title: Posterior Glottic Insufficiency in Children.
abstract: BACKGROUND
  Dysphonia secondary to posterior glottic insufficiency (PGI) can be difficult to identify and correct. Inadequate arytenoid approximation from medial arytenoid erosion results in a breathy, soft voice. The anatomical location of the gap is difficult to correct by vocal fold injection laryngoplasty. This study reviews the presentation, evaluation, and treatment for pediatric patients who were identified with PGI.
  
  
  METHODS
  An Institutional Review Board-approved chart review was performed on all patients who were diagnosed with PGI at our institution from 2013 to 2015. We studied the presentation, workup, and treatment for these patients, including laryngoscopy, parent or patient-based voice impairment ratings, and response to treatment.
  
  
  RESULTS
  Seven patients were identified. Erosion of the medial arytenoid was identified on microlaryngoscopy for all of these patients. The patients had suboptimal improvement from injection laryngoplasty. Three patients underwent surgical correction with an endoscopic posterior cricoid reduction laryngoplasty (EPCRL) with significant improvement in voice, assessed by perceptual, laryngoscopic, and patient-based measures.
  
  
  CONCLUSIONS
  The key diagnostic procedures to identify posterior glottic insufficiency include laryngoscopic findings of a posterior glottal gap, microlaryngoscopy with close inspection of the posterior glottis and medial arytenoids, and suboptimal response to injection laryngoplasty. The EPCRL is an effective procedure to treat dysphonia from PGI.
authors.affiliation: 1 Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, UT, USA.
authors.forename: Reema
authors.initials: R
authors.lastname: Padia
authors.affiliation: 1 Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, UT, USA.
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D055154:Dysphonia / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005931:Glottis; D006801:Humans; D007223:Infant; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000601:surgery*; D007821:Laryngeal Muscles / Q000601:surgery*; D058753:Laryngoplasty / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014831:Voice; D055815:Young Adult
keywords: glottic insufficiency; laryngoplasty; neonatal dysphonia; pediatric dysphonia