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Objective Despite the fact that vocal nodules are the most common cause of chronic dysphonia in children, uncertainty and lack of consensus complicates practically every diagnostic and management decision. Selecting an optimal staging system is fundamental to understanding a disease process, mandatory for uniform reporting, and crucial to predicting natural history and treatment outcomes. The ideal prognostic model for vocal nodules is under intense debate. The purpose of this study was to analyze the predictive power of vocal nodule grade to severity of voice metrics in children. Methods Seventy-nine patients diagnosed with vocal cord nodules between 2006 and 2012 were drawn from UPMC Children's Hospital of Pittsburgh Voice, Resonance and Swallowing Center Research Registry. Subject age at time of diagnosis, nodule grade, relevant co-morbidities, scores on The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), parent-reported Pediatric Voice Handicap Index (pVHI), the phonotraumatic behaviors profile, habitual speaking pitch fundamental frequencies, pitch range, volume intensity, and s/z ratio were recorded and compiled into a de-identified database for analysis. Results Based on the Kruskal-Wallis H Test, there was no statistically significant correlation between nodule grade and total pitch range (p = .21), s/z ratio (p = .50), volume intensity (p = .33), overall CAPE-V Scores (p = .15), or pVHI Scores (p = .29). Chi-squared tests also revealed no significant associations between nodule grade and abnormality in habitual speaking pitch (p = .14 for fundamental frequency while sustaining a vowel sound, p = .37 for fundamental frequency while speaking structured tasks i.e. counting, or p = .76 while speaking in conversation). Conclusion The current “gold-standard” for grading vocal nodule size suggests that the nodules themselves are not driving the standard dysphonic metrics that are most commonly collected and monitored in such children. This outcome is consistent with other studies reporting similar findings and was expected based on the inconsistencies in the reported literature to date. By extension, the conventional wisdom of avoiding surgical treatment of vocal nodules in children seems prudent as there is little evidence to suggest that the nodules themselves are “driving” the severity of the dysphonia. Ultimately identifying the true “drivers” of dysphonia in children will suggest alternative therapies that are more specific and directed to the pathophysiology. Most pediatric voice care professionals will welcome such discoveries as those in the front line of patient care are often rendered helpless and frustrated.

To analyse the possible changes on the acoustic parameters and auditory-perceptive characteristics of children's voice after adenoidectomy with or without tonsillectomy.Prospective cohort study of children aged 5-12 years at one month before surgery (t0) and one (t1), three (t3) and six (t6) months after adenoidectomy with or without tonsillectomy. On each assessment the acoustic parameters (fundamental frequency, jitter %, shimmer % and harmonics-to-noise ratio) and auditory-perceptive analysis (nasal resonance, loudness, pitch, GRBAS scale and maximum phonation time) were recorded.A total of 51 children were considered for data analysis. Nasal resonance revealed a significant decrease in the number of cases with hyponasality, from 86.3% at t0 to 12.8% at t1 (p 0.001), 2.3% at t3 (p 0.001) and 2.8% at t6 (p 0.001). This improvement was maintained during the late follow-up time with no significant difference on nasal resonance between t0 and t3 (p = 0.250) and t3 and t6 (p = 0.250). All children with alteration on the GRBAS scale before the procedure showed a normal voice quality after the surgery. Regarding the acoustic parameters none showed a significant change with the surgery.The results suggest that adenoidectomy with or without tonsillectomy is a safe procedure concerning voice alterations and can improve voice quality and nasal resonance in a sustained manner.

Background Velopharyngeal insufficiency (VPI) occurs when the velopharyngeal sphincter (VPS) is unable to completely seal anatomical closure between the nasal and oral cavities during speech. Palatal repair can restore VPS function but the prevalence of VPI after repair has been reported ranging from 20% to 40%. The combination of flexible videonasopharyngoscopy (FVNP) and multiplanar videofluoroscopy (MPVF) has been reported as the best approach for assessing the VPS mechanism and planning effective surgical procedures aimed to correct VPI. Objective To study the outcome of three different techniques for performing pharyngeal flaps with the common denominator of individually designing the flap according to findings of VFNP and MPVF. Material and methods A total of 140 cases of pharyngeal flap surgery were reviewed. Three surgeons performed 3 different surgical techniques. All cases underwent nasometry, VNP and MPVF preoperatively. All surgical procedures were carefully planned and designed according to findings of VNP and MPVF. Results Nasal emission was completely eliminated in all cases. One-hundred-thirty-four patients (95%) demonstrated mean nasalance within normal limits after the surgical procedure whereas 6 patients persisted with mean nasalance scores above reference values postoperatively. There were no intraoperative or postoperative complications in any of the cases. No clinical data of sleep disordered breathing was detected in any of the cases after 2 months of postoperative follow-up. However, one case presented with clinical data of sleep disordered breathing 8 months postoperatively. Conclusions The results of this study suggest that as long as pharyngeal flaps are being designed according to the findings of imaging procedures, different surgical techniques can provide similar successful outcomes with minimal complications.

Objective Tonsillar hypertrophy may affect velopharyngeal closure and speech resonance. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with normal palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance. Methods Eighty seven children with hypertrophied tonsils and normal palate were subjected to tonsillectomy for indications other than speech problems. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech (APA) and nasometric assessment of nasalance was measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy. Results Thirteen patients were excluded from the study because of associated adenoid hypertrophy. The mean baseline of APA scores showed insignificant changes postoperatively. However, significant postoperative changes of nasometric parameters were detected, and the overall postoperative nasalance score was improved for nasal and oral sentences. Also, improvement of velopharyngeal closure was observed postoperatively with accession of palatal mobility and significant increase in coronal closure pattern. Conclusion hypertrophied tonsils may impair velopharyngeal function in children with normal palate by hindering palatal elevation. Tonsillectomy is a beneficial procedure for such patients as it can improve the velopharyngeal closure and speech resonance.

Objectives Cepstral measures have mainly been evaluated by studies conducted on dysphonic and healthy adults, and many of these studies have reported the advantages of using cepstral measures for the evaluation of dysphonia however there is a paucity regarding to the cepstral analyses' results in dysphonic children. In this present study, it is hypothesized that cepstral peak prominence (CPP) and some other parameters of cepstral analysis would differ in children with vocal nodules when compared with the same parameters of cepstral analysis of healthy children. Methods In this present study, totally 54 children aged between 5 years old to 12 years and 7 months participated. The study group consisted of 20 males and 7 females diagnosed with vocal nodules. The control group consisted of an equal number of age- and gender-matched healthy peers. Analysis of Dysphonia in Speech and Voice software (CSL Model 4500 equipment, Kay Elemetrics Group) was used to gather speech sample recordings according to the Consensus Auditory-Perceptual Evaluation of Voice/Turkish protocol. Cepstral measures of all the six CAPE-V sentences and sustained/a/sample were calculated. CPP, CPP fundamental frequency, CPP standard deviation (CPP SD), Low_high spectral ratio (L/H ratio), L/H ratio standard deviation parameters were taken into account when statistical analyses were completed. In addition to the descriptive statistics of ceptral measures for both groups, the differences between the study and control groups according to the gender were documented. Results It was found that for both genders CPP and CPP SD values were significantly higher for the control group for vowel-weighted sample, all voiced-weighted sample, glottal attack-weighted sample, nasal weighted sample, and voiceless-weighted sample. In the vowel-weighted sample, CPP and CPP SD were significantly higher for the control group in males. In females, a difference was only observed on the CPP parameter for the same sentence. In terms of the CPP value of the sustained phonation sample, a significant difference was only detected for males, whereas no difference was detected for females. Conclusions In conclusion, present study found that cepstral analysis can be used to determine the difference between dysphonic and healthy voices of children and indicated that cepstral analysis should be a compulsory component of routine clinical voice evaluation of children. In addition, this present study indicates that of the cepstral analysis of sentences appear to be more sensitive to dysphonia than the analysis of vowel samples. In future studies, normative values of the CAPE-V/Turkish sentences and cutoff values for differentiating dysphonia from normal voice should be evaluated using a larger sample size.

Objectives This study aimed to determine the cepstral acoustic parameters that vary depending on age and gender in vocally healthy children, and to establish normative data for cepstral analysis. Background Cepstral measurements are among the strongest predictors of auditory-perceptual evaluation of voice and differentiate between healthy and dysphonic voices. More spesificially, ceptral peak prominence is accepted to be as a strong acoustic predictor of breathiness and overall severity of dysphonia. Cepstral measures determine voice quality reliably not only in sustained vowel samples but also in running speech samples. Determining the parameters related to the acoustic profile of children with normal voices can lead us to a better understanding of the effect of changes in the larynx and vocal fold structure during growth and development. There is a limited number of norm studies examining the cepstral acoustic properties of pediatric voice. Determining norm-specific values and clinical guidelines of cepstral acoustics according to the age and gender in vocally healthy children are utmost important. Methods A total of 160 vocally healthy children were divided into the following four age groups: Group-I included children within the age range of 4–7 years, Group-II included 7–11 years, Group-III 11–14 years, and Group-IV included children within the age range of 14–18 years. An equal number of male and female participants were assigned to each group. PENTAX Medical CSL Model 4500 was used for recording all tasks. For acoustic analysis, Multi-Dimensional Voice Program and Analysis of Dysphonia in Speech and Voice were used. Results Cepstral Peak Prominence (CPP), Cepstral Peak Prominence Standard Deviation (CPP SD), and Low-To-High Spectral Ratio (L/H Ratio) increased with age. It is found that the CPP parameter of all-voiced sentences and nasal-weighted sentences increased with age in boys, while no significant pattern was observed in any sample for girls. For L/H ratio, it can be said that there is a general increase with age in all speech samples, except for the vowel-weighted and voiceless plosive sentence samples, evident especially in the group above the age of 15 years. This study concluded that the CPP SD parameter in the vowel-weighted sentences increased with age in boys. It was also noticed in this study that CPP F0 standard deviation (SD) intervals were narrower in vowel-weighted, easy onset, and voiceless plosive sentence samples than in all-voiced, hard glottal attack and nasal-weighted sentence samples. Conclusion This study established cepstral acoustic normative values for a wide age range of the pediatric population. It is thought that age and gender specific cepstral acoustic findings presented in this study contributed to the related literature. In addition, to our knowledge, this is the first study that provides a normative cepstral acoustic database of the CAPE-V/Turkish sentences in the pediatric population.

Children with speech sound disorders (SSDs) who present the devoicing of plosive and/or fricative sounds may have difficulties with glottal respiratory control.To analyze acoustic vocal measures, spectrographic aspects and the risk of dysphonia among children with devoicing SDDs and compare the results with those of other groups of children.Twenty-five boys aged between six and 12 years participated. They were divided into four groups: the SSD-devoicing (PPDG), dysphonia (DG), SSDs other than devoicing (PPOG) and control groups (CG). The vocal tasks were recorded, and perceptual-auditory and acoustic voice analyses were performed. The children's parents answered questions about voice-related aspects (to determine a dysphonia risk score). All data were compared among the groups.Due to the sample size, an effect size analysis was considered, and the results showed possible differences between the PPDG and the other groups in measures of fundamental frequency (F0), jitter, shimmer, harmonic-to-noise ratio, maximum frequency of harmonic definition and dysphonia risk score.The PPDG showed a high F0 and abnormal jitter and shimmer values. Although the voices of the children in this group had more harmonics than noise, the maximum frequency for defining the harmonics was very restricted. The PPDG had the lowest dysphonia risk score among all of the groups. Variations in F0, jitter and shimmer may indicate difficulties with controlling vocal adjustments, which appear to be hyperfunctional and not to impact vocal projection or voicing.

OBJECTIVES. Report data on acoustic measures of voice in sustained vowels produced by typically developing children, aged 4 to 19 years, to add to the cross-sectional reference values in a pediatric database. METHODS. Recordings of sustained vowel /ɑ/ phonation were obtained from 158 children (80 males, 78 females) aged 4 to 19 years who were judged to be typically developing with respect to speech and voice. Acoustic analyses were performed with the Multidimensional Voice Program (MDVP(™)) and the Analysis of Dysphonia in Speech and Voice (ADSV(™)), both from Pentax Medical. RESULTS. Values from both MDVP and ADSV are reported for children in the following age cohorts: 4 to 6 years, 7 to 9 years, 10 to 12 years, 13 to 15 years, and 16 to 19 years. CONCLUSION. The data in this study complement previously published data and contribute to a pediatric reference database useful for research and for clinical practice related to children’s voice. Acoustic parameters most sensitive to age and sex are identified.

Purpose The study aimed at testing the effect of supra segmental training on vocal emotional prosody perception of children with hearing impairment. The objectives of the study were to compare the perception of vocal emotional prosody (happy, sad, and neutral) in children with hearing impairment with and without a short-term prosody training and to draw correlations between the vocal emotional prosody perception scores and the subject factors - chronological age, age of hearing aid fitting, duration of the intensive intervention (speech, language and auditory training without breaks more than 30 days) and language age in children with hearing impairment. Method Thirty children with hearing impairment in the age range of 4.1–9.2 years with a language age of 3–7 years participated in the study. The authors formulated 24 concrete Malayalam sentences and their picture representations and these were recorded under three emotional variations (happy, sad, and neutral). Using random sampling, the thirty participants were divided into the control group (CWHI) and the experimental (CWHIt) group. The study was carried out in two phases; phase 1 (training) attended by only the experimental group and phase 2 (testing) attended by both the groups. Results There was a significant difference between CWHI and CWHIt in the happy, sad, and neutral vocal emotional prosody conditions. Chronological age, duration of speech-language-auditory training, and language age showed a positive correlation with the vocal emotional prosody perception scores; and no correlation was found between the age of fitting of hearing aids and the emotion perception scores. Conclusion The results of the study points out that with adequate prosody training, the children with hearing impairment using benefiting hearing aids could improve their vocal emotional prosody perception. Owing to the role of prosody perception in speech & language, social and cognitive development, the supra segmental training should be made an integral part of the assessment and management intervention strategies.

Introduction The modern standard of voice diagnostics in both the adult and pediatric populations is based on perceptual, acoustic and videolaryngoscopic assessment, as well as self-assessment of voice quality. Currently, only two tools for assessing the voice in the pediatric population were translated into Polish: pVHI and its abbreviated version - cVHI (Children Voice Handicap Index). Thanks to the use of pVHI, the therapist and the patient, as well as his family and relatives, become aware of what functional zones are disturbed as a result of voice problems. Aim The aim of the study was to analyze various methods of assessing children's voice, including the pVHI voice disability questionnaire in children with various voice disorders. In addition, the authors wanted to develop a classification of the degree of disability of children's voice expressed by the sum of points obtained in pVHI. Material and method The study included a group of 89 children aged 5-12. Each child underwent a standard otolaryngological and phoniatric examination procedure with hearing assessment and fiberoscopic laryngeal evaluation. The voice of the dysphonic children was assessed with a spectrogram and the GRBAS scale. The children's guardians completed the Pediatric Voice Handicap Index (pVHI). Results Polish children without voice disorders obtained an average of 1.9 points as a total result of the pVHI questionnaire. The results of the questionnaire obtained from children with voice disorders were on average 24.7 (SD 13.9). Total and individual domain scores were significantly higher in children with dysphonia than in asymptomatic children. Children with voice disorders were rated an average of 1.95 (SD 0.6) degree of hoarseness in Yanagihara's scale, and obtained an average overall score of 4.8 on the GRBAS scale (SD 2). A common upward trend in all types of evaluation is evident, along with an increase in the handicap expressed in pVHI score. Statistical analysis showed significant dependence between the overall pVHI score and other voice rating indicators. The result correlated to a moderate degree with the sum of points obtained from GRBAS and the severity of hoarseness assessed subjectively (G) and objectively according to Yanagihara's scale. In addition, weak correlations of the functional part of the questionnaire with the presence of learning problems, and the emotional part with the presence of problems with socialization were noticed. Analyzing the results of the questionnaire depending on the GRBAS results and the Yanagihara scale, a better fit of the exponential trend line than the linear one was observed. The point of inflection of the exponential curve, and thus a significant deterioration in voice assessment indicators, was observed in children who obtained over 32 points, which is 33% of the maximum value that can be obtained from the questionnaire. Conclusions A new voice assessment tool for the pediatric population has been developed that complements the diagnostic facilities of the otolaryngologist, phoniatrician and speech therapist. Adaptation of the Polish version of the Voice Handicap Index (pVHI) allows the introduction of a new diagnostic indicator into medical and speech therapy practice. The pVHI questionnaire result differentiates children with voice and speech disorders from healthy children. The analysis of children's voice using various methods allows the clinician to further characterize the disturbance of voice quality. It is possible to assess the scale of the severity and type of problem, as well as the spheres of life it concerns most. There is a correlation between the severity of voice disorders and the severity of voice disability expressed in the pVHI question.

There is still a lack of information available to clinicians regarding evaluation and treatment of pediatric voice disorders. The purpose of the present study was to develop an Arabic version of the pediatric V-RQoL.and methods: 290 children and adolescents were included in the study. The PV-RQoL was translated into Arabic and pilot-tested on twenty participants with vocal complaints, and then amended culturally according to their suggestions. Then, application of the modified Arabic questionnaire in its final version, the APV-RQoL, was done on 130 patients with vocal complaint, out of them 70 patients were re-tested 14 days later, and 140 control without vocal complaints.There was a statistically significant difference between the control and the voice disordered groups (P 0.001).The APV-RQoL was proved to be reliable, showing high internal consistency and test-retest reliability with excellent item domain to domain correlation. Also, it was proved to be valid by confirmatory factor analysis, and by correlation with the Arabic PVHI scores, with high sensitivity and specificity.The Arabic version of PV-RQoL is considered to be a valid and reliable assessment tool used by parents of Arabic speaking children.

Purpose The anatomical, physiological, and phenotypic characteristics of children with Down Syndrome results in deviated acoustic and aerodynamic measures in their voice. These deviant vocal presentations may negatively affect the quality of life of children with Down syndrome. The present study aimed to systematically review the available literature on acoustic and aerodynamic voice characteristics of children with Down syndrome. Method A systematic review of studies on acoustic and aerodynamic measures of voice in children with Down Syndrome (using PubMed/MEDLINE, CINAHL, Scopus, ProQuest, Cochrane, Ovid, Science Direct) was carried out. Keywords based on Population–Investigation–Outcome were used to develop search strings. Two authors screened titles and abstracts independently, and appropriate studies were analyzed in detail for data extraction. Results Out of the 1432 studies, two studies met the inclusion criteria. Different acoustic and aerodynamic measures were employed, such as fundamental frequency, intensity, phonation time, jitter, shimmer and ESGP, MAFR, and LAR. Conclusion Overall, there was a lack of standardized criteria for the evaluation of acoustic and aerodynamic characteristics in the Down syndrome population. Acoustically, there was no significant difference between children with DS and typically developing children. However, aerodynamic studies suggest that there is a significant impairment of glottal valving in children with Down syndrome.

Objective Posterior palatal defect after cleft palate (CP) repair is not a rare problem, it may cause velopharyngeal insufficiency (VPI). The aim of this study was to assess the effectiveness of a superiorly-based pharyngeal flap (PF) with modification of its end to accommodate the defect in treatment of post-palatoplasty VPI. Methods Thirteen children with VPI due to posterior palatal defect after CP repair were included in this study. PF was used in treatment of all patients, the lower end of the flap was fashioned in a V-shape to accustom the shape of the defect with peeling of its overlying mucosa to enhance wound healing. The PF was inserted deeply into a tunnel created within the defect between the oral and nasal layers of the palate. Pre- and postoperative evaluation using auditory perceptual assessment (APA), nasometric assessment and velopharyngoscopy were performed. Results Significant improvement of APA and nasalance score for both oral and nasal sentences was achieved. Also, velopharyngoscopy showed complete velopharyngeal closure in all patients postoperatively. Conclusion A modified PF is an effective treatment for VPI caused by posterior palatal defect that may be encountered after CP repair.

Introduction Open airway surgery is used to treat severe grades of laryngotracheal stenosis in children. Scarring of the airway following these procedures may lead to voice impairment and impact quality of life. This study was designed to characterize vocal outcome in children submitted reconstructive airway surgery and verify how this correlates to voice related quality of life in this population. Material and methods Children submitted to open airway surgery that had been decannulated for a minimum of 30 days and had functional speech were invited to participate. Pediatric Voice-Related Quality-of-Life survey (PVRQoL) was applied, consensus auditory perceptive of voice (CAPE-V) protocol was used for perceptual voice evaluation and acoustic analysis was performed using Praat software. Results Twenty children were enrolled in the study with an average age of 4 years and 8 months. Averages for PVRQoL exceeded normative values in 80% of the children. Half of the children had normal voice or mild dysphonia and half had moderate dysphonia, according to perceptual evaluation. Measures of F0, jitter and particularly shimmer were abnormal in most of the children. Conclusion Voice quality varies from normal to moderately impaired in children following reconstructive airway surgery. Voice quality impacts quality of life in the majority of cases and the degree of dysphonia does not always correlate with voice related quality of life scores.

Background Voice abnormalities often go unrecognized in patients with 22q11.2 deletion because speech abnormalities become the focus of evaluation. Objective To analyze voice and vocal fold abnormalities in patients with 22q11.2 deletion by examining voice, not speech. Methods This is a case series with chart review from 2009 to 2016. Records of both a velocardiofacial syndrome (VCF) clinic and pediatric otolaryngology clinic at a tertiary pediatric hospital were reviewed. All patients with confirmed 22q11.2 deletion were identified. Cardiac, otolaryngological, speech, and voice characteristics were recorded along with surgical history. Main outcomes included voice characteristics based on speech therapy assessment, along with vocal fold or laryngeal abnormalities. Co-morbidities and surgical history were also recorded. Results 109 patients were identified with 22q11.2 deletion by genetic testing. Eighteen percent (n = 20) displayed a vocal fold or laryngeal abnormality, either congenital or iatrogenic. The most common congenital abnormalities were laryngeal web (n = 10) and subglottic stenosis (n = 7). The most common iatrogenic abnormality was paralyzed left vocal fold (n = 4). Perceptual analysis by speech therapy showed 65% (n = 71) with a voice within normal limits while 17% (n = 19) were not within normal limits. Of the 20 patients with a vocal fold abnormality, 15% (n = 3) presented a voice within normal limits, while 65% (n = 13) were not within normal limits. Of the 19 patients with a voice outside normal limits, 68% (n = 13) had a diagnosed vocal fold abnormality. Sixteen percent (n = 3) of these patients had an abnormal voice as a result of other issues. Conclusion Out of 109 patients with 22q11.2 deletion, 18% displayed a laryngeal abnormality and 17% had abnormal vocal quality. This suggests that voice and vocal fold abnormalities are important to consider in this population. Distinguishing between speech and voice abnormalities in patients with 22q11.2 deletion can help ensure appropriate intervention.

Introduction Unilateral vocal fold paresis may significantly impair the vocal quality and laryngeal competence of a child. Relatively little literature relates to injection medialisation laryngoplasty (IML) in children and previous reports have involved small numbers of heterogenous cases. Methods A retrospective review was conducted of paediatric patients managed by our multidisciplinary specialist voice clinic undergoing IML for unilateral vocal fold paresis. Cases of bilateral paresis, those characterised by vocal fold fixation, and patients without formal pre and post-operative voice evaluation were excluded. Results Eighteen IML procedures were performed in 12 children eligible for inclusion between 2005 and 2015. The average age at time of procedure was 12 years (range 9–15 years). Autologous fat was used in 5 procedures, succeeded by calcium hydroxylapatite (Radiesse ® Voice) from 2011 (n = 13). A significant improvement in median GRBAS score components was observed after calcium hydroxylapatite injection in terms of grade (p = 0.008), breathiness (p = 0.002) and aesthenia (p = 0.016). A pre- and post-procedural Voice Handicap Index was self-completed by 6 patients receiving calcium hydroxylapatite injection; the median change in score was an improvement of 19 points (interquartile range 36.5). Conclusion We describe the outcomes of a comparatively large paediatric series and have found IML using calcium hydroxylapatite to be a reliable technique associated with improved subjective outcome measures. Management of UVCP in the child is a challenge with particular investigative and interventional considerations. Further study supported by high quality subjective and, where possible, objective outcome measures, is required to better inform patient selection, timing of intervention and choice of injection material.

Background Normative nasalance scores are essential for treatment and assessment purposes for clinicians. The purpose of the current study is to determine the normative data on nasalance scores for Farsi speaking children. Comparing to the obtained normative data, hypernasal or hyponasal speech (i.e. the higher or lower nasalance score) can be evaluated. Methods Ninety-six Farsi speakers ranging from 4 years to 11 years old with typically developing speech were included in this study. Mean nasalance scores were obtained using the Universal Parameters System sentences with nasometer II (model 6450). The nasalance data was also analyzed for any gender, age and phonetic context dependence. Results Normative nasalance values were determined, Nno differences were found for gender and age for the school-aged children. With an increasing in age, the nasalance score also increased in oral passages but not in nasal passages. Furthermore, amongst the nasalance scores there was a significant difference between these four categories of sentences: 7 sentences loaded with oral stop consonants, 5 sentences loaded with oral fricative consonants, 2 sentences loaded with oral affricatives and 3 sentences loaded with nasal consonants. Conclusions The absence of age and gender differences led to a computation of an overall mean nasalance score for different types of phonetic context (Nasal, oral and oronasal). These normative nasalance data for Farsi speaking children will provide important reference information during speech assessments of children with velopharyngeal insufficiency.

Background Cleft lip and palate (CLP) is the most common craniofacial anomaly. CLP affects resonance, voice and speech. Besides the most frequently reported resonance and speech disorders, several reports have addressed acoustic abnormalities in the voice of patients with CLP. However, there are just a few reports focusing on vocal treatment in this population. Objective To study whether a Speech and Language Pathology (SLP) intervention including vocal rehabilitation for children with CLP and velopharyngeal insufficiency (VPI) provides significant improvement of abnormal acoustic parameters of voice. Material and methods Fifteen children with cleft lip and palate (CLP) and velopharyngeal insufficiency (VPI) were studied. Age ranged 4–5 years. A matched control group of children without craniofacial anomalies and adequate speech, resonance and voice was assembled. All children underwent acoustic analysis of voice at the onset and at the end of SLP intervention including vocal rehabilitation. Results Hypernasality persisted unchanged following SLP intervention. Mean Fundamental Frequency (F0) did not demonstrate a significant difference between the control and the active groups. At the onset of the intervention mean shimmer and jitter were significantly higher in all patients with CLP as compared to controls. At the end of the intervention shimmer and jitter significantly decreased in patients with CLP showing no differences as compared to controls. Conclusion SLP intervention including vocal rehabilitation improves abnormal acoustic parameters of voice. Besides surgical treatment for VPI the SLP intervention in children with CLP should also address vocal rehabilitation.

Purpose Vocal fold nodules are usually caused by voice overuse or vocal hyperfunction, and their symptoms include persistent hoarseness – a disturbance in the vocal fold vibrations which results in a turbulent passage of air in the glottis, manifested as a raspy, rough voice. The aim of the study was to present data concerning voice quality in patients with vocal nodules and to compare electroglottographic analysis (EGG) with acoustic analysis. Methods The study examined 57 children with vocal fold nodules (Group 1). Each patient underwent a phoniatric evaluation of the vocal tract, a videolaryngoscopic examination, and a voice quality assessment, employing electroglottographic and acoustic analyses. The control group consisted of 37 healthy children (Group 2). The following parameters were analyzed: Closed Quotient (EGG signal), Peak Slope, Normalized Amplitude Quotient and Cepstral Peak Prominence (acoustic signal - waveform). Results Changes in the EGG signal could be detected in 95% of the patients with vocal nodules, indicating the occurrence of vocal nodules and glottal insufficiency. The acoustic analysis confirmed breathy phonation in 63% of the patients. The Closed Quotient parameter proved to be more effective than Peak Slope. Closed Quotient, Peak Slope and Normalized Amplitude Quotient allowed for the differentiation of the EGG signal and the acoustic signal in groups 1 and 2 in a statistically significant way. Conclusions The results of electroglottographic and acoustic analysis show incorrect voice parameters in patients with vocal nodules with reference to the control group. At the same time, the EGG analysis proved to be more effective than the analysis of the acoustic signal.

to assess the diagnostic value of Lithuanian version of Glottal Function Index (GFI-LT) questionnaire in pediatric dysphonia screening.The GFI-LT was completed by 82 children (7-16 years old): 41 patients with voice disorders (patients group) and 41 healthy subjects (control group). Auditory-perceptual evaluation of voice was performed using the Grade Roughness Breathiness (GRB) protocol. Acoustic voice analysis was accomplished for F0, SDF0, jitter, shimmer and NNE using Dr. Speech, Tiger Elemetrics software. To evaluate the diagnostic accuracy differentiating normal and dysphonic voice, the receiver operating characteristic statistics were used.Perceptually dysphonia was revealed in all children of the patients group. Grade I (65.9%) was the most prevalent (p 0.05). No dysphonia was detected in the control group. Acoustic voice analysis revealed statistically significantly (p 0.001) deteriorated all acoustic voice parameters in patients' group comparing to control group. Statistically significant (p 0.05) strong or moderate correlations were found between the GFI-LT, auditory-perceptual rating and all acoustic voice parameters of the patients group. The strongest correlations were observed between GFI-LT and G (r = 0.70), R (r = 0.69), jitter (r = 0.56) and SDF0 (r = 0.56). No statistically significant correlations between GFI-LT and children' age or gender were found (p 0.05). The GFI-LT cut-off score of ≥3.0 was associated with excellent test accuracy (AUC = 0.961) distinguishing children with voice disorders from healthy controls, resulting in a balance between sensitivity and specificity (95.1% vs 85.4%).GFI-LT is considered to be a valid and reliable tool for self-assessment and screening of voice disorders in children.

Background A reliable acoustic analysis necessitates the availability of standard normative values at different ages. Normative values of vocal acoustic parameters are readily available for the adult population but not much data are available for the pediatric population. Objectives Providing a database for the normative vocal acoustic parameters in preschool and elementary school Egyptian children to lay out an objective model for the diagnosis and optimal treatment of childhood voice disorders. Methods A total of 237 Egyptian children between the ages of 4 and 9 years from both genders were enrolled in the study. A Computer-assisted acoustic vocal analysis was done for all children. Results Fundamental frequency values differed significantly according to gender with higher measures in girls. Mean values of the fundamental frequency were 258.57 Hz ± 39.69, jitter percentage 0.85% ± 0.67, shimmer percentage 1.59% ± 1.03, fundamental tremors 1.64HZ ± 0.421, maximum phonation time 4.81sec. ± 1.73 and harmonic/noise ratio were 15.34 dB ± 10.65. A decline of measures of the fundamental frequency and jitter percentage with increasing age and an increase of values of harmonic/noise ratio and shimmer percentage in children residing in rural areas are observed. Conclusion This study provides an insight into the normative values of vocal acoustic parameters in preschool and elementary school Egyptian children. Comparable to other studies, both fundamental frequency and jitter percentage values show a decline with increasing age. Also, fundamental frequency values differ significantly among genders. The difference in socioeconomic environment seems to influence some of the vocal acoustic parameters in children.

This is a case of a 4 year old female with recalcitrant recurrent respiratory papillomatosis with decreasing intersurgical interval that had improvement in clinical course after administration of the quadrivalent HPV vaccine.

A child's voice is used both as a tool for communication and as a form of emotional expression. Thus, voice disorders suffered by children have negative effects on their quality of life, which can be assessed using the "Pediatric Voice Handicap Index" (P-VHI). This questionnaire is completed by the parents of dysphonic patients and it has been validated in different languages: Italian, Korean, Arabic, and Spanish. More recently, the "Children Voice Handicap Index-10" test (C-VHI-10) was developed and validated, an Italian version reduced into 10 items that is answered by children themselves. The objective of this study was to develop and validate a short Spanish version of the P-VHI (P-VHI-10) and to assess whether it is comparable to the Italian C-VHI-10.We conducted a cross-sectional study on 27 patients between 6-15 years of age. We developed an abbreviated version of the P-VHI that consisted of 10 statements to be answered by parents of children with dysphonia (P-VHI-10). These statements were based on the 10 items with the highest score in the validated Spanish version of the P-VHI. In addition, the validated Italian version of C-VHI-10 was translated into Spanish and this translation was reviewed and modified by three specialists, resulting in an adapted version to be answered by parents (C*-VHI-10). The parents and children included in the study of this index were the same patients as those included in the study to validate the Spanish P-VHI.There were no significant differences in the results obtained with the extended version of the P-VHI (17.4) and with the P-VHI-10 (18.7: Pearson coefficient = 0.602, p 0.36). A paired student's t-test identified significant differences (p 0.0001) when comparing the P-VHI-10 and C*-VHI-10, both of which were answered by parents, with average scores of 18.7 and 9.48, respectively. Both these reduced versions have good internal consistency, with a satisfactory Cronbach's alpha coefficient (α = 0.75 to P-VHI-10 and α = 0.73 in C*-VHI-10). No statistically significant differences were found when the average total score between the C-VHI-10 and C*-VHI-10 were compared, with a Pearson's correlation coefficient of 0.559 (p 0.9).The short version of the P-VHI10 questionnaire is a clinically valid tool that has good internal consistency.

Purpose To examine perceptually the realization of unaspirated affricates and voice onset time (VOT) features of /t/ in Mandarin-speaking children with repaired cleft palate, and to explore the difficulties associated with unaspirated affricate production from the perspective of the VOT of /t/. Method Twenty-three children with repaired cleft palate and 22 age-matched typical native Mandarin speakers were recruited. Speakers with cleft palate were allocated into two groups based on expert perceptual judgment of nasality: one group with perceived normal resonance (PNR) (n = 14, average age = 9.3 years), and another group with perceived hypernasal resonance (PHR) (n = 9, average age = 10.3 years). Intervention Stimuli were collected through a series of picture naming tasks, targeting the production of initial consonants /t/ and three unaspirated Mandarin affricates /ts, tʂ, tɕ/. The productions of each affricate were evaluated by two experienced speech therapists. The VOT of /t/ was measured using PRAAT speech analysis software. Result The majority of unaspirated affricates were omitted and/or weakly realized by the group of PHR speakers, but not for the PNR group. A significantly smaller mean VOT value associated with /t/ was identified for the PHR group, as compared to the PNR group. A group difference for VOT value was not found between the PNR group and the typical control group. Conclusion The voicing features of /t/ and omitted/weak realization of unaspirated affricates identified in the PHR group indicated that the deviant production of unaspirated affricates in the cleft palate group could be associated with the voicing characteristics of the alveolar stop /t/, and this merits further investigation.

Nasometry is a method of measuring the acoustic correlates of resonance through a computer-based instrument called nasometer. High nasalance scores in comparison to normative data suggest hypernasality and/or other nasality disorders, while low scores suggest hyponasality. Normative values of nasalance for Egyptian Arabic speakers were established using the Arabic SNAP (Simplified Nasometric Assessment Procedures) test. Objectives to evaluate the diagnostic accuracy of Arabic SNAP test to allow for its use in the differentiation between normal and hypernasal speech in Egyptian Arabic-speaking children. Methods Nasalance scores of normal children (n = 92) on Arabic SNAP test were compared to those of 30 children with velopharyngeal insufficiency due to cleft palate. Receiver operating characteristic (ROC) curve was used to determine cutoff points with the highest sensitivity and specificity. Results Statistically significant differences were found between both groups for all items in nasometric evaluation (p 0.05). Cutoff points were determined and certain items were selected for routine nasometric evaluation. Conclusion The Arabic SNAP test is a sensitive and specific tool for evaluation of children with hypernasality and can be used for both diagnosis and follow up of these cases.

This study aims to examine the effect of voice therapy on dysphonia on children with benign vocal fold lesions, as measured by perceptual evaluation using the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and acoustic and aerodynamic measures (jitter, shimmer, noise-to-harmonic ratio, phonation threshold pressure, mean airflow during voicing, subglottic pressure during comfortable phonation).Prospective disease-specific outcomes database.Subjects identified in the database consisted of 28 children (14 male, 14 female) between the ages of three and eighteen. Pre- and post-therapy perceptual, acoustic and aerodynamic measures were compared using two-sided paired t-test.There was a statistically significant difference in perceptual ratings of voice quality (p .001) and in phonation threshold pressure before and after therapy (p = .034). While acoustic measures improved after therapy, changes were not statistically significant.Children with dysphonia secondary to benign vocal fold lesions showed positive change in perceptual ratings of voice quality and in phonation threshold pressure after voice therapy.

Objectives To explore the immediate effects of voice focus adjustments on the oral-nasal balance of hypernasal speakers, measured with nasalance scores. Methods Five hypernasal speakers (2 M, 3 F) aged 5–12 (SD 2.7) learned to speak with extreme forward and backward voice focus. Speakers repeated oral, nasal, and phonetically balanced stimuli. Nasalance scores were collected with the Nasometer 6450. Results From the average baseline of 34.27% for the oral stimulus, nasalance increased to 46.07% in forward and decreased to 30.2% in backward focus. From the average baseline of 64.53% for the nasal stimulus, nasalance decreased to 64.13% in forward and decreased to 51.73% in backward focus. From the average baseline of 51.33% for the phonetically balanced stimulus, nasalance increased to 58.87% in forward and decreased to 46.2% in backward focus. Conclusions Forward voice focus resulted in higher and backward voice focus resulted in lower nasalance scores during speech for a group of hypernasal speakers. However, there was an exception: One male speaker showed decreased nasalance in forward voice focus. Future research should investigate the longer-term effectiveness of the intervention.

Objectives Describe acoustic and laryngeal findings in pediatric patients with subjective dysphonia attributed to laryngopharyngeal reflux (LPR). Determine the impact of LPR on perceived voice quality using the pediatric Voice Handicap Index (pVHI). Compare these findings with age-matched normative values as well as data on pediatric patients with dysphonia due to other etiologies. Methods Retrospective case series of pediatric patients (age 2–17 years) evaluated at a specialty pediatric voice clinic at a tertiary care children's hospital from January 1 2007 to December 31 2017 in whom LPR in whom LPR was deemed to be the most significant contributing factor for dysphonia based on physical examination and history. Patients with structural laryngeal abnormalities unrelated to LPR, such as raised lesions, stenosis, papillomatosis, or vocal fold immobility were excluded. Results 163 out of 1195 evaluable patients met inclusion criteria. Of these, 87% had pVHI and 83% had acoustic data available from their first appointment for analysis. Mean total pVHI score was 24 (range: 0–81). Perturbation measures were elevated in both females (jitter 1.38%, shimmer 4.16%) and males (jitter 2.01%, shimmer 5.62%). Laryngologic assessment revealed: vocal fold changes including erythema and/or pre-nodules in 72% of patients. Cobblestoning of any portion of the pharynx was present in 67% with hypopharyngeal cobblestoning the most common, present in 64% of patients. Conclusion Pediatric patients with clinically diagnosed LPR have pVHI, jitter, and shimmer scores that are comparable to previously reported patients with raised lesions, scar and immobility, and values that are significantly higher than published normative data. Dysphonic children should be assessed for LPR and treated when indicated. Level of evidence 4.

Background Current pediatric voice assessment guidelines include instrumental measurements of fundamental frequency (F0) and the perturbation indices jitter and shimmer. In children below 10 years, gender, age, height and weight effects on these parameters have been inconsistently characterized. Recent research in healthy children showed, that differences in habitual speaking voice intensity (voice SPL) under the usual assessment procedure significantly affect jitter and shimmer. These effects were reduced in phonations with controlled voice SPL >80 dBA. Reliable measurement methods and description of physiologic influencing factors are essential to identify pathologic voices. Objective This cross-sectional single cohort study investigates in children between 5;0 and 9;11 years how gender, age, height and weight affect voice F0, jitter and shimmer in phonations at individually “medium” voice intensity (modeling the usual clinical practice) and with controlled voice SPL >80 dBA. Subjects and methods 68 vocally healthy children (39 f/29 m) aged 5;0–9;11 years provided 3 prolonged phonations of/a/at individually “medium” and controlled voice intensity at “>80 dBA” (visual feedback, 10 cm distance). F0 (Hz), jitter (%), shimmer (%) and voice SPL (dBA) were determined with PRAAT. Gender, age, height and weight effects without and with controlled voice SPL were assessed by descriptive statistics, Analysis of Variance and Linear Mixed Models. Results F0 (Hz), jitter (%), shimmer (%) and voice SPL (dBA) were significantly different in medium voice compared to >80 dBA (p 80 dBA this difference was only minimal (girls: 328.9(52.2), boys 327.9(51.2)). Mean jitter (0.27(0.10)) and shimmer (4.34(1.68)) were smaller and showed less spread (jitter: 0.5(0.26); shimmer: 9.47(3.47)) with >80 dBA. Gender, age, height and weight had no significant effects on F0, jitter, shimmer and voice SPL in both phonation types (p-range = 0.42–0.99). Conclusions Neither without nor with controlled voice SPL there were systematic gender, age, height or weight effects on voice F0, jitter and shimmer. Gender related F0 discrepancies were equalized in phonations with >80 dBA. In children below 10 years gender related acoustic voice differences may be mainly linked to behavior, which should be considered in future works regarding physiologic voice development.

Objective Velopharyngeal insufficiency (VPI) is a common complication after cleft palate repair, it may be due to lack of levator sling reconstruction and/or palatal shortening. Furlow palatoplasty has the advantages of retro-positioning of levator palati muscles and palatal lengthening. The aim of this study was to assess the efficacy of Furlow palatoplasty in the treatment of VPI in patients who undergone previous palatoplasty. Methods Twenty-three children with post-palatoplasty VPI were included in the study. Furlow technique which was not used in the primary repair, has been used as a secondary corrective surgery. Preoperative and postoperative evaluation of velopharyngeal function was performed, using auditory perceptual assessment (APA) and nasometry for speech, and flexible nasopharyngoscopy for velopharyngeal closure. Results Significant improvement of APA and nasalance score for oral and nasal sentences was achieved. Flexible nasopharyngoscopy showed complete velopharyngeal closure in 19 patients (82%) postoperatively. Conclusion Furlow palatoplasty is considered a useful treatment option for VPI in patients with previously repaired cleft palate, it improves the speech and velopharyngeal closure.

Even with early surgical repair, the majority of cleft palate children demonstrate articulation errors and have typical cleft palate speech. Objective Was to determine the nature of articulation errors of Arabic consonants in Egyptian Arabic-speaking children with velopharyngeal insufficiency (VPI). Subjects and methods Thirty Egyptian Arabic-speaking children with VPI due to cleft palate (whether primary repaired or secondary repaired) were studied. Auditory perceptual assessment (APA) of children speech was conducted. Nasopharyngoscopy was done to assess the velopharyngeal port (VPP) movements while the child was repeating speech tasks. Mansoura Arabic Articulation test (MAAT) was performed to analyze the consonants articulation of these children. Results and conclusion The most frequent type of articulatory errors observed was substitution, more specifically, backing. Pharyngealization of anterior fricatives was the most frequent substitution, especially for the /s/ sound. The most frequent substituting sounds for other sounds were /ʔ/ followed by /k/ and /n/ sounds. Significant correlations were found between the degrees of the open nasality and VPP closure and the articulation errors. On the other hand, the sounds (/ʔ/,/ħ/,/ʕ/,/n/,/w/,/j/) were normally articulated in all studied group. The determination of articulation errors in VPI children could guide the therapists for designing appropriate speech therapy programs for these cases.

Objectives The purpose of this study was to collect nasalance scores for normal Korean-speaking children and adults and to determine whether age, vowel contexts, and stimulus length influence nasalance scores. Methods Fifty-seven children aged 4–6 years and 17 adults participated in the study. Mean nasalance scores were obtained for eight sentences devoid of nasal consonants divided into the vowel/a/and/i/contexts; the sentences consisted of 4, 8, 16, and 31 syllables. All subjects were asked to repeat the speech stimuli twice after the examiner. The headset of the nasometer was replaced between the first and second recordings. An average value of the nasalance scores from the two recordings for each stimulus was calculated and used in the statistical analysis as a representative measure for each subject. Results Mean and standard deviations of nasalance scores were obtained for each speech stimulus and each age group. The statistical analysis indicated significant effects of age and vowel context and a significant interaction between age and the vowel context on nasalance scores. However, the effect of stimulus length on nasalance scores was not significant. All speakers had higher nasalance scores for the vowel/i/contexts than for the vowel/a/contexts. Adults had higher nasalance scores compared to children in both vowel contexts. Conclusions These normal nasalance values from Korean-speaking children aged 4–6 years will provide important reference information for resonance assessment of children with cleft palate who have been considered for secondary palatal surgery. The results of the study suggest that subjects’ age and the vowel content of speech stimuli should be carefully considered when interpreting the nasalance scores.

Background Acoustic analysis of voice can provide instrumental data concerning vocal abnormalities. These findings can be used for monitoring clinical course in cases of voice disorders. Cleft palate severely affects the structure of the vocal tract. Hence, voice quality can also be also affected. Objective To study whether the main acoustic parameters of voice, including fundamental frequency, shimmer and jitter are significantly different in patients with a repaired cleft palate, as compared with normal children without speech, language and voice disorders. Materials and methods Fourteen patients with repaired unilateral cleft lip and palate and persistent or residual velopharyngeal insufficiency (VPI) were studied. A control group was assembled with healthy volunteer subjects matched by age and gender. Hypernasality and nasal emission were perceptually assessed in patients with VPI. Size of the gap as assessed by videonasopharyngoscopy was classified in patients with VPI. Acoustic analysis of voice including Fundamental frequency (F0), shimmer and jitter were compared between patients with VPI and control subjects. Results F0 was significantly higher in male patients as compared with male controls. Shimmer was significantly higher in patients with VPI regardless of gender. Moreover, patients with moderate VPI showed a significantly higher shimmer perturbation, regardless of gender. Conclusion Although future research regarding voice disorders in patients with VPI is needed, at the present time it seems reasonable to include strategies for voice therapy in the speech and language pathology intervention plan for patients with VPI.

This case report describes a 5-year-old girl with chronic dysphonia and high-pitched voice since birth. Vocal quality was noted to be harsh. Videostroboscopy revealed significant hyperfunction and a Type II congenital anterior glottic web. Endoscopic division of the anterior glottic web was performed with significant improvement in vocal quality and quality of life. This paper describes methods of analyzing, diagnosing, and treating anterior glottic web with a focus on quality of life. Also, unique acoustic and aerodynamic voice features are identified. No other descriptions of a voice characteristic for anterior glottic web currently exist in the literature.

Although a history of cleft palate is the most common cause of velopharyngeal dysfunction (VPD), there are other disorders that can also cause hypernasality and/or nasal emission. These include other structural anomalies of the velopharyngeal valve (velopharyngeal insufficiency), neurophysiological disorders that result in inadequate velopharyngeal movement (velopharyngeal incompetence), and even faulty articulation placement in the pharynx (velopharyngeal mislearning). Unfortunately, individuals with non-cleft causes of hypernasality and/or nasal emission do not typically present at a cleft palate/craniofacial center where there are professionals who specialize in the evaluation and treatment of these disorders. As a result, they are often misdiagnosed and do not receive appropriate treatment. In this review, we present various conditions that can cause hypernasality and/or nasal emission during speech. We discuss appropriate treatment based on the underlying cause of the condition. It is important that pediatric otolaryngologists are able to recognize these disorders so that affected patients are referred to specialists in velopharyngeal dysfunction for treatment.

Objective The purpose of this study was to determine whether test–retest nasalance score variability differs between Korean children with and without cleft palate (CP) and vowel context influences variability in nasalance score. Participants Thirty-four 3-to-5-year-old children with and without CP participated in the study. Methods Three 8-syllable speech stimuli devoid of nasal consonants were used for data collection. Each stimulus was loaded with high, low, or mixed vowels, respectively. All participants were asked to repeat the speech stimuli twice after the examiner, and an immediate test–retest nasalance score was assessed with no headgear change. Results Children with CP exhibited significantly greater absolute difference in nasalance scores than children without CP. Variability in nasalance scores was significantly different for the vowel context, and the high vowel sentence showed a significantly larger difference in nasalance scores than the low vowel sentence. The cumulative frequencies indicated that, for children with CP in the high vowel sentence, only 8 of 17 (47%) repeated nasalance scores were within 5 points. Conclusions Test–retest nasalance score variability was greater for children with CP than children without CP, and there was greater variability for the high vowel sentence(s) for both groups.

voice disorders are common in the pediatric population and can negatively affect children's quality of life. The pediatric voice handicap Index (pVHI) is a valid instrument to assess parental perception of their children voice but it is not translated into French language. The aim of the present study was to adapt a French version of the pVHI and to evaluate its psychometric properties including construct validity, reliability, and some aspects of external validity.we performed a cross sectional study including 32 dysphonic children and 60 children with no history of voice problems between 3 and 12 years of age. The original pVHI was translated into French language according to forward-backward rules and then administered to parents or caregivers. Construct validity and internal consistency were explored using confirmatory factor analysis and Cronbach's alpha. The questionnaire was filled twice to assess test-retest reliability using the intra-class correlation coefficient. The external validity was explored by comparing the French pVHI total and subscales scores between dysphonic and asymptomatic children. Correlations between the French pVHI and both the perceptual GRBAS scale and the health-related quality of life (HRQOL) survey "Vécu et Santé Perçu de l'Adolescent et de l'Enfant" (VSP-Ap) were also performed.the structure of the French pVHI showed a good fit with excellent reliability (α = 0.929) and high test-retest reliability. Significant differences were found between the group of dysphonic children and the control group (p 0.001). The French pVHI scores were positively correlated to all parameters of the GRBAS scale (p 0.05). Significant negative correlations were found between the Functional domain of the pVHI and various domains of the VSP-Ap as Leisure Activities, Schooling and Sentimental Relationship (p 0.05).the French pVHI is considered to be a valid and reliable instrument to assess voice-related quality of life in children with voice disorder. We recommend its use in the multidimensional protocols for assessing voice disorder in the pediatric population.

Objectives Published reports and previous studies from our institution have reported worse overall speech results, including significantly higher rates of persistent articulation errors, in patients undergoing palatoplasty at age >18 months. This study further investigates the effects of late repair on long term speech outcomes. Methods A retrospective review was performed of non-syndromic patients undergoing primary palatoplasty at age >18 months between 1980 and 2006 at our institution. Longitudinal speech results were compared based on reason for late repair and age at repair. Results Forty-one patients were greater than 18 months of age at the time of palatoplasty, and 24 fit criteria for longitudinal data analysis. There was a statistically significant improvement in nasality scores at Time Point 1 for international adoptees compared to the non-adopted population (p = 0.04). Patients with submucosal clefts were found to have significantly less severe nasal emission scores at Time Point 1 compared to those with overt clefts (p = 0.04), but not at Time Point 2. There were no significant differences between scores if repair was performed between 18 and 36 months or >36 months, nor any difference in incidence of articulation errors between subgroups of patients with late repair at either Time Point. Conclusion Our experience demonstrates that cleft palate repair after 18 months of age is associated with a significantly increased incidence of articulation errors associated with VPI, irrespective of reason for late repair, highlighting the persistence of learned compensatory behaviors in speech and the importance of proceeding with early repair.

To determine incidence of dysphonia in patients with history of prematurity and evaluate the correlation between dysphonia and risk factors unique to premature infants. The aim of this study is to determine parent-perceived vocal quality in patients with history of prematurity and whether duration of intubation, number of intubations, and incidence of patent ductus arteriosus repair were correlated with these perceptions.Cohort study of premature patients presenting to outpatient clinics from January 2010 to January 2013 in tertiary care center. Patients gestational age ≤37 weeks at birth without history of tracheostomy or known vocal fold pathology were eligible. A volunteer sample was obtained from patients presenting in Otolaryngology clinics from January 2010 to January 2013 whose parents agreed to complete surveys. Outcomes were assessed via parental completion of pediatric voice outcomes score (pVOS) and pediatric voice-related quality of life (pVRQOL) instruments. The primary outcome assessed was the incidence of dysphonia in infants with a history of prematurity without known vocal pathology. Additionally, patient factors associated with dysphonia were evaluated. The hypothesis tested was formulated prior to data collection.Sixty-nine participants were included. Mean age at follow-up was 28 (3-197) months. Mean gestational age was 29 (23-37) weeks. Mean intubation duration was 3 (0-22) weeks and median number of intubations was 1 (range 0-5). Voice outcome scores varied widely with pVRQOL scores demonstrating a mean of 89.2±18.1 (25-100) and pVOS with a mean of 11.4±2.2 (0-13). Univariate analysis utilized Spearman correlation coefficients for continuous variables and Wilcoxon Two-sample test for categorical groups. Significance was set at p0.05. All significant univariate associations were placed in a multivariate model. Duration of intubation ≥4 weeks was the only factor which correlated with dysphonia on multivariate analysis (p=0.0028, OR=6.4, 95% CI=1.9-21.6).The data suggest that prolonged intubation is associated with poorer long term parent-perceived voice quality in premature patients. Further study is required to correlate parent perceptions with objective vocal quality data and physical findings of vocal pathology. These data may increase the clinician's suspicion for and evaluation of dysphonia in this population.

Objectives Velopharyngeal insufficiency (VPI) may be due to functional or anatomic causes, and can lead to speech deficits, communication difficulty, and emotional strain on patients and their caregivers. The VPI Effects on Life Outcomes (VELO) instrument quantifies quality of life outcomes in VPI patients both before and after VPI surgery. This study aims to identify pre-operative patient characteristics associated with better post-operative quality of life. Methods This study is a retrospective chart review of 51 patients who underwent VPI surgery between 2009 and 2018 at a tertiary free-standing children's hospital. A 26-item parent-proxy VELO questionnaire was administered by telephone to parents to assess their child's quality of life post-VPI surgery. Results Twenty-seven parents responded to the VELO questionnaire. Average post-operative VELO score was significantly higher in non-syndromic patients as compared with syndromic patients. Average post-operative VELO score was not significantly different between patients with and without submucous cleft (SMC) or those with mild to moderate versus severe pre-operative hypernasality. On multivariate analysis, absence of genetic syndrome, lack of submucous cleft, and presence of severe-pre-operative hypernasality were significantly and positively associated with increased post-operative VELO scores. Conclusion Children who undergo VPI surgery are more likely to have better post-operative quality of life outcomes if their VPI was not associated with a genetic syndrome or submucous cleft. Non-syndromic and non-SMC patients with severe pre-operative hypernasality may benefit significantly from VPI surgery and have improved post-operative quality of life.