Pediatric Pulmonology 1544-51 (1993) State of the Art Review z - Aerodynamic and Laryngographic Assessment of Pediatric Vocal Function David J. Zajac, PhD, ccc-SLP,’ Zsolt Farkas, MD,~ Linda J. Dindzans, MD,~ and Sylvan E. Stool, MD~ Key words: Laryngeal airway resistance; electroglottography; harshness; breathiness; hoarseness; vocal fry; jitter; shimmer. INTROD CTlO zyxwvutsrqp An experienced physician frequently can make a pre- sumptive diagnosis in children with airway disorders al- most instinctively by simply listening to the respiration, voice, and cry of the child. While voice disorders in children have long been recognized, this is an area where the “art of medicine” has prevailed, but it remains largely an untapped area of scientific investigation. Tradition- ally, both otolaryngologists and speech-language pathol- ogists differentiate between voice and speech. Voice re- fers to the sounds produced by the vocal cords. Speech refers to the final outcome after the sound is produced in the larynx and modified by articulation and meaning is irnpartcd. This article is restricted to discussion of the disordered voice. Recent technological developments have increased the scientific interest in adult voicc disorders. Some of the techniques, which document and quantify voice charac- teristics, can be utilized in children. Our goal is to ac- quaint pulmonologists with the current knowledge and techniques available for the evaluation of voicc disorders in children. The incidence of voice disorders has been estimated by some studies to approach 40% in school children.’.’ De- spite the frequency of the problem, little scientific data are extant. The reasons for this may be related to the necessity to develop a multifaceted team approach be- cause of the complexity of these problems. In addition, reliable, feasible, quantitative, recording and voice anal- ysis are essential for the proper assessment and follow-up care of these children. Historically, the tests available required cooperation, comprehension, and/or coordination, which tcnded to ex- clude the pediatric population. New techniques utilize computer analysis and are relatively noninvasive. The implementation of these techniques is also aided by the fact that today’s children are not “technophobic,” and have previous familiarity with computers and electronic gadgets. While these techniques do not supercede the need for direct visualization of the larynx for diagnosis, they provide a very effective adjunct to the initial exami- nation and allow for documentation of disease progres- sion and of the effectiveness of therapy. Social factors also contribute to the generally increased interest in voice disorders in children. Until recently, paents were largely unconcerned with such deficiencies as long as they were not of such magnitude that they interfcrcd with communication. Recently, however, par- ents have become aware that we are prejudged by our voices, regardless of the content of our speech. This fact has long been accepted by both speech-language patholo- gists and media personalities. Recognition of the inipor- tance of voice quality has now crept into the secular sphere. There arc businesses which encourage their man- agcment level employees to not only “dress for success,” but also to consult “voice image” specialists. Trendy zy From the Spccch, Voice and Language Analysis Laboratory. Chil- dren’s Hospital of Pittsburgh and zyxw Cleft-Palate-Craniofacial Center. University of Pittsburgh, Pittsburgh, Pennsylvania’: Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh, Pitts- burgh. Pcnnsylvania’; and the Milwaukee Ear, Nosc &Throat Clinic, Milwaukee. Wisconsin.3 Rcceived April 25. 1992; (revision) accepted for publication July 23. 1992. Address corrcspondence and reprint requests to Dr. S.E. Stool. Depart- ment of Pediatric Otolaryngolog)/, Children’s Hospital of Pittsburgh. 3705 Fifth Avenue at DeSoto Street, Pittsburgh. PA IS2 13. zyx 0 1993 Wiley-Liss, Inc.