Dysphonia secondary to traumatic avulsion of the vocal fold in infants

Bray, David P.; Cavalli, Lesley; Eze, N. C.; Mills, Nikki; Hartley, Benjamin E. J.

doi:10.1017/s0022215110001131

Cited by 13 publications

(16 citation statements)

References 18 publications

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“…[2][3][4][5] Voice quality has not been included in these long-term outcomes and reported only in isolated case reports. 6 Extremely preterm infants usually require respiratory support, typically endotracheal intubation, in the neonatal period because of physiologic immaturity. 7 Dysphonia is a recognized complication of endotracheal intubation.…”

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confidence: 99%

“…Laryngeal injuries visualized postextubation in neonatal subjects range from mild erythema, edema, and granulation of the vocal folds to arytenoid cartilage dislocation, subglottic stenosis, laryngeal tears, and avulsion of the vocal folds. 6,[8][9][10][11][12] Surgical ligation of a patent ductus arteriosus (PDA) has been frequently associated with left vocal fold paralysis in some series. 13 Several authors have identified a relationship between intubation factors and neonatal laryngeal injury.…”

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confidence: 99%

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Voice Abnormalities at School Age in Children Born Extremely Preterm

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Isolated case reports of abnormal voice after extremely preterm birth are well described; however, there are no systematic studies of long-term voice outcomes in children born preterm.WHAT THIS STUDY ADDS: Significant voice abnormalities were found in more than half of tested children born before 25 weeks' gestation. Multivariable analyses showed that the number of intubations, not the duration of intubation, and female gender were strongly associated with this adverse outcome. abstract BACKGROUND AND OBJECTIVES: Voice abnormality is a frequent finding in school age children born at ,25 weeks' gestation in Western Australia. The objective of this study was to determine the frequency of voice abnormality, voice-related quality of life, and demographic and intubation factors in this population. METHODS:Survivors ,25 weeks' gestational age in Western Australia born from 1996 to 2004 were included. Voice assessments (auditory perceptual assessment scale and Pediatric Voice Handicap Index) were carried out by speech pathologists. Intubation history was obtained by retrospective chart review. RESULTS:Of 251 NICU admissions, 154 (61%) survived. Exclusions were based on severe disability (11) or distant residence (13). Of 70 assessed, 67 completed assessments, 4 (6%) were in the normal range and 39 (58%) showed moderate-severe hoarseness. Simultaneous modeling of demographic and intubation characteristics showed an increased odds of moderate-severe voice disorder for children who had more than 5 intubations (odds ratio 6.96, 95% confidence interval 2.07-23.40, P = .002) and for girls relative to boys (odds ratio 3.46, 95% confidence interval 1.12-10.62, P = .030). Tube size and duration of intubation were not significant in the multivariable model. Median scores of parent-reported voice quality of life on the Pediatric Voice Handicap Index were markedly different for preterm (22) and term (3) groups, P , .001. CONCLUSIONS:Voice disorders in this population were much more frequent than expected. Further studies are required to assess voice across a broader range of gestational ages, and to investigate voiceprotective strategies in infants requiring multiple episodes of intubation. Pediatrics 2013;131:e733-e739 AUTHORS:

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Voice Abnormalities at School Age in Children Born Extremely Preterm

et al. 2013

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“…Six studies have identified dysphonia as a symptom of laryngeal pathology following intubation in preterm children [11,12,13,14,15,16]. Avulsion, scarring, oedema and lesions of the vocal folds have been described [11,13,16]. Injury to the cricoarytenoid joint, such as subluxation or fixation, resulted in decreased vocal cord movement [13].…”

Section: Introductionmentioning

confidence: 99%

“…Injury to the cricoarytenoid joint, such as subluxation or fixation, resulted in decreased vocal cord movement [13]. Dysphonia has also been identified as a symptom of acquired airway pathology, including subglottic stenosis and subglottic cysts [11,12,14,15]. Surgical management of such pathology may also result in dysphonia [15].…”

Section: Introductionmentioning

confidence: 99%

“…Surgical ligation of patent ductus arteriosus (PDA) in infancy has been associated with left vocal cord paralysis resulting from accidental resection of the left recurrent laryngeal nerve, which may cause dysphonia [17]. One study reported a case of an adolescent female using supraglottic phonation as a compensatory voicing strategy secondary to ablation and scarring of the left aryepiglottic fold and vocal cord [11]. Thus, the possibility that adverse voice outcomes may be associated with maladaptive, hyperfunctional voicing behaviours must also be considered.…”

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confidence: 99%

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Dysphonia in Very Preterm Children: A Review of the Evidence

et al. 2014

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Introduction: Intubation is a known risk factor for dysphonia yet is essential in the perinatal care of many very preterm infants. Children born preterm, who are frequently resuscitated with endotracheal intubation, may be at risk of dysphonia at school age and beyond. Objectives: To identify and describe the evidence pertaining to long-term voice outcomes and risk factors for developing dysphonia in preterm children. Results: In addition to case studies and series, three larger-scale studies have reported on dysphonia and voice outcomes in preterm children. Studies reporting treatment outcomes were not available. Factors associated with poor voice outcomes included female gender, birth weight <1,000 g, birth at <27 weeks' gestation, surgical closure of patent ductus arteriosus, emergency versus elective intubations and multiple intubations. Adverse voice outcomes were associated with laryngeal pathology and compensatory supraglottic compression. Conclusions: Dysphonia is a newly reported, long-term complication of preterm birth, yet the number of relevant studies remains limited. Further research is required to confirm the risk factors for developing dysphonia, which will inform future voice treatment studies.

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Intubation‐Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients

2021

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Objectives/Hypothesis We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability. Study Design Retrospective Study. Methods Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale. Results Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0–3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS‐2 and BDSS‐3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS‐1 (mild) or BDSS‐2. History of multiple and prolonged intubations were seen more frequently in BDSS‐2 or BDSS‐3. Post‐op pVHI reduced an average of 15 points for BDSS‐0 to BDSS‐2, but only 3 points for BDSS‐3. Post‐op pVHI matched normal values for preintervention dysphonic children. Conclusions The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher‐grade BDs, whereas low GA is more likely to be associated with BDSS‐1 to BDSS‐2. Level of Evidence 4 Laryngoscope, 131:2550–2557, 2021

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Dysphonia secondary to traumatic avulsion of the vocal fold in infants

Cited by 13 publications

References 18 publications

Voice Abnormalities at School Age in Children Born Extremely Preterm

Voice Abnormalities at School Age in Children Born Extremely Preterm

Dysphonia in Very Preterm Children: A Review of the Evidence

Intubation‐Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients

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