacher-reported outcome measure of the effects of voice disorders on children. It is anticipated that the deployment of the TRPVHI in conjunction with other subjective tools, both in the initial evaluation and the follow-up of the treatment results, will allow a better understanding of the physical, functional, and emotional effects of voice disorders on children. Furthermore, it can potentially lead further research to enable the use of the TRPVHI for screening purposes.
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Affiliation(s)
- Damlasu Yağcıoğlu
- Department of Speech and Language Therapy, Hacettepe University, Ankara, Turkey
| | - Fatma Esen Aydınlı
- Department of Speech and Language Therapy, Hacettepe University, Ankara, Turkey
| | - Gizem Aslan
- Department of Speech and Language Therapy, Hacettepe University, Ankara, Turkey
| | - Meltem Ç Kirazlı
- Department of Speech and Language Therapy, Hacettepe University, Ankara, Turkey
| | - Ayşen Köse
- Department of Speech and Language Therapy, Hacettepe University, Ankara, Turkey
| | - Nuri Doğan
- Department of Education, Hacettepe University, Ankara, Turkey
| | - Sevtap Akbulut
- Department of Otolaryngology, Demiroglu Bilim University, İstanbul, Turkey
| | - Taner Yılmaz
- Department of Ear-Nose-Throat, Hacettepe University, Ankara, Turkey
| | - Esra Özcebe
- Department of Speech and Language Therapy, Hacettepe University, Ankara, Turkey
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Patel RR, Ternström S. Quantitative and Qualitative Electroglottographic Wave Shape Differences in Children and Adults Using Voice Map-Based Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2977-2995. [PMID: 34319772 DOI: 10.1044/2021_jslhr-20-00717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Purpose The purpose of this study is to identify the extent to which various measurements of contacting parameters differ between children and adults during habitual range and overlap vocal frequency/intensity, using voice map-based assessment of noninvasive electroglottography (EGG). Method EGG voice maps were analyzed from 26 adults (22-45 years) and 22 children (4-8 years) during connected speech and vowel /a/ over the habitual range and the overlap vocal frequency/intensity from the voice range profile task on the vowel /a/. Mean and standard deviations of contact quotient by integration, normalized contacting speed, quotient of speed by integration, and cycle-rate sample entropy were obtained. Group differences were evaluated using the linear mixed model analysis for the habitual range connected speech and the vowel, whereas analysis of covariance was conducted for the overlap vocal frequency/intensity from the voice range profile task. Presence of a "knee" on the EGG wave shape was determined by visual inspection of the presence of convexity along the decontacting slope of the EGG pulse and the presence of the second derivative zero-crossing. Results The contact quotient by integration, normalized contacting speed, quotient of speed by integration, and cycle-rate sample entropy were significantly different in children compared to (a) adult males for habitual range and (b) adult males and adult females for the overlap vocal frequency/intensity. None of the children had a "knee" on the decontacting slope of the EGG slope. Conclusion EGG parameters of contact quotient by integration, normalized contacting speed, quotient of speed by integration, cycle-rate sample entropy, and absence of a "knee" on the decontacting slope characterize the wave shape differences between children and adults, whereas the normalized contacting speed, quotient of speed by integration, cycle-rate sample entropy, and presence of a "knee" on the downward pulse slope characterize the wave shape differences between adult males and adult females. Supplemental Material https://doi.org/10.23641/asha.15057345.
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Affiliation(s)
- Rita R Patel
- Department of Speech, Language and Hearing Sciences, Indiana University Bloomington
| | - Sten Ternström
- Division of Speech, Music, and Hearing, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
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Normative vocal acoustic parameters for preschool and elementary school Egyptian children. Int J Pediatr Otorhinolaryngol 2021; 143:110662. [PMID: 33667836 DOI: 10.1016/j.ijporl.2021.110662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND A reliable acoustic analysis necessitates the availability of standard normative values at different ages. Normative values of vocal acoustic parameters are readily available for the adult population but not much data are available for the pediatric population. OBJECTIVES Providing a database for the normative vocal acoustic parameters in preschool and elementary school Egyptian children to lay out an objective model for the diagnosis and optimal treatment of childhood voice disorders. METHODS A total of 237 Egyptian children between the ages of 4 and 9 years from both genders were enrolled in the study. A Computer-assisted acoustic vocal analysis was done for all children. RESULTS Fundamental frequency values differed significantly according to gender with higher measures in girls. Mean values of the fundamental frequency were 258.57 Hz ± 39.69, jitter percentage 0.85% ± 0.67, shimmer percentage 1.59% ± 1.03, fundamental tremors 1.64HZ ± 0.421, maximum phonation time 4.81sec. ± 1.73 and harmonic/noise ratio were 15.34 dB ± 10.65. A decline of measures of the fundamental frequency and jitter percentage with increasing age and an increase of values of harmonic/noise ratio and shimmer percentage in children residing in rural areas are observed. CONCLUSION This study provides an insight into the normative values of vocal acoustic parameters in preschool and elementary school Egyptian children. Comparable to other studies, both fundamental frequency and jitter percentage values show a decline with increasing age. Also, fundamental frequency values differ significantly among genders. The difference in socioeconomic environment seems to influence some of the vocal acoustic parameters in children.
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Feinstein H, Abbott KV. Behavioral Treatment for Benign Vocal Fold Lesions in Children: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:772-788. [PMID: 33751899 DOI: 10.1044/2020_ajslp-20-00304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This systematic review aims to identify, classify, and evaluate existing information regarding treatment for benign vocal fold lesions in children and to identify gaps and limitations that may limit effective pediatric voice treatment. Method A literature search was performed using electronic databases (PubMed and Google Scholar) as well as reference lists from previous reviews, studies, and books. Included in the present review are studies that described behavioral treatment for children with benign vocal fold lesions presumed to be phonotraumatic (vocal fold nodules and edema). Results Twenty-one studies were eligible for inclusion in the review. Eight different research designs were used, and three intervention types were identified: direct voice intervention (voice training), indirect treatment (vocal hygiene or counseling), and comparative studies that contrasted different treatment methods. The most commonly used treatment method was eclectic direct intervention, which focused on vocal exercises or voicing patterns. Postintervention improvement was reported in all studies. In general, findings suggested an advantage of direct over indirect intervention and of longer treatment duration over short-term approaches. Conclusions The findings suggest that behavioral voice therapy may be generally effective in treating children with vocal fold nodules. Several limitations emerged in the corpus of studies reviewed including heterogeneity of research methods, missing information about outcome measures, and inappropriate statistical analyses. Thus, a need exists for further well-designed controlled studies to enhance the body of knowledge about developmental factors affecting vocal treatment outcomes, in particular, vocal fold structure as well as cognitive and linguistic development.
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Affiliation(s)
- Hagar Feinstein
- Department of Communication Sciences & Disorders, University of Delaware, Newark
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Espinosa M, Ongkasuwan J. Pediatric Unilateral Vocal Fold Paralysis: Workup and Management. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stojanović J, Belić B, Erdevički L, Jovanović S, Jovanović M, Srećković S. QUALITY OF LIFE IN DYSPHONIC CHILDREN MEASURED ON PEDIATRIC VOICE-RELATED QUALITY OF LIFE (PVRQOL) SCALE IN SERBIA. Acta Clin Croat 2021; 60:75-81. [PMID: 34588725 PMCID: PMC8305349 DOI: 10.20471/acc.2021.60.01.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/11/2018] [Indexed: 11/28/2022] Open
Abstract
Hoarseness occurs in children of both genders, from the earliest age and beyond, and is caused by improper use or overuse of vocal apparatus. The study included 91 hoarse children aged 6-12 (study group) and 243 healthy children (control group) of the same age. The study group underwent detailed medical history, phoniatric examination, larynx fiber endoscopy, allergy treatment, audiologic treatment, and pulmonary treatment. Pediatric Voice-Related Quality of Life questionnaire, Serbian version (PVRQOL) was completed by parents of both groups of children. We did not find statistically significant differences in the hoarse children based on diagnosis (muscle tension disorder and vocal fold nodules) and age in physical domain, socio-emotional and global domain score (p>0.01). The results showed that parents did not recognize hoarseness as a health problem in children. There were significant gender differences in the group of children with hoarseness, i.e. parents in all three PVRQOL questionnaire domains recognized hoarseness as a significant health problem in girls, but not in boys. The presence of hoarseness impairs the quality of life in pediatric population. Social and emotional domains indicated greater impact in boys.
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Affiliation(s)
| | - Branislav Belić
- 1Otorhinolaryngology Department, Phoniatric Division, Kragujevac Clinical Center, Kragujevac, Serbia; 2University of Kragujevac, Faculty of Medical Sciences, Department of Otorhinolaryngology, Kragujevac, Serbia; 3University of Kragujevac, Faculty of Medical Sciences, Department of Ophthalmology, Kragujevac, Serbia; 4University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Kragujevac, Serbia
| | - Ljiljana Erdevički
- 1Otorhinolaryngology Department, Phoniatric Division, Kragujevac Clinical Center, Kragujevac, Serbia; 2University of Kragujevac, Faculty of Medical Sciences, Department of Otorhinolaryngology, Kragujevac, Serbia; 3University of Kragujevac, Faculty of Medical Sciences, Department of Ophthalmology, Kragujevac, Serbia; 4University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Kragujevac, Serbia
| | - Svetlana Jovanović
- 1Otorhinolaryngology Department, Phoniatric Division, Kragujevac Clinical Center, Kragujevac, Serbia; 2University of Kragujevac, Faculty of Medical Sciences, Department of Otorhinolaryngology, Kragujevac, Serbia; 3University of Kragujevac, Faculty of Medical Sciences, Department of Ophthalmology, Kragujevac, Serbia; 4University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Kragujevac, Serbia
| | - Mirjana Jovanović
- 1Otorhinolaryngology Department, Phoniatric Division, Kragujevac Clinical Center, Kragujevac, Serbia; 2University of Kragujevac, Faculty of Medical Sciences, Department of Otorhinolaryngology, Kragujevac, Serbia; 3University of Kragujevac, Faculty of Medical Sciences, Department of Ophthalmology, Kragujevac, Serbia; 4University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Kragujevac, Serbia
| | - Sunčica Srećković
- 1Otorhinolaryngology Department, Phoniatric Division, Kragujevac Clinical Center, Kragujevac, Serbia; 2University of Kragujevac, Faculty of Medical Sciences, Department of Otorhinolaryngology, Kragujevac, Serbia; 3University of Kragujevac, Faculty of Medical Sciences, Department of Ophthalmology, Kragujevac, Serbia; 4University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Kragujevac, Serbia
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Benign Vocal Fold Lesions in Children. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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