Vocal Symptoms and Voice Quality in Children With Allergy and Asthma

Better Breathing, Tougher Speaking? A Scoping Review of the Effects of Inhaled Corticosteroids on the Voice Quality of Asthmatic Children

BACKGROUND

Inhaled corticosteroids (ICS) are a common treatment for certain lung diseases, including chronic obstructive pulmonary disorder in adults, and asthma across the lifespan. There is a link between the use of ICS and dysphonia in adults. This scoping review aims to investigate the incidence of dysphonia, in children aged under 12, who use ICS to treat asthma.

METHODS

A scoping review was conducted, in accordance with the guidelines prescribed by Arksey and O'Malley (2005). ASHAWire, Science Direct, PubMed, and ProQuest databases were searched. Out of the total yield of 1471 articles, four articles met the inclusion criteria, that is, were primary studies reporting on voice quality in children who use ICS, who present with asthma and/or allergy.

RESULTS

The majority of papers yielded from the initial search were retrieved because of the use of the term "dysphonia" in the basic definitions of asthma and descriptors of its side effects. Only four studies presented primary data about the presence of dysphonia in asthmatic children (with or without comorbid allergic conditions). None specifically investigated the relationship between ICS and dysphonia. Research questions focused on side effects associated with allergies and asthma, which included some information about medication. Only three of the four studies conducted a comprehensive review of the voice and utilized video laryngoscopy.

DISCUSSION

The evidence of a relationship, between ICS and dysphonia in children, is not conclusive, and is complicated by the connection between asthma, and breath support for phonation. There is a need for more thorough and focused investigation of the relationship between ICS, with or without bronchodilator use, and any resultant effects on children's vocal quality.

Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians

INTRODUCTION

To update the European guidelines for the assessment of voice quality (VQ) in clinical practice.

METHODS

Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected.

RESULTS

Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases.

CONCLUSION

The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach.

The Occurrence of Laryngeal Pathologies in a Treatment-Seeking Pediatric Population

OBJECTIVES

The purpose of this study was to 1) describe the age- and sex-specific occurrence of laryngeal pathologies in a treatment-seeking pediatric population in the voice unit of Ghent University Hospital, Belgium, and 2) describe this population in terms of vocal parameters, vocal complaints, influencing factors, and treatment history and recommendation.

STUDY DESIGN

Retrospective, observational study.

METHODS

All patient records were analyzed for children (0-18 years) who consulted the ear, nose, and throat department of Ghent University Hospital for the first time between July 2015 and June 2021 with complaints of dysphonia. In total, 103 children (66 males, 37 females) with a mean age of 10.01 years (SD: 3.4, range 3.93-17.96) were included in this study. Laryngeal pathology was diagnosed using a flexible videolaryngo(strobo)scopy. The influence of age and sex on laryngeal etiology (organic/functional voice disorder) was examined using a Welch-modified t test and a Fisher's exact test, respectively.

RESULTS

Organic lesions were observed in 77.7% of the participants, with vocal fold nodules (VFNs) being the most common diagnosis (66.0%). A functional voice disorder was diagnosed in 22.3% of the children. Children with a functional voice disorder are significantly older than children with an organic voice disorder. There was no statistically significant difference between males and females in laryngeal etiology. Mean dysphonia severity index was -2.7 (SD: 3.2, range -9.3 to +3.7), the mean acoustic voice quality index 4.70 (SD: 1.5, range 2.35-8.27), and the mean pediatric voice handicap index 29.8 (SD: 13.6, range 5-60). The occurrence of vocal misuse was mentioned in 80.6% of the patient records.

CONCLUSION

Organic voice disorders, especially VFNs, are predominant in treatment-seeking children with dysphonia. Functional voice disorders become more common with increasing age during childhood. A disordered vocal quality, reduced vocal capabilities and reduced voice-related quality of life were found.

Detection of human papillomavirus (HPV) DNA in benign laryngeal lesions and role of cigarette smoking as an inducing factor

The association of human papillomavirus (HPV) in laryngeal malignancies is largely known. This study evaluated the association between HPV and benign laryngeal lesions and also the role of smoking and alcohol consumption in increasing the prevalence of HPV in such benign lesions. Seventy-eight specimens of benign laryngeal lesions including 26 polyps, 26 dysplasia, and 26 other lesions such as nodules and cysts were enrolled in this study. Polymerase chain reaction (PCR) technique was used to detect HPV DNA in the tissues. The role of smoking and alcohol consumption in the prevalence of HPV was also evaluated through appropriate statistical tests. This study showed that the prevalence of HPV in benign laryngeal lesions was not statistically significant. The Cohen's effect size for comparing polyps vs. other lesions was nearly 0.7, indicating that HPV prevalence in laryngeal polyps may be clinically meaningful. Another finding in our study is the role of smoking in increasing the HPV prevalence in laryngeal polyps (P = 0.034). In benign laryngeal polyps, HPV prevalence may be clinically important. Smoking acts as a co-factor to induce HPV infection in laryngeal polyps in our study.

Cut-off point for high dysphonia risk in children based on the Child Dysphonia Risk Screening Protocol: preliminary findings

OBJECTIVES

The objective of the study was to establish a cut-off point for high dysphonia risk in children using the Child Dysphonia Risk Screening Protocol (DRSP-C).

METHODS

Through a preliminary study, voice recordings of 59 children (4-12 years of age) were collected during an auditory-perceptual analysis using the Consensus Auditory-Perceptual Evaluation of Voice protocol. Thirty of the patients had voice disorders (patient group), and 29 did not (control group). A risk score for dysphonia was then calculated, and data were compared between groups. The relationship between overall degrees of deviation and questionnaire scores was analysed. The questionnaire's validity was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-off points were obtained based on diagnostic criteria for screening procedures.

RESULTS

The DRSP-C score was found to be higher for the patient group, as was the partial score for vocal behaviour. No correlation was found between overall degrees of dysphonia and questionnaire scores. The area under the ROC curve was measured as 0.678, denoting limited diagnostic capacity. The cut-off point was set at 16.50. Thus, above this value, dysphonia risk is higher.

CONCLUSION

A cut-off point for high dysphonia risk was calculated. The DRSP-C proved to be a promising tool for children's clinical vocal and health promotion and should be used in conjunction with General Dysphonia Risk Screening.

Surgical and therapeutic advances in the management of voice problems in children and young people

PURPOSE OF REVIEW

The current article reviews advances in both the assessment of paediatric voice disorders, as well as surgical, medical and therapeutic treatments.

RECENT FINDINGS

It is important to evaluate the impact of a voice disorder from both the parent and child perspective. Outpatient laryngoscopy with stroboscopy is very possible even in young children; however, high-speed ultrasound is a plausible alternative. High-speed videolaryngoscopy, videokymography and dynamic computed tomography, offer potential for augmenting the assessment of vocal fold vibratory characteristics in children. The evidence to support the efficacy of both indirect and direct voice therapy interventions is growing. The management of vocal fold palsy has advanced to include laryngeal reinnervation. Intubation injury with/without surgical intervention offers challenge and gives rise to voice disorders that may be lifelong.

SUMMARY

Although assessment and management practices of paediatric voice disorders closely follow those applied to adults, there are important differences and a developmental approach is required when considering both surgical and therapeutic management. Children can benefit from both indirect and direct therapy treatments following an ear, nose and throat assessment which utilizes paediatric instrumentation and considers the health of the entire airway. Underlying medical contributory factors should be explored and treated. Voice disorders due to congenital and acquired changes of the vocal tract may be amenable to surgery.