Comparison of the Pediatric Voice Handicap Index with perceptual voice analysis in pediatric patients with vocal fold lesions.

Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
Archives of otolaryngology--head & neck surgery (Impact Factor: 2.33). 12/2011; 137(12):1258-62. DOI: 10.1001/archoto.2011.193
Source: PubMed


To compare a subjective patient/family-derived voice handicap survey with an expert observer-derived method of evaluating voice disturbance in pediatric patients with vocal fold lesions (VFLs).
Retrospective review.
Tertiary care referral center.
Thirty-eight children with VFLs referred for voice evaluation.
Pediatric Voice Handicap Index (pVHI) scores and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores. Percentages for CAPE-V (100-point scale) and pVHI (92-point scale) were calculated for direct comparisons. Relationships between pVHI scores and CAPE-V scores were investigated using the Spearman rank correlation.
Thirty-eight patients with VFLs (median age, 8.3 years; age range, 4.2-17.2 years; 63% males) were included from a database of more than 600 children and evaluated between November 15, 2005, and June 15, 2010. The median CAPE-V overall score was 30.3 (range, 1-67), and the normalized total pVHI score was 29.3 (range, 0-73) (P = .90). The Spearman rank correlation showed significant fair correlations between CAPE-V overall and functional pVHI and between CAPE-V strain and breathiness, and the pVHI total, functional, but none higher than ρ = 0.44 (P ≤ .03). The correlation was higher in males for CAPE-V loudness to total pVHI (ρ = 0.40, P = .04) and in females for CAPE-V breathiness (ρ = 0.58, P = .03) and strain (ρ = 0.55, P = .04) to total pVHI.
The CAPE-V and the pVHI are useful tools in the measurement of voice outcomes in children with VFLs. There are fair correlations between the CAPE-V and the pVHI, and they likely evaluate important yet different aspects of voice disturbance. Significant gender differences in these correlations should be further evaluated in future studies.

31 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Voice problems negatively affect how children are perceived both by adults and by their peers. Although voice disorders are common in the pediatric population, there is still a lack of information available to clinicians regarding evaluation and treatment of pediatric voice disorders. The purpose of the present study was to develop an Arabic version of pediatric VHI and to test its validity and reliability. Fifty children with voice disorders were included in the study. The Arabic version of PVHI was derived in the standard way for test translation. The translated version was then administrated to the parents or caregiver of children with voice disorders and parents of 75 children with no history or symptoms of voice problems. Participants' responses were statistically analyzed to assess the validity, and to compare the pathological group with the control group. The results showed high internal consistency and reliability of the Arabic version of PVHI (Cronbach's α=0.93 and r=0.95, respectively), and high item-domain and domain-total correlation (r=0.86-0.97). There was a statistically significant difference between the control and the voice disordered groups (P<0.001). The Arabic version of PVHI is considered to be a valid and reliable assessment tool used by the parents and caregivers of children with voice disorders to assess the severity of voice disorders in Arabic language speaking children.
    International journal of pediatric otorhinolaryngology 06/2012; 76(9):1297-303. DOI:10.1016/j.ijporl.2012.05.023 · 1.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: There's no greater challenge in pediatric laryngology than diagnosis and treatment of chronic dysphonia following laryngotracheal reconstruction of acquired subglottic stenosis. Videolaryngoscopy with stroboscopy provides incomparable diagnostic information to fiberoptic endoscopy. Unfortunately, this pediatric subpopulation which would benefit the most from videolaryngoscopy with stroboscopy infrequently does. We present the unique videolaryngostroboscopic patterns with their diagnostic and treatment implications in this complex population. Methods: From a total database of 113 children with histories of subglottic stenosis and/or airway reconstruction between January 1, 2000 and September 30, 2011, successive frames of recorded videolaryngostroboscopies in twenty-three dysphonic children were reviewed. These stroboscopies were compared to age and gender matched controls with dysphonia due to vocal nodules consecutively analyzed from the time period 2009-2011. To validate the similarity of our patient population to others previously reported, we also collected the standardized perceptual, acoustic, and aerodynamic measures of voice analysis and parent/patient reported quality of life. Results: The voices of patients' pre- and post-airway reconstruction are typically moderately breathy and harsh in voice quality with the majority exhibiting a restricted pitch range and vocal strain. Reduced vocal volume intensity and low habitual speaking pitch were common. Overall, the severity of voice fell within the moderately dysphonic range. Despite universal glottic aperture incompetence, muscle tension dysphonia of the true vocal cords was seen. The glottic muscle tension was confirmed indirectly by noting a consistent "posterior cricoarytenoid bulge." In addition, our group termed a unique pattern of "circumferential supraglottic squeeze" which included both lateral plica ventricularis (false vocal folds) and anteroposterior squeeze opposing the arytenoids to the epiglottic petiole (termed by our group as "arytenoid hooding"). In no patients were the true vocal cords fully visualized. While superficially appearing as hyperfunction, these findings paradoxically represented compensation for laryngeal hypofunction marking the hyperfunction not the problem but a symptom. Actual "mucosal waves" were seen involving the false vocal cords. Conclusions: Videolaryngoscopy with stroboscopy results in patterns that are not only unique to patients after airway reconstruction for subglottic stenosis but are also critical for both surgical and non-surgical treatment of chronic dysphonia in these children.
    International journal of pediatric otorhinolaryngology 02/2013; 77(5). DOI:10.1016/j.ijporl.2013.01.028 · 1.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Common among children, vocal symptoms are a cause of concern for parents who seek elucidation of their diagnosis and treatment. Vocal nodules are the major cause of dysphonias in children and are related to vocal abuse. We conducted a literature review considering clinical, physiopathological, epidemiological, and histological aspects of vocal nodules, as well as diagnostic methods, highlighting the main studies addressing this issue. The controversial points of treatments were also discussed.
    European Journal of Pediatrics 05/2013; 172(9). DOI:10.1007/s00431-013-2048-x · 1.89 Impact Factor
Show more