What is the diagnostic value of laryngeal videostroboscopy in pediatric patients with dysphonia?
Background: Laryngeal videostroboscopy has been proven to be a valuable tool in the evaluation of adult voice disorders. It allows for detailed assessment of glottal closure, mucosal pliability and subtle vocal fold lesions. Pediatric dysphonia is found in six percent to nine percent of children. Stroboscopy is presently used infrequently to evaluate pediatric dysphonia.
Study Design: Retrospective case series review
Setting: A single academic health center
Synopsis: Patients with prolonged dysphonia between the ages of three and 17 were included in the study. All patients were referred following failed speech therapy, with diagnoses of vocal nodules or unresolved dysphonia. Clinicians performed rigid transoral or flexible transnasal stroboscopy in all patients. In general, older children tolerated rigid stroboscopy better than younger children, but children as young as eight tolerated rigid exams. Researchers identified benign mucosal disease of the vocal fold in 89 percent of patients. Only 51 percent of patients had vocal nodules, however. Polyps were found in 19 percent, and cysts were found in 10 percent. Sulcus vocalis was found in five percent. Coexistent inflammatory disease was diagnosed in 51 percent and was attributed to reflux laryngitis, non-specific laryngitis and rhinosinusitis. Voice therapy was the most common intervention, but endoscopic laryngeal microsurgery was performed in 20 percent of patients. This study demonstrates that laryngeal videostroboscopy can be routinely performed in children. The use of stroboscopy in this study changed the diagnosis in a substantial number of children with dysphonia. Despite being referred with a diagnosis of nodules, researchers identified other vocal fold lesions in almost 35 percent of patients.
Bottom Line: Laryngeal videostroboscopy provides important diagnostic information in pediatric patients with dysphonia, differentiating nodules from polyps, cysts and other pathology.
Citation: Mortensen M, Schaberg M, Woo P. Diagnostic contributions of videolaryngostroboscopy in the pediatric population. Arch Otolaryngol Head Neck Surg. 2010;136(1):75-79.
—Reviewed by Michael M. Johns, MD