Vocal Quality of Decannulated Children Following Laryngeal Reconstruction

Abstract

Laryngotracheal reconstruction with expansion surgery is a reliable method for treatment of laryngotracheal stenosis in children. It allows for decannulation of the patient and restoration of vocal communication. Previous information regarding vocal quality in these patients has been scant. Sixteen children who underwent successful laryngotracheal reconstruction were evaluated using a standardized voice assessment during each of the following: phoneme prolongation, counting, storytelling, and spontaneous conversation. Interjudge ratings were obtained to establish reliability. The location and severity of the laryngotracheal stenosis and the method of treatment were reviewed. Twelve children have a functional voice compared to six preoperatively. Overall, vocal parameters suggested a particular pattern consisting of a lower than optimal pitch and a restricted pitch range. Laryngotracheal reconstruction does make oral communication possible for children who would otherwise have persistent tracheotomy. However, vocal quality appears to be disturbed in most of the patients.

Congenital anterior glottic webs with subglottic stenosis: Surgery using perichondrial keels

“…This might also explain the quality of voice following laryngotracheal reconstruction of subglottic stenosis. As reported by Zalzal et al [12], 15 of 16 patients following laryngotracheal reconstruction had ''abnormal'' voices. Among congenital glottic webs, the reconstruction of a good glottic aperture by pulling residual normal vocal tissue anteriorly to meet at the anterior thyroid cartilage, making sure they are created at the same level on both sides, with a good healthy subglottic lumen, should maximize the vocal quality.…”

Vibratory source, vocal quality and fundamental frequency following pediatric laryngotracheal reconstruction

“…Although the data describing voice following LTR are limited, investigators have consistently noted that many children exhibit dysphonia following successful airway reconstruction [5,7,15,16]. Descriptions of post-surgical laryngeal structure and mobility related to phonation have been included in several studies.…”

“…Vocal quality following LTR has been examined using perceptual characterization [5,7,9,10,15,16] and acoustic analysis [5,9]. There are strengths and limitations to both methods in terms of how precisely and reliably vocal quality may be described.…”

“…Because the post-surgical larynx is necessarily altered and may be characterized by missing, immobile, or poorly approximated structures, dysphonia is a frequent outcome of augmentation and resection reconstructive surgeries [1,4,5,7,[9][10][11][12]. In augmentation procedures, a cartilaginous graft is placed between the edges of a surgically created split in the anterior and/or posterior cricoid plate [2].…”

“…Surgeons who perform pediatric LTR have traditionally measured surgical outcomes based on successful airway restoration [2][3][4][5][6]. In order to expand the scope of outcome analysis and promote improved phonation in children after LTR, surgeons and speech-language pathologists have expressed a desire for comprehensive information about post-surgical voice outcomes [5,[7][8][9]]. …”