title: Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options.
abstract: OBJECTIVE
  To establish the benefit of ansa cervicalis-recurrent laryngeal nerve reinnervation (ANSA-RLN) for the management of dysphonia secondary to unilateral vocal cord paralysis (UVCP) in children. Children treated with ANSA-RLN for the management of dysphonia secondary to unilateral vocal fold immobility will have superior acoustic, perceptual, and stroboscopic outcomes compared to injection laryngoplasty and observation.
  
  
  METHODS
  Retrospective case-series chart review.
  
  
  METHODS
  Laryngeal, perceptual, and acoustic analysis of dysphonia was performed in 33 children (age 2-16 years) diagnosed with UVCP. Comparison of pre-post function for treatment groups (no treatment, injection laryngoplasty, ANSA-RLN) with additional comparison between gestational ages, age at initial evaluation, and gender were examined. Perceptual measures included Pediatric Voice Handicap Index (pVHI) and Grade, Roughness, Breathiness, Asthenia, Strain (GBRAS) perceptual rating. Objective measures included semitone (ST) range, jitter%, shimmer%, noise-to-harmonic ratio, voicing, and maximum phonation time.
  
  
  RESULTS
  Post-treatment, pVHI, jitter%, and ST were significantly improved for ANSA-RLN subjects compared to injection subjects. Improved function (laryngeal diadochokinesis, pVHI, GRBAS, and/or acoustic) was observed in all ANSA-RLN subjects who had vocal fold paralysis as the only laryngeal diagnosis.
  
  
  CONCLUSIONS
  This study presents one of the largest studies of pediatric vocal fold paralysis diagnosis and treatment. The study looks at the spectrum of function in patients with UVCP and looks at the outcomes of options: no treatment, injection laryngoplasty, and ANSA-RLN. Although surgical outcomes vary, both injection laryngoplasty and ANSA-RLN show benefit in laryngeal function, voice stability, voice capacity, perceptual rating, and pVHI scores. Both injection laryngoplasty and ANSA-RLN showed improvements post-treatment, and should be considered for management of pediatric UVCP. However, the ANSA-RLN group showed better and longer-lasting perceptual and acoustic parameters in comparison with the injection and control groups. Reinnervation, even long term after the onset of vocal fold paralysis, should be considered a viable permanent treatment for pediatric UVCP.
authors.affiliation: Department of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.|Department of Otolaryngology-Head & Neck Surgery, Perelman School of Medicine of The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Zur
authors.affiliation: Department of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Carroll
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D055154:Dysphonia / Q000209:etiology / Q000601:surgery*; D004576:Electromyography; D005260:Female; D005865:Gestational Age; D006801:Humans; D007267:Injections; D007828:Laryngoscopy / Q000379:methods; D007830:Larynx / Q000502:physiology; D008297:Male; D012009:Recurrent Laryngeal Nerve / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000150:complications
keywords: Vocal cord paralysis; injection laryngoplasty; pediatric; reinnervation; voice handicap