Author(s)
Anne Hseu, MD
Grant Spencer, B.A., Kosuke Kawai, Sc.D., Roger Nuss, MD
Affiliation(s)
Otolaryngology & Communication Enhancement, Boston Children's Hosp., Boston, MA.
Abstract:
The most common etiologies of dysphonia in the pediatric population are vocal fold nodules and muscle tension dysphonia. Vocal therapy is the first line treatment for these disorders in children. Despite this, not all children undergo therapy. The goal of this study is to examine how factors such as patient demographics and parental perceptions differ between children that choose to undergo or not to undergo voice therapy.
Methods: A retrospective review was conducted of all pediatric patients seen at a tertiary voice clinic between Jan 2014 and Dec 2017. Patients were included if diagnosed with vocal fold nodules and/or muscle tension dysphonia. Patients were divided into groups of children that received voice therapy at our institution and those that did not. Data including demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores were analyzed between groups. Distance to therapy site was approximated using patient zip codes.
Results: 346 children were included, 224 (65%) boys and 122 (35%) girls. In the two years following initial diagnosis, 74 (21%) children participated in voice therapy at our institution. Patients who underwent voice therapy were older than those who did not (mean age: 9.1 [SD 3.5] vs. 7.6 [SD 3.8] years; p=0.004). Patients who received voice therapy were more likely to live closer to the therapy site (mean distance: 15.5 [SD 13.0] vs. 24.3 [SD 23.9] miles; p<0.001). Likelihood of receiving voice therapy did not differ by gender or health insurance status (private vs. public).
Patients who underwent voice therapy had significantly greater CAPE-V Overall Severity scores than those who did not (mean score: 44.6 [SD 19.4] vs. 37.4 [SD 18.0]; p=0.003). Higher CAPE-V Strain scores were associated with increased likelihood of voice therapy, while pVHI scores did not differ between the two groups.
Conclusion: Greater patient age, shorter distance to therapy site, and increased CAPE-V Overall Severity and Strain scores were associated with increased likelihood of receiving voice therapy. Gender, insurance status (private vs. public), and pVHI scores did not affect likelihood of receiving voice therapy. Patients may be primarily considering ease of access and necessity of treatment when considering voice therapy.