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Surgical and therapeutic advances in the management of voice problems in children and young people

Cavalli, Lesley J.a,b; Cochrane, Lesley A.c

Current Opinion in Otolaryngology & Head and Neck Surgery: June 2019 - Volume 27 - Issue 3 - p 178–184
doi: 10.1097/MOO.0000000000000533
SPEECH THERAPY AND REHABILITATION: Edited by H. Fiona Robinson and Jo Patterson

Purpose of review The current article reviews advances in both the assessment of paediatric voice disorders, as well as surgical, medical and therapeutic treatments.

Recent findings It is important to evaluate the impact of a voice disorder from both the parent and child perspective. Outpatient laryngoscopy with stroboscopy is very possible even in young children; however, high-speed ultrasound is a plausible alternative. High-speed videolaryngoscopy, videokymography and dynamic computed tomography, offer potential for augmenting the assessment of vocal fold vibratory characteristics in children. The evidence to support the efficacy of both indirect and direct voice therapy interventions is growing. The management of vocal fold palsy has advanced to include laryngeal reinnervation. Intubation injury with/without surgical intervention offers challenge and gives rise to voice disorders that may be lifelong.

Summary Although assessment and management practices of paediatric voice disorders closely follow those applied to adults, there are important differences and a developmental approach is required when considering both surgical and therapeutic management. Children can benefit from both indirect and direct therapy treatments following an ear, nose and throat assessment which utilizes paediatric instrumentation and considers the health of the entire airway. Underlying medical contributory factors should be explored and treated. Voice disorders due to congenital and acquired changes of the vocal tract may be amenable to surgery.

aDepartment of Speech and Language Therapy, Great Ormond Street Hospital

bDivision of Psychology and Language Sciences, Faculty of Brain Sciences, University College London

cDepartment of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK

Correspondence to Lesley J. Cavalli, BSc (Hons), MSc, FRCSLT HCPC, Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK. Tel: +44 0 207 813 8110; e-mail:

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