Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T16:12:06.291Z Has data issue: false hasContentIssue false
  • English
  • Français

Managing dysphonia in paediatric patients with complex airway conditions

Published online by Cambridge University Press:  17 June 2015

S Ojha ,
J Setlur ,
G Bunting  and
C J Hartnick
S Ojha*
Affiliation:
Royal National Throat, Nose and Ear Hospital, London, UK
J Setlur
Affiliation:
Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
G Bunting
Affiliation:
Department of Speech-Language and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
C J Hartnick
Affiliation:
Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
*
Address for correspondence: Miss Shilpa Ojha, 194 Bromyard Avenue, Acton, London W3 7FN, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To suggest a phonosurgical management strategy that can be used for children who have previously undergone laryngotracheal reconstruction.

Methods:

This cases series describes three children who presented with complex, multi-level airway stenosis and marked dysphonia. Phonosurgical intervention involved endoscopic and open approaches, and was combined with voice therapy. A phonosurgical reconstruction management algorithm is suggested for evaluating and treating these complex conditions.

Results:

Pre-operative assessment is critical, and should involve voice analysis and glottal anatomy assessment using office laryngoscopy and stroboscopy. The risks must be weighed up against the benefit of vocal improvement. Surgical intervention should involve combined endoscopic and open approaches.

Conclusion:

Voice restoration after paediatric airway reconstruction is a complex challenge. Surgical intervention should be conducted in a step-by-step manner to reduce the risk of worsening dysphonia and airway compromise. The risks and benefits must be carefully explored and discussed.

Keywords

DysphoniaChildVoice DisordersAlgorithmLaryngoscopy
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 8 , August 2015 , pp. 820 - 824
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Cotton, R. The problem of pediatric laryngotracheal stenosis: a clinical and experimental study on the efficacy of autogenous cartilaginous grafts placed between the vertically divided halves of the posterior lamina of the cricoid cartilage. Laryngoscope 1991;101(suppl 56):1–34Google Scholar
2Sell, D, McCurtain, F. Speech and language development in children with acquired subglottic stenosis. J Laryngol Otol Suppl 1988;17:35–8CrossRefGoogle ScholarPubMed
3Clary, RA, Pengilly, A, Bailey, M, Jones, N, Albert, D, Comins, J et al. Analysis of voice outcomes in pediatric patients following surgical procedures for laryngotracheal stenosis. Arch Otolaryngol Head Neck Surg 1996;122:1189–94CrossRefGoogle ScholarPubMed
4Tirado, N, Chadha, K, Allegro, J, Forte, V, Campisi, P. Quality of life and voice outcome after thyroid ala graft laryngotracheal reconstruction in young children. Otolaryngol Head Neck Surg 2011;144:770–7CrossRefGoogle ScholarPubMed
5Zalzal, GH, Loomis, SR, Fisher, M. Laryngeal reconstruction in children. Assessment of vocal quality. Arch Otolaryngol Head Neck Surg 1993;119:504–7CrossRefGoogle ScholarPubMed
6Bailey, CM, Clary, RA, Pengilly, A, Albert, DM. Voice quality following laryngotracheal reconstruction. Int J Pediatr Otorhinolaryngol 1995;32(suppl):S93–5CrossRefGoogle ScholarPubMed
7Zur, KB. Pediatric airway reconstruction and the voice. In: Hartnick, CJ, ed. Pediatric Aerodigestive Disorders. San Diego: Plural Publishing, 2009Google Scholar
8Baker, S, Kelchner, L, Weinrich, B, Lee, L, Willging, P, Cotton, R et al. Pediatric laryngotracheal stenosis and airway reconstruction: a review of voice outcomes, assessment, and treatment issues. J Voice 2006;20:631–41CrossRefGoogle ScholarPubMed
9Prescott, CA. Peristomal complications of paediatric tracheostomy. Int J Pediatr Otorhinolaryngol 1992;23:141–9CrossRefGoogle ScholarPubMed
10Varghese, AM, Cheng, AT. Epiglottic repositioning procedure for supraglottic stenosis/collapse. Ann Otol Rhinol Laryngol 2011;120:478–83CrossRefGoogle ScholarPubMed