Overview

This text offers a comprehensive and current review of the care of children with voice disorders. It includes an overview of anatomy and physiology of the pediatric laryngeal mechanism, associated neural controls and phonatory behavior across childhood. A thorough discussion of the etiologic correlates of pediatric voice disorders is provided. The spectrum of evaluation techniques ranging from basic to innovative high tech instrumentation is presented. Evidence driven treatment approaches for common as well as unique pediatric voice disorders is covered in a practical, case-based format. The central theme throughout this text is our focus on a truly integrated, multi-disciplinary approach to the care of children with voice disorders, yet the needs of the solo or school-based practitioner are addressed. A supplemental DVD with select practice materials in printable patient use format, color images of laryngeal pathologies, digital audio and video samples for perceptual rating practice with additional case studies are included. With contributions from Alessandro de Alarcon, MD, MPH; Ann Kummer, PhD; Wendy LeBorgne, PhD; Stephanie Zacharias, PhD; Janet Beckmeyer, MA; and Janet Middendorf, MA.

Audience

Primary Subject: Voice
Secondary Subject: Pediatrics
Secondary Subject: Speech and Language Pathology / Voice and Voice Therapy
Audience Level: Professional/Textbook - Desk Copy

Preface
Acknowledgments
Contributors
Introduction

1. Anatomy and Physiology of the Pediatric Larynx and Respiratory System
a. This chapter will provide the necessary fundamental information related to the anatomy and physiology of voice in the developing child. It will include information about typical embryologic and post natal development of structures and functions of the upper aerodigestive tract and lower respiratory tract.
2. Neural Controls and the Development of Phonation
a. Central controls and peripheral nervous system innervations needed to support the development and production of normal voice is presented. There will be discussion of the development of vocal motor control as well as a review of the current knowledge pertaining to the physiology of phonation across childhood (e.g. as used during cry and speech).
3. Voice Disorders of Childhood
a. In-depth information on the pathophysiology of childhood voice disorders including common and uncommon vocal fold pathologies, structural defects (e.g. webs, clefts), neuromotor dysfunction, functional causes, and systemic related etiologies (e.g. reflux). There will be in-depth descriptions of associated structural changes, histology, and causes for each etiology. Images and case examples will be provided.
4. Evaluating the voice disordered child: A collaborative approach
a. This chapter will cover all of the available methods of pediatric voice assessment from the initial interview to the systematic application of perceptual, acoustic, aerodynamic, imaging, and handicapping indices/ quality of life (and other self-assessment) instruments. Assessment methods that are all considered standard care, evidence based, and some newer procedures for the pediatric population (e.g. high speed imaging) will be reviewed in detail. Accomplishing a comprehensive assessment from a collaborative perspective (SLP and MD) as well as specific information and guidelines for the solo and school-based practitioner will be presented.
5. Treatment: A collaborative approach
a. This chapter will approach treatment from a collaborative model, but also address the specific needs of the solo and school-based practitioner. There will be a review of traditional behavioral based techniques, as well as emerging techniques and new models of delivery (e.g. telehealth and gaming, etc.). Advances in medical-surgical care for the child with a voice or airway disorder are changing. This section will provide a current review of medical-surgical interventions with sample cases to reflect key decision points.
6. Managing Children with Complex Voice Needs
a. This chapter will provide necessary information related to the management and care of children will special voice needs. Although the fundamentals of evaluation and treatment will be covered in the previous chapters, this chapter will allow for an in-depth review of specific techniques and care issues associated with lower incidence but high importance pediatric populations such as the childhood performer, the complex airway and medically fragile child and children with craniofacial anomalies.

About The Authors

Lisa N. Kelchner, PhD

Lisa N. Kelchner, Ph.D. CCC-SLP, BRS-S is an Associate Professor in the Department of Communication Sciences and Disorders at the University of Cincinnati and a Research Associate at the Center for Pediatric Voice Disorders, Cincinnati Children’s Hospital Medical Center. Her research is focused on the assessment and treatment of children with airway protection and voice disorders, especially those related to pediatric airway injury and reconstruction. Dr. Kelchner is the Director of Graduate Studies for the Department of Communication Sciences and Disorders at the University of Cincinnati.

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Susan Brehm, PhD

Susan Baker Brehm, Ph.D., CCC-SLP, is an Associate Professor in the Department of Speech Pathology and Audiology at Miami University (Ohio) and a Research Associate at the Center for Pediatric Voice Disorders, Cincinnati Children's Hospital Medical Center. Her research is focused on clinical assessment and voice outcomes in children with laryngeal and other upper airway disorders. Dr. Brehm is the Director of Graduate Studies for the Department of Speech Pathology at Miami University.

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Barbara Weinrich, PhD

Barbara Weinrich, Ph.D., CCC-SLP, is a Professor in the Department of Speech Pathology and Audiology at Miami University (Ohio) and a Research Associate at the Center for Pediatric Voice Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Her research is focused on assessment and treatment of voice disorders, including a variety of approaches to unique voice problems, as well as research regarding treatment efficacy.

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