0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Assessment of Vibratory Characteristics in Children Following Airway Reconstruction Using Flexible and Rigid Endoscopy and Stroboscopy

Stephanie R. C. Zacharias, PhD1,2,3; Barbara Weinrich, PhD2,4,5; Susan Baker Brehm2,4,5; Lisa Kelchner, PhD2,3,4; Dimitar Deliyski, PhD1,3,6,7; Meredith Tabangin, MPH8; Alessandro de Alarcon, MD, MPH1,4,6,7,9
[+] Author Affiliations
1Communications Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
2Division of Speech-Language Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
3Department of Communication Sciences and Disorders, University of Cincinnati, Ohio
4Center for Pediatric Voice Disorders, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
5Miami University, Department of Speech Pathology and Audiology, Oxford, Ohio
6Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati, Ohio
7Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
8Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
9Aerodigestive and Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
JAMA Otolaryngol Head Neck Surg. 2015;141(10):882-887. doi:10.1001/jamaoto.2015.1740.
Text Size: A A A
Published online

Importance  Up to half of children have substantial dysphonia after airway reconstruction. Visual assessment of vocal function is valuable. Feasibility of flexible and rigid endoscopy has been reported; however, the clinical utility of stroboscopy has not been examined. Rating of vibratory characteristics, such as mucosal wave and amplitude of vibration, is essential for the development of interventions to improve voice outcomes.

Objective  To examine (1) clinicians’ ratings of anatomical and physiological features in children following airway reconstruction on initial voice evaluation using videolaryngostroboscopy and (2) the relationship of age to the type of endoscopy used.

Design, Setting, and Participants  Retrospective medical record review of 32 patients aged 3 to 21 years evaluated for post–airway reconstruction dysphonia between July 2011 and July 2012 at a quaternary care children’s hospital.

Interventions  Clinical voice evaluation protocol including rigid and/or flexible endoscopy with stroboscopy.

Main Outcomes and Measures  Demographic and voice quality characteristics were collected. The ability to complete endoscopy and ratings of anatomical and/or physiological features were assessed by a consensus of 4 clinicians. A t test was used to determine whether age was a significant factor in successful completion of videolaryngostroboscopy.

Results  Of 31 children who underwent flexible videolaryngostroboscopy, 22 (71%) examinations were completed with a distal chip endoscope and 9 (29%) with a fiberoptic. Significant differences were found in age between children who completed the distal chip vs fiberoptic examination (mean [SD], 7.3 [2.7] vs 5.5 [6.2] years; P = .05). Rigid endoscopy was attempted for 14 (44%) of 32 patients; 9 examinations (64%) were successful. Significant differences were found in age between patients for whom a rigid endoscopy could be successfully completed vs those for whom it was not (mean [SD], 12.9 [3.4] vs 6.2 [2.1] years; P < .001). Eighteen (56%) were glottic phonators, 8 (25%) supraglottic, and 6 (19%) aphonic. Vibratory characteristics were visible in 10 of 37 examinations (27%); 6 (16%) had ratable characteristics.

Conclusions and Relevance  Endoscopy can be successfully completed in most children who have undergone airway reconstruction, most often using a distal chip endoscope. We found that vibratory characteristics were often not assessed adequately using videolaryngostroboscopy. Further work identifying imaging modalities that better display vibratory characteristics, such as high-speed videoendoscopy, may provide new insight into vocal function and lead to a more thorough evaluation.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Visible Vibratory Tissue Characteristics by Scope Type
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Discrete Ratings of Vibratory Tissue Characteristics by Scope Type
Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

179 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Can the Clinical History Distinguish Between Organic and Functional Dyspepsia?

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Can the Clinical History Distinguish Between Organic and Functional Dyspepsia?

brightcove.createExperiences();