September 2019 HSC Section 1 Congenital and Pediatric Problems

higher total score on the pVHI questionnaire. For the follow-up health status, the presence of stridor and worse inspiratory pulmonary function tests (FiV1%VCmax) were significantly associated with a higher total score on pVHI questionnaire. The presence of stridor at follow-up outpatient visit was significantly associated with a higher parent-reported VAS. DISCUSSION In this study, we report the long-term voice outcome and voice-related quality of life after surgery for acquired LTS. We found high values for total pVHI questionnaire and VAS and low values for total DSI, indicating significant voice disturbance at long-term follow-up. After multivari- ate analysis, we found that the presence of comorbidities and glottic involvement of the stenosis are significant factors associated with a higher total score on the pVHI questionnaire. The presence of stridor at time of follow-up and poor inspiratory pulmonary function testing are signif- icant factors for higher VAS and higher total score on pVHI questionnaire. Airway surgery is always a balance between creat- ing an adequate airway for life-long ventilation while at the same time maintaining an acceptable voice and swallowing function. Although most studies focus on the airway aspect, reporting decannulation rates as outcome measure, only a small number of studies have reported on voice outcome after surgery. All report a worryingly high incidence of voice disturbance, abnormal laryngeal features, and phonation characteristics such as ventricu- lar band phonation, vocal cord immobility, and anterior commissure blunting. 5,6,17,18 Because laryngotracheal stenosis is a rare condition, most of these studies have small numbers and fail to identi- fy significant factors associated with voice outcome. Pooling

TABLE I. Patient Characteristics of Study Population for pVHI (n 5 55).

Female/male

30 of 25

Median age; range (in years)

11 (4–17)

Median follow-up after surgery; range (in years)

7 (2–16)

Tracheostomy present preoperatively

44

Grade of stenosis (Cotton-Myer) Grade I

1

Grade II

16

Grade III

37

Grade IV

1

Site of stenosis

Only subglottic

33

Glottic involvement

22

Number of patients with comorbidities*

31

Bronchopulmonary dysplasia

10

Tracheomalacia

9

Congenital syndrome

9

Congenital heart disease

4

Other †

8

Type of surgery Single-stage laryngotracheal reconstruction

53

Double-stage laryngotracheal reconstruction

1

Cricotracheal resection

1

Median age at surgery; range (in years)

2 (0–12)

Multiple Linear Regression Analysis Table IV shows the results for the multivariate linear regression model. The presence of comorbidities and glot- tic involvement of the stenosis are significant factors for *Seven patients had more than one comorbidity. † Others include mental retardation, reflux disease, and obstructive sleep apnea. pVHI 5 pediatric voice handicap index.

Fig. 1. Flow chart of inclusion and exclusion. DSI 5 Dysphonia Severity Index; LTS 5 laryngotracheal stenosis, pVHI 5 pediatric Voice Handicap Inventory. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

Laryngoscope 127: July 2017

Pullens et al.: Voice Outcome After Pediatric Airway Surgery

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