How Bad Is It? Baseline Subjective and Objective Vocal Assessments of Pediatric Voice Disorders

Introduction: Pediatric voice disorders can vary in severity and quality of life. Common pathology includes vocal fold lesions (VFL), vocal cord dysfunction (VCD) or paradoxical vocal fold movement, vocal fold paralysis (VFP), and post-airway reconstruction dysphonia (PARD). The objective of this study is to compare baseline measurements of dysphonia severity and quality of life impact of these various disorders in children.

Methods: Data collected on children ( < 18 years old) seen in a voice disorders clinic at a quaternary children’s hospital between March 2004 and February 2025 and enrolled in a prospective voice registry were reviewed. Demographics, presenting diagnosis, baseline Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and Pediatric Voice Handicap Index (pVHI) scores were analyzed. CAPE-V (scale 0-100) and pVHI (scale 0-92) are validated assessments for which higher scores reflect worse vocal quality or voice-related quality of life.

Results: 634 children with 4 categories of voice pathology were included: VFL (n=311, 49.05%), VCD (n=119, 18.77%), VFP (n=114, 17.98%), and PARD (n=90, 14.20%). Mean age was 8.48 years (SD 4.54) and 51.8% were male. Mean CAPE-V and pVHI scores in the sample were 32.4 (SD 25.2) and 26.6 (SD 17.8), respectively. Mean CAPE-V for VFL was 35.9 (SD 18.3); for VCD, 7.0 (SD 10.8); for VFP, 50.9 (SD 28.4); and for PARD, 47.6 (SD 26.9). Mean pVHI for VFL was 26.1 (SD 13.7); for VCD, 9.7 (SD 13.4); for VFP, 38.2 (SD 19.5); and for PARD, 35.7 (SD 16.5). VCD patients had the lowest CAPE-V/pVHI measures followed by VFL, PARD, and VFP patients. VCD and VFL measures significantly differed from the other categories of voice disorders (p < 0.0001). PARD and VFP CAPE-V/pVHI measurements did not significantly differ (p=0.71).

Conclusions: Children presenting with VCP tend to have worse objective measurement of voice based on the CAPE-V assessment and voice-related quality of life as measured with the pVHI. Capturing baseline and prospective metrics for these pathologies is crucial for counseling patients and families on the impact of therapy and expected changes with growth and interventions.