Cross-sectional follow-up of voice outcomes in children who
have a history of airway reconstruction surgery
School of Psychological Sciences and
Health, University of Strathclyde, Glasgow,
Otolaryngology/Airway Surgery, Royal
Hospital for Children, NHS Greater
Glasgow and Clyde, Glasgow, UK
NHS Ayrshire and Arran, Crosshouse
Hospital, Kilmarnock, UK
W. Cohen, School of Psychological Sciences
and Health, University of Strathclyde,
This project was supported by generous
grants from Action Medical Research, The
Hugh Fraser Foundation and Jeffrey
Objectives: This study reports vocal function in a cross-section of children with
subglottic stenosis. Each child had a history of laryngotracheal reconstruction and/
or cricotracheal resection surgery. Vocal function was measured using laryngoscopy,
acoustic analysis, perceptual evaluation and impact of voice on quality of life.
Design: All patients aged >5 years with history of laryngotracheal reconstruction
and/or cricotracheal resection surgery at the Scottish National Complex Airways
service were invited to participate.
Setting: Data were gathered in the Royal Hospital for Children in Glasgow in a sin-
gle outpatient appointment.
Participants: Twelve of 56 former patients (aged 5-27) provided a voice sample and
eleven consented to awake laryngoscopy. All consented for detailed evaluation of
their medical records.
Main outcome measures: Acoustic analysis of fundamental frequency and pitch
perturbation was conducted on sustained vowel [a]. Perceptual evaluation was con-
ducted by 4 trained listeners on a series of spoken sentences. Impact on quality of
life was measured using the paediatric voice-related quality of life questionnaire.
Laryngeal function was descriptively evaluated.
Results: Four children had normal voice acoustically, perceptually and in relation to
voice-related quality of life. One of these had vocal fold nodules unrelated to surgi-
cal history. Two other children had “near normal” vocal function, defined where
most voice measurements fell within the normal range.
Conclusions: Normal or “near normal” voice is a possible outcome for children who
have had this surgery. Where there is an ongoing complex medical condition, voice
outcome may be poorer.
Airway narrowing from subglottic stenosis (SGS) may be congenital
or acquired following intubation or neonatal laryngotracheal injury.
Although uncommon, (incidence <0.63%
), intervention establishes
an airway through bypassing the obstruction (tracheostomy) or
reconstructive surgery to expand or excise stenosis.
Two open sur-
gical techniques exist as follows: laryngotracheal reconstruction
(LTR) and partial cricotracheal resection (CTR).
Primary surgical out-
comes are survival or decannulation.
In adults, voice quality is reduced following LTR or CTR, particu-
larly in women.
In children, voice outcome may be poor
with good voice-related quality of life (QoL) despite persist-
ing levels of hoarseness.
Voice quality is largely better where the
resulting phonation is glottic rather than supraglottic.
Voice outcome varies according to surgical procedures or how
voice is evaluated,
with, for example different tools for evaluating
QoL and different techniques for evaluating voice quality. Published
Accepted: 29 November 2017
Clinical Otolaryngology. 2018;43:645–651. wileyonlinelibrary.com/journal/coa © 2017 John Wiley & Sons Ltd