Voice-Related Complaints in the Pediatric Population

Abstract

Subjective evaluation of the voice by the patient is routinely assessed in the adult dysphonic population; this is, however, not the case in the pediatric population. There were three objectives of this study: the first goal was to study the ability of children aged 5-13 years to express themselves about physical, emotional, and sociofunctional aspects of their voice. The second goal was to explore if specific voice-related complaints were expressed by dysphonic children as compared with normophonic children. The third goal was to compare the dysphonic children's voice-related complaints with those of their mothers. The overall objective was to set the grounds for the elaboration of a standardized questionnaire in French concerning subjective evaluation of voice in children. Twenty-five dysphonic children with vocal complaint (15 nodules, one polyp, one microweb, eight unspecified) and 55 normophonic children aged 5-13 years were interviewed. The interviews were semistructured based on a canvas of voice-related questions. The dysphonic children's mothers were interviewed with the mean of a written questionnaire and were invited to discuss their answers orally with the examiner. The results were analyzed qualitatively and statistically. A Chi-square test and the Fisher's test were used to analyze the differences between the complaints expressed by the dysphonic and the normophonic children, and a binomial test was used to compare the children's answers with their mothers' answers. The qualitative analysis of the interviews suggests that children are capable of reflecting over their own voice and of giving autonomous information about different aspects of their voice. It also appeared that voice is a complex phenomenon and that it needs to be clearly and cautiously defined to the children. We identified 27 different complaints related to the voice, out of which 17 were significantly more expressed by dysphonic than by normophonic children (P<0.05). Three of the 27 identified complaints show significant discordances between the mothers and the dysphonic children. The results suggest that children are capable of making a subjective and autonomous evaluation of their voice and that dysphonic children experience significantly more voice-related discomfort than nondysphonic children. The complaints expressed by the dysphonic children and their mothers are not all in concordance. The main conclusion is that a standardized subjective evaluation of the voice, not only by the parents but also by the child him/herself, would be relevant in the assessment of pediatric dysphonia.

Análise da qualidade de vida relacionada à voz na população infantil

“…Parents of children and adolescents can measure the impact of voice disorder on their children's quality of life using the PVRQoL survey (6) -a valid instrument composed of ten questions divided into two domains: physical and socio-emotional that can sensitively identify the impact of vocal alteration (5) . Research has reported that children without voice disorders present PVRQoL scores close to 100 (17) -not showing negative impact on quality of life, whereas children with laryngeal alterations present reduced scores for all domains compared with those of children without laryngeal and vocal alterations, demonstrating that vocal deviation interferes with quality of life (17) .…”

“…The specific scientific literature describes three parental assessment tools related to the voice, namely: Pediatric Voice Outcome Survey (PVOS), Pediatric Voice Handicap Index (PVHI), and Pediatric Voice-related Quality-of-Life (PVRQoL) protocol (5) . The use of voice assessment tools applied to parents of children and adolescents is important because they have the ability to understand the context of the problem and, from this perception, seek specialized assistance for their children (6) .…”

Validation and Standardization of the Pediatric Voice Symptom Questionnaire: A Double-Form Questionnaire for Dysphonic Children and Their Parents

“…32 In the child form, the items address the child himself or herself (for example: ''Do you have to strain when you speak? ''); in the parent form, the items duplicate those used in the child form but address the parents (for example: ''Do your child strain when he/she speaks?…”

“…However, two recent studies where focused group interviews were conducted with dysphonic children and their parents show that children are both conscious of and affected by their vocal symptoms and that they are capable of describing them accurately without adult help already from the age of 5 years. 31,32 The studies also found evidence that the parental evaluation of the child's difficulties is not in full concordance with the child's own evaluation. The validity of the parental proxies in the three existing voice-related child questionnaires has not been studied.…”

Curva ROC do Protocolo Qualidade de Vida em Voz Pediátrico (QVV-P)

“…The parental assessment protocols have been highly recommended in the pediatric voice clinic, since the young age of the patient can derail the vocal self-assessment (1) . Among the parental assessment procedures, we highlight the quality of life related to voice, enabling better targeting of therapeutic procedures (2)(3)(4) .…”