Dysphonia in Children

Introduction. Vocal symptoms are common among the pediatric population and are often caused by vocal abuse. Laryngoscopy is essential for their diagnosis because it helps differentiate several laryngeal lesions, leading to a decision for suitable treatments considering each case.Objectives. This study aims to present the clinical characteristics, and the laryngoscopic diagnosis of a dysphonic child population.Methods. The parents of 304 children, aged from 4 to 18 years and presenting prolonged hoarseness, answered a questionnaire about their children's voice, and all children were subjected to videolaryngostroboscopy.Results. Male children aged from 7 to 12 years (64%) were predominant. Vocal abuse (n-162) and nasal obstruction symptoms (n-10) were the most frequent associated symptoms. The vocal symptoms had a chronic evolution (over 1 year) and were reported by most parents (n-200). The most commonly diagnosed lesions in the laryngoscopic exams were vocal nodules (n-175) and epidermal cysts (n-47). Furthermore, there was an association of some lesions, especially minor structural alterations.Conclusion. In the present study, dysphonia occurred mainly in children aged from 7 to 12 years, predominantly males. Vocal abuse and nasal obstruction symptoms were frequently reported. Vocal nodules and cysts were the most commonly diagnosed laryngeal lesions in the laryngoscopic exams.

Consequences of Chronic Nasal Obstruction on the Laryngeal Mucosa and Voice Quality of 4- to 12-Year-Old Children

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mucosal Bridge of the Vocal Fold: Difficulties in the Diagnosis and Treatment

Mucosal bridges are rare laryngeal lesions probably of genetic origin. They may cause dysphonia of varying degrees, especially when associated with other laryngeal lesions such as vocal sulci and cysts. Reports on mucosal bridges are rare, and the better treatment is inconclusive.Aim. To report the authors' experience in 14 cases of mucosal bridge showing details on endoscopic examinations and treatment.Study Design. Retrospective study.Methods. We reviewed the medical records of 14 patients with a diagnosis of mucosal bridge confirmed by video-laryngostroboscopy and direct laryngoscopy who attended the Outpatient Clinic of Voice Disorders of the Discipline of Otorhinolaryngology, Botucatu Medical School, São Paulo State University, São Paulo. Data collected included information on gender, age, symptoms, time of onset, history of intubation, smoking status, alcohol intake, associated laryngeal lesions, treatment, and GRBAS (grade of hoarseness, roughness, breathiness, asthenia, and stress) scale ratings.Results. of 14 patients, 10 were females and four were males. There was a prevalence of adults (n = 12), with only two of the patients being younger than 13 years (10 and 13 years). Mucosal bridges showed no correlations with smoking, alcohol intake, or gastroesophageal and sinonasal symptoms. Voice abuse was reported in 50% of the cases that consisted of patients who had high-voice demand occupations. In seven cases, mucosal bridges were associated with other laryngeal lesions, particularly vocal cysts and sulci. All patients who underwent surgery and phonotherapy showed improved vocal quality.Conclusions. We documented 14 patients with dysphonia caused by mucosal bridge. Promising results were obtained with surgery.

Sulcus vocalis: evidence for autosomal dominant inheritance

We found evidence of autosomal dominant hereditary transmission of sulcus vocalis. Four dysphonic patients from three generations of the same family were submitted to videolaryngoscopic examination (three patients) and to direct laryngoscopy ( one patient) to diagnose the hoarseness. Sulcus vocalis was diagnosed in all four patients. The finding of four affected individuals in three generations, with vertical transmission affecting man and women, is more consistent with autosomal dominant inheritance pattern; it is an etiological model that we propose for the sulcus vocalis in this pedigree.

Avaliação da via aérea do paciente obeso para predição da dificuldade de intubação traqueal: efeito da manipulação laríngea

Pós-graduação em Anestesiologia - FMB

Preditores clínicos de laringoscopia difícil em pediatria

Pós-graduação em Anestesiologia - FMB

Classificação de Mallampati em fonação para predição da dificuldade de intubação traqueal em obesos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Preanesthetic assessment data do not influence the time for tracheal intubation with Airtraq (TM) video laryngoscope in obese patients

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Severe distal cytomegalovirus esophagitis with aerodigestive symptoms in an immunocompetent infant

We report a case of an immunocompetent infant, with no evidence of neurological disorders, which developed clinical manifestation of recurrent crisis of choking, dysphagia, laryngeal stridor and sub costal retractions since the first day of life. Direct laryngoscopy was unremarkable. Upper gastrointestinal series showed a dilated tortuous esophagus with severe peristalsis impairment and reflux episodes till the proximal third of the esophagus. An upper gastrointestinal endoscopy showed a moderately dilated esophagus with erosive lesions in the distal esophagus. Esophageal biopsy specimens revealed CMV inclusion bodies associated to moderate inflammation and immunohistochemistry was positive for CMV early antigen. Prolonged 24 h esophageal pH metry was within normal limits. Antiviral therapy with intravenous ganciclovir was introduced and was associated with rapid improvement of the symptoms. Child gradually increased oral intake and weight gain, and there were no side effects related to therapy. Thus, the respiratory symptoms could have been a supra esophageal manifestation of a non-acid reflux disease related to the CMV esophagitis.