Quality of Life and Voice Outcomes after Thyroid Ala Graft Laryngotracheal Reconstruction in Young Children

Abstract

Objectives. (1) To assess the long-term impact of thyroid ala cartilage laryngotracheal reconstruction (TAC-LTR) on health-related quality of life (QOL) in infants using 4 validated instruments: Health Utility Index version 3 (HUI3), Pediatric Voice-Related QOL (PVRQOL), Impact on Family Questionnaire, and a visual analog scale and (2) to perform acoustic and perceptual voice assessments to evaluate long-term voice quality outcomes. Study Design. Prospective study. Setting. Tertiary academic pediatric hospital. Subjects. Eligible children who received TAC-LTR before the age of 24 months between 1995 and 2007. Methods. Interviews with parents and children using 4 validated instruments, voice analyses, and endoscopic evaluation were performed. Results. Twelve patients (7 male, 5 female, median age 10 years) were enrolled over a 6-month period. The mean age at LTR was 5 months (range, 1-20 months), and the mean study follow-up period was 9 years (range, 2-14 years). The average speech HUI3, PVRQOL, and Impact on Family scores were 0.83 (95% confidence interval = 0.74, 0.92), 0.93 (interquartile range [IQR] = 0.81, 1.00), and 0.65 (IQR = 0.54, 0.92), respectively. All acoustic scores were either normal or mildly abnormal for the variables jitter, shimmer, noise-to-harmonic ratio, peak amplitude variation, and fundamental frequency. The Consensus Auditory-Perceptual Evaluation of Voice overall severity score was in the normal to mildly abnormal range for 8 of 9 patients. Conclusion. This is the first study to explore and quantify long-term QOL and voice quality in children following LTR with thyroid ala graft at a very young age. Most patients had very good functional voice outcome as evidenced by the HUI3 and PVRQOL scores. This was corroborated by acoustic and perceptual voice assessments.