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Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options.
Laryngoscope. 2015 Dec; 125 Suppl 11:S1-15.L

Abstract

OBJECTIVES/HYPOTHESIS

To establish the benefit of ansa cervicalis-recurrent laryngeal nerve reinnervation (ANSA-RLN) for the management of dysphonia secondary to unilateral vocal cord paralysis (UVCP) in children. Children treated with ANSA-RLN for the management of dysphonia secondary to unilateral vocal fold immobility will have superior acoustic, perceptual, and stroboscopic outcomes compared to injection laryngoplasty and observation.

STUDY DESIGN

Retrospective case-series chart review.

METHODS

Laryngeal, perceptual, and acoustic analysis of dysphonia was performed in 33 children (age 2-16 years) diagnosed with UVCP. Comparison of pre-post function for treatment groups (no treatment, injection laryngoplasty, ANSA-RLN) with additional comparison between gestational ages, age at initial evaluation, and gender were examined. Perceptual measures included Pediatric Voice Handicap Index (pVHI) and Grade, Roughness, Breathiness, Asthenia, Strain (GBRAS) perceptual rating. Objective measures included semitone (ST) range, jitter%, shimmer%, noise-to-harmonic ratio, voicing, and maximum phonation time.

RESULTS

Post-treatment, pVHI, jitter%, and ST were significantly improved for ANSA-RLN subjects compared to injection subjects. Improved function (laryngeal diadochokinesis, pVHI, GRBAS, and/or acoustic) was observed in all ANSA-RLN subjects who had vocal fold paralysis as the only laryngeal diagnosis.

CONCLUSIONS

This study presents one of the largest studies of pediatric vocal fold paralysis diagnosis and treatment. The study looks at the spectrum of function in patients with UVCP and looks at the outcomes of options: no treatment, injection laryngoplasty, and ANSA-RLN. Although surgical outcomes vary, both injection laryngoplasty and ANSA-RLN show benefit in laryngeal function, voice stability, voice capacity, perceptual rating, and pVHI scores. Both injection laryngoplasty and ANSA-RLN showed improvements post-treatment, and should be considered for management of pediatric UVCP. However, the ANSA-RLN group showed better and longer-lasting perceptual and acoustic parameters in comparison with the injection and control groups. Reinnervation, even long term after the onset of vocal fold paralysis, should be considered a viable permanent treatment for pediatric UVCP.

Authors+Show Affiliations

Department of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A. Department of Otolaryngology-Head & Neck Surgery, Perelman School of Medicine of The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.Department of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26257068

Citation

Zur, Karen B., and Linda M. Carroll. "Recurrent Laryngeal Nerve Reinnervation in Children: Acoustic and Endoscopic Characteristics Pre-intervention and Post-intervention. a Comparison of Treatment Options." The Laryngoscope, vol. 125 Suppl 11, 2015, pp. S1-15.
Zur KB, Carroll LM. Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options. Laryngoscope. 2015;125 Suppl 11:S1-15.
Zur, K. B., & Carroll, L. M. (2015). Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options. The Laryngoscope, 125 Suppl 11, S1-15. https://doi.org/10.1002/lary.25538
Zur KB, Carroll LM. Recurrent Laryngeal Nerve Reinnervation in Children: Acoustic and Endoscopic Characteristics Pre-intervention and Post-intervention. a Comparison of Treatment Options. Laryngoscope. 2015;125 Suppl 11:S1-15. PubMed PMID: 26257068.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options. AU - Zur,Karen B, AU - Carroll,Linda M, Y1 - 2015/08/08/ PY - 2015/06/25/revised PY - 2015/06/30/accepted PY - 2015/8/11/entrez PY - 2015/8/11/pubmed PY - 2016/5/14/medline KW - Vocal cord paralysis KW - injection laryngoplasty KW - pediatric KW - reinnervation KW - voice handicap SP - S1 EP - 15 JF - The Laryngoscope JO - Laryngoscope VL - 125 Suppl 11 N2 - OBJECTIVES/HYPOTHESIS: To establish the benefit of ansa cervicalis-recurrent laryngeal nerve reinnervation (ANSA-RLN) for the management of dysphonia secondary to unilateral vocal cord paralysis (UVCP) in children. Children treated with ANSA-RLN for the management of dysphonia secondary to unilateral vocal fold immobility will have superior acoustic, perceptual, and stroboscopic outcomes compared to injection laryngoplasty and observation. STUDY DESIGN: Retrospective case-series chart review. METHODS: Laryngeal, perceptual, and acoustic analysis of dysphonia was performed in 33 children (age 2-16 years) diagnosed with UVCP. Comparison of pre-post function for treatment groups (no treatment, injection laryngoplasty, ANSA-RLN) with additional comparison between gestational ages, age at initial evaluation, and gender were examined. Perceptual measures included Pediatric Voice Handicap Index (pVHI) and Grade, Roughness, Breathiness, Asthenia, Strain (GBRAS) perceptual rating. Objective measures included semitone (ST) range, jitter%, shimmer%, noise-to-harmonic ratio, voicing, and maximum phonation time. RESULTS: Post-treatment, pVHI, jitter%, and ST were significantly improved for ANSA-RLN subjects compared to injection subjects. Improved function (laryngeal diadochokinesis, pVHI, GRBAS, and/or acoustic) was observed in all ANSA-RLN subjects who had vocal fold paralysis as the only laryngeal diagnosis. CONCLUSIONS: This study presents one of the largest studies of pediatric vocal fold paralysis diagnosis and treatment. The study looks at the spectrum of function in patients with UVCP and looks at the outcomes of options: no treatment, injection laryngoplasty, and ANSA-RLN. Although surgical outcomes vary, both injection laryngoplasty and ANSA-RLN show benefit in laryngeal function, voice stability, voice capacity, perceptual rating, and pVHI scores. Both injection laryngoplasty and ANSA-RLN showed improvements post-treatment, and should be considered for management of pediatric UVCP. However, the ANSA-RLN group showed better and longer-lasting perceptual and acoustic parameters in comparison with the injection and control groups. Reinnervation, even long term after the onset of vocal fold paralysis, should be considered a viable permanent treatment for pediatric UVCP. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/26257068/Recurrent_laryngeal_nerve_reinnervation_in_children:_Acoustic_and_endoscopic_characteristics_pre_intervention_and_post_intervention__A_comparison_of_treatment_options_ L2 - https://doi.org/10.1002/lary.25538 DB - PRIME DP - Unbound Medicine ER -