Aerodynamic measurements in the pediatric population

ABSTRACT Voice disorders affect approximately one million American children and the associated impacts on quality of life are significant. These disorders often go underdiagnosed and undertreated in children due to subjective, imprecise evaluation methods, and the misconception that children do not experience a change in voice-related quality of life. The ability to perform at school, relate to friends and family, participate in social activities, or engage in everyday activities can be severely affected by voice impairment. A key part of providing voice care is a complete voice assessment, including aerodynamic evaluation of vocal input. The primary goals of this proposal are to develop noninvasive aerodynamic assessments which are reliable in the pediatric population, and to describe differences between healthy and dysphonic pediatric voices between the ages of 4-17 years. Three methods of aerodynamic measurement have been developed in our laboratory: complete airflow interruption; incomplete airflow interruption; and airflow redirection. These methods have been validated and shown to be accurate with adults. We have demonstrated improved measurement reliability for aerodynamic parameters using complete airflow interruption in children. Additional modifications must be made to optimize assessment and address anatomic and physiological differences between adults and children. We will adjust our current protocols with shorter trial times, auditory masking, visual feedback in the form of gamification, and cheek restraints. These modifications will allow for more reliable measurement of aerodynamic parameters in children. Aerodynamic evaluation will be performed in children with normal voice and children with voice disorders related to vocal fold nodules or polyp. Aerodynamic parameters will be correlated with pediatric voice-related quality of life score, lesion characteristics, clinician-based perceptual voice assessment, and acoustic voice assessment. This research will optimize a reliable method of aerodynamic voice assessment in children, determine how aerodynamic input differs in the setting of a voice disorder and how that correlates with other voice measures, and generate normative data ranges for aerodynamic parameters measured by mechanical interruption. Complete assessment of pediatric voice has been limited by patient-controlled methods of aerodynamic measurement, which are not well-suited to children. This research represents a shift in pediatric voice evaluation and provides a foundation for complete, objective, reliable voice assessment in children.