title: Assessment of Vibratory Characteristics in Children Following   Airway Reconstruction Using Flexible and Rigid Endoscopy   and Stroboscopy.
abstract: OBJECTIVE
  Up to half of children have substantial dysphonia after airway reconstruction. Visual assessment of vocal function is valuable. Feasibility of flexible and rigid endoscopy has been reported; however, the clinical utility of stroboscopy has not been examined. Rating of vibratory characteristics, such as mucosal wave and amplitude of vibration, is essential for the development of interventions to improve voice outcomes.
  
  
  OBJECTIVE
  To examine (1) clinicians’ ratings of anatomical and physiological features in children following airway reconstruction on initial voice evaluation using videolaryngostroboscopy and (2) the relationship of age to the type of endoscopy used.
  
  
  METHODS
  Retrospective medical record review of 32 patients aged 3 to 21 years evaluated for post–airway reconstruction dysphonia between July 2011 and July 2012 at a quaternary care children’s hospital.
  
  
  METHODS
  Clinical voice evaluation protocol including rigid and/or flexible endoscopy with stroboscopy.
  
  
  METHODS
  Demographic and voice quality characteristics were collected. The ability to complete endoscopy and ratings of anatomical and/or physiological features were assessed by a consensus of 4 clinicians. A t test was used to determine whether age was a significant factor in successful completion of videolaryngostroboscopy.
  
  
  RESULTS
  Of 31 children who underwent flexible videolaryngostroboscopy, 22 (71%) examinations were completed with a distal chip endoscope and 9 (29%) with a fiberoptic. Significant differences were found in age between children who completed the distal chip vs. fiberoptic examination (mean [SD], 7.3 [2.7] vs. 5.5 [6.2] years; P = .05). Rigid endoscopy was attempted for 14 (44%) of 32 patients; 9 examinations (64%) were successful. Significant differences were found in age between patients for whom a rigid endoscopy could be successfully completed vs. those for whom it was not (mean [SD], 12.9 [3.4] vs. 6.2 [2.1] years; P < .001). Eighteen (56%) were glottic phonators, 8 (25%) supraglottic, and 6 (19%) aphonic. Vibratory characteristics were visible in 10 of 37 examinations (27%); 6 (16%) had ratable characteristics.
  
  
  CONCLUSIONS
  Endoscopy can be successfully completed in most children who have undergone airway reconstruction, most often using a distal chip endoscope.We found that vibratory characteristics were often not assessed adequately using videolaryngostroboscopy. Further work identifying imaging modalities that better display vibratory characteristics, such as high-speed videoendoscopy, may provide new insight into vocal function and lead to a more thorough evaluation.
authors.forename: Stephanie R C
authors.initials: SR
authors.lastname: Zacharias
authors.forename: Barbara
authors.initials: B
authors.lastname: Weinrich
authors.forename: Susan Baker
authors.initials: SB
authors.lastname: Brehm
authors.forename: Lisa
authors.initials: L
authors.lastname: Kelchner
authors.forename: Dimitar
authors.initials: D
authors.lastname: Deliyski
authors.forename: Meredith
authors.initials: M
authors.lastname: Tabangin
authors.forename: Alessandro
authors.initials: A
authors.lastname: de Alarcon
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D055154:Dysphonia / Q000175:diagnosis* / Q000209:etiology*; D019723:Endoscopes; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D011183:Postoperative Complications; D012137:Respiratory System / Q000601:surgery*; D049489:Stroboscopy; D020535:Video-Assisted Surgery; D014833:Voice Quality / Q000502:physiology; D055815:Young Adult