Voice Therapy Improves Acoustic and Auditory‐Perceptual Outcomes in Children

Abstract

This study employed acoustic measures as well as auditory-perceptual assessments to examine the effects of voice therapy in children presenting with benign vocal fold lesions.Methods: A retrospective, observational cohort design was employed. Sustained vowels produced by 129 children diagnosed with benign vocal fold lesions were analyzed, as well as connected speech samples produced by 47 children. Treatment outcome measures included Consensus of Auditory-Perceptual Evaluation of Voice (CAPE-V), jitter, shimmer, Noise-to-Harmonic Ratio (NHR), cepstral peak prominence (CPP), and Low-to-High Ratio (LHR) on sustained vowels, and CPP and LHR on connected speech.Results: Following voice therapy, significant improvements in CAPE-V ratings (p < 0.001) were observed. Additionally, jitter (p = 0.041), NHR (p = 0.019), and CPP (p < 0.01) on sustained vowels, and CPP (p = 0.002), and LHR (p = 0.008) on connected speech significantly improved following voice therapy. CPP increased with age in males but did not change in females. CAPE-V ratings and perturbation measures indicated that dysphonia was more severe in younger children pre and posttherapy.Conclusions: Auditory-perceptual and acoustic measures demonstrated improved voice quality following voice therapy in children with dysphonia. CPP effectively quantified voice therapy gains and allowed for analysis of connected speech, in addition to sustained vowels. These findings demonstrate the value of CPP as a tool in assessing therapy outcomes and support the efficacy of voice therapy for children presenting with vocal fold lesions.

Economic Burden of Induced Laryngeal Obstruction in Adolescents and Children

“…ILO can be both debilitating and traumatic for pediatric patients 50,51 as it limits athletic activity 8 and undermines health-related quality of life. 52,53 Past work indicates that the financial burden of ILO is significant for adults; 23 however, it is unknown if pediatric patients are similarly affected. Additionally, it is unclear how comorbid asthma and socioeconomic disadvantage influence the economic burden placed on families.…”

“…It is also likely that the effects of ILO therapy are not instant, but require some time for full benefit to be achieved. 52 Thus, patients may have continued to report dyspnea in medical appointments following therapy initiation. Additional research is needed to understand the timeframe involved in managing ILO symptoms.…”

“…First, patients in the current study did not undergo continuous laryngoscopy during exercise as the necessary equipment is not widely available in the United States. 18,52,57 As such, laryngoscopy costs may differ for patients who undergo this procedure. Costs could also be higher when clinic protocols include videostroboscopy for pediatric dyspnea patients.…”

Voice Disorder Prevalence and Vocal Health Characteristics in Children

“…Considering that 12% of children in the current study had already experienced a voice complaint and 80% of these problems were chronic, it is clear that effective voice-related medical care is crucial for this population. 39,[74][75][76] This is particularly important given that voice problems were associated with limited social/extracurricular interactions, increased school absences, and negative attention from adults. 13,77 Additionally, Peds-VRQOL scores were substantially higher for children with voice problems, suggesting that dysphonia was negatively associated with quality of life.…”

Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

“…Induced laryngeal obstruction (ILO) involves adduction of laryngeal or supralaryngeal tissues on inhalation . The resulting dyspnea can be frightening, debilitating, and costly, limiting quality of life for those affected . Symptom triggers vary and include irritants, environmental factors, and physical exertion .…”