Prevalence of Dysphonia in Children with Adenotonsillar Problems and the Impact of Surgery on Voice

Abstract

Objective/Hypothesis: Adenotonsillar problems might affect the voices of patients with pediatric dysphonia, which is very common. This study aimed to evaluate the prevalence of dysphonia in patients with adenotonsillar problems and to demonstrate the impact of tonsillectomy and adenoidectomy (T & A) on their voice postoperatively.Study Design: Single-institution retrospective study. Methods: Subjects were recruited from those children admitted for the purpose of T & A, and all underwent the auditory-perceptual assessment by speech therapists preoperatively. If children demonstrated scores >2 in the G parameter, we performed subjective (pediatric voice handicap index [pVHI], severity, talkativeness scale) and objective (Multi-Dimensional Voice Program) voice analyses preoperatively and 1 and 3 months postoperatively.Results: Among the 1,197 patients, 91 (7.6%) patients showed dysphonia with a score >2 in the G parameter preoperatively. The follow-up voice analysis was completed in 51 and 22 patients after 1 and 3 months, respectively. Although there were no significant differences in the amount of speech preoperatively and postoperatively, the average visual analog scale score for dysphonia severity was significantly decreased at postoperative 1 month and postoperative 3 months. The average total pVHI score, jitter, shimmer, noise-to-harmonic ratio, and soft phonation index were significantly decreased at 1 and 3 months postoperatively. Subjective scores given by parents did not correlate with the acoustic parameters; however, the postoperative subjective parameters were significantly correlated with objective parameters.Conclusions: Voice problems were significantly improved after T & A in the short term and long term. In those with pediatric dysphonia, decreased mouth breathing and compliance with vocal hygiene would be helpful for voice improvement.

Voice Change After Adenotonsillectomy in Children: A Systematic Review and Meta‐Analysis

“…Computerized acoustic voice analysis is a computer-based method for objectively and reproducibly assessing vocal fold function; data analysis software is employed to analyze vocal parameters in a noninvasive manner. 40,41 The softwares used in the included studies were the Computerized Speech Lab, 12,24,29 the Multi-Dimensional Voice Program, [13][14][15]22,24,41 the standardized commercial voice analysis system, 16 the Praat software, 23,26,28,41 and the XION Medical DIVAS 2.5 Digital Voice Analysis. 25 The aerodynamic assessment includes the transglottic flow and the subglottic pressure to understand the variations in pressure and airflow during vocal fold vibration.…”

“…One method was clinical evaluation by a speech-language pathologist [12][13][14][15][16][17][18][19]23 or otolaryngologist. 27,28 The other was a caregiver assessment questionnaire, which comprised the Pediatric Voice Handicap Index, 15,25,27,29 Pediatric Voice Outcome Survey, 26 and visual analog scale. 29…”

“…27,28 The other was a caregiver assessment questionnaire, which comprised the Pediatric Voice Handicap Index, 15,25,27,29 Pediatric Voice Outcome Survey, 26 and visual analog scale. 29…”

“…The characteristics of the 23 studies were shown in Table I, with a total of 2154 patients analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Among these studies, ten studies were from Asia, 16,[20][21][22][24][25][26][27]29,30 nine studies were from Europe, 11,[13][14][15]17,28,[31][32][33] two study from South America, 18,23 one study from Africa, 19 and one study from the United States. 12 Five studies enrolled a normal control group.…”

Paediatric voice disorder: who to refer and how to assess? A summary of recent literature

“…Two studies outline the importance of information gathering to ensure the voice is well supported during other medical care: one in children with multisystem syndrome following SARS-CoV-2 infection [27 ▪ ] leading to recommended admission questions to identify dysphonia and dysphagia; and the other in children attending for adenotonsillar problems [34 ▪ ]. Several studies describe the presence of voice problems in Downs syndrome [30 ▪ ]; Pompe disease [24 ▪ ,40 ▪ ] and cleft lip/palate [22 ▪ ,25], all of which provide helpful insight for appropriate clinical management.…”