The Pediatric Airway, Voice and Swallowing Center is currently involved in the following clinical investigations:
- An NIH-funded study to evaluate the efficacy of vocal therapy on children with vocal nodules. This is a randomized controlled multi-center trial of children with vocal fold nodules in two treatment arms. Subjects will receive vocal therapy for 6 to up to 12 weeks with a certified speech language pathologist to evaluate the efficacy of vocal therapy on children with vocal nodules.
The primary objective of this study is to determine the impact of voice therapy on voice-related quality of life in children age 6-10 years old with apparent vocal fold nodules, as measured by the validated Pediatric Voice-Related Quality of Life Instrument (PVRQOL) administered 4 weeks after completion of voice therapy.
We are currently seeking male and female children between the ages of 6 to 10 years of age diagnosed with vocal nodules. Those who are interested in the study will undergo videostroboscopy or in some cases operative microsuspension laryngoscopy if in-office stroboscopy cannot be tolerated. They will also undergo aerodynamic and acoustic assessments as well as an audiology exam. If subjects qualify for the study, they will receive 6 to 12 weeks of vocal therapy with a certified speech language pathologist depending to which vocal therapy program they are randomly assigned.
- A study that aims to use optical imaging technology to trace the development of a child’s vocal cord structure as it matures and develops form infancy through adolescence. Children who are hoarse enough to have significant impairment in their ability to make themselves understood and who are non-responsive to conservative measures (voice therapy) represent a difficult challenge. It is currently not known if or when the adult paradigm for surgical excision of these nodules can be applied to children. In adults with symptomatic vocal fold nodules non-responsive to conservative measures, phonomicrosurgical techniques are utilized. Some authors advocate early surgical excision for similarly affected children, citing an approximate 90% rate of vocal improvement rate. One hypothesis for such success is that perhaps operating on the primitive vocal fold before it matures might limit post-operative scarring. Other surgeons do not remove the nodules until the children are well into their teen-age years so that they can employ adult phonomicrosurgical techniques and minimize post-operative scarring. There is no data to validate either concern as we currently do not know when vocal cord structure matures. Our study aims to lay the groundwork to solve this controversy by developing methods for imaging and quantitatively analyzing the pediatric vocal fold microstructure to be able to chart the development of the vocal cord over time.
We are currently seeking children ages 1 month to 18 years of age who are undergoing largyngoscopy and bronchoscopy for airway evaluation and who are already scheduled for general anesthesia with intravenous catheter placement as part of standard clinical care.
We are also conducting investigational studies in:
- Gastroesophageal reflux and chronic cough
- Occult gastroesophageal reflux
- Surgical outcomes of children undergoing excision of vocal fold cyst and nodules
- Innovative treatment of children with juvenile recurrent respiratory papillomas
- Biofeedback therapy for children with paradoxical vocal fold motion
- Nerve reinervation procedures to treat unilateral vocal fold paralysis
- Airway reconstruction for subglottic stenosis
- Endoscopic repairs for children with laryngeal clefts
- Pre-operative positive pressure therapy in lowering the risk of adenotonsillectomy in children with sleep apnea
- Use of cine-MRI dynamic imaging in defining anatomic anomalies in children with velopharyngeal insufficiency
- Use of cine-MRI dynamic imaging in defining anatomic anomalies in children with obstructive sleep apnea