Laryngeal Microsurgery for the Treatment of Vocal Nodules and Cysts in Dysphonic Children

Abstract

Introduction: Vocal nodules and cysts are frequent causes of infantile dysphonia. Vocal therapy is the first treatment. Microsurgery has restricted indications, especially for nodules. Objective: To describe our experience with microsurgery for nodules and cysts in children. Methods: Dysphonic children (aged 4–18 years) with the diagnosis of nodules and vocal cysts were initially selected. Of these children, only those were included who had undergone microsurgery. For nodules and cysts, the microsurgery was indicated in cases of failure of vocal therapy and in cases of voice worsening or doubts about the diagnosis. All children were submitted to auditory perceptual vocal analysis and videolaryngostroboscopy (before and after surgery, after 6 months). Surgical outcomes were: total improvement (disappearance of vocal symptoms and of the laryngeal lesions); partial improvement (partial improvement of symptoms and/or maintenance of lesions); no improvement (maintenance or worsening of the symptoms and/or persistence of the lesions). ­Results: There were 78 children with vocal nodules and 27 children with vocal cysts. Surgery was indicated for 12 children with vocal nodules (15.4%) and 12 children with cysts (44.4%). Total improvement registered for nodules and cysts was 75 and 83.4%, respectively. Partial improvement for both lesions was 25 and 16.6%, respectively. Conclusion: The best outcome for laryngeal microsurgery in dysphonic children was for vocal cysts. So, we encourage laryngologists for this conduct in vocal cysts. The success of microsurgery for vocal nodules was lower, and in these cases voice therapy seems to be the best treatment.

Effects of voice therapy in children with vocal fold nodules: A systematic review

“…Treatment options for paediatric VFNs are based on adult therapies and include direct and indirect voice treatment, phonosurgery, and modulation of associated factors such as allergy or reflux (Mudd & Noelke, 2018; Nuss et al., 2010; Ongkasuwan & Friedman, 2013). Voice therapy is preferable in children because of the phonotraumatic nature of VFNs and the associated high recurrence rate after phonosurgery (Martins et al., 2013, 2020; Mudd & Noelke, 2018). Immaturity of the laryngeal structures and the frequent failure to respect postoperative vocal rest also make phonosurgery a controversial choice in children with VFNs (Martins et al., 2020).…”

“…Voice therapy is preferable in children because of the phonotraumatic nature of VFNs and the associated high recurrence rate after phonosurgery (Martins et al., 2013, 2020; Mudd & Noelke, 2018). Immaturity of the laryngeal structures and the frequent failure to respect postoperative vocal rest also make phonosurgery a controversial choice in children with VFNs (Martins et al., 2020). Direct voice therapy techniques modify vocal behaviour through motor execution, somatosensory feedback, or auditory feedback.…”