Subjective evaluation of the voice by the patient is routinely assessed in the adult dysphonic population; this is, however, not the case in the pediatric population. There were three objectives of this study: the first goal was to study the ability of children aged 5-13 years to express themselves about physical, emotional, and sociofunctional aspects of their voice. The second goal was to explore if specific voice-related complaints were expressed by dysphonic children as compared with normophonic children. The third goal was to compare the dysphonic children's voice-related complaints with those of their mothers. The overall objective was to set the grounds for the elaboration of a standardized questionnaire in French concerning subjective evaluation of voice in children. Twenty-five dysphonic children with vocal complaint (15 nodules, one polyp, one microweb, eight unspecified) and 55 normophonic children aged 5-13 years were interviewed. The interviews were semistructured based on a canvas of voice-related questions. The dysphonic children's mothers were interviewed with the mean of a written questionnaire and were invited to discuss their answers orally with the examiner. The results were analyzed qualitatively and statistically. A Chi-square test and the Fisher's test were used to analyze the differences between the complaints expressed by the dysphonic and the normophonic children, and a binomial test was used to compare the children's answers with their mothers' answers. The qualitative analysis of the interviews suggests that children are capable of reflecting over their own voice and of giving autonomous information about different aspects of their voice. It also appeared that voice is a complex phenomenon and that it needs to be clearly and cautiously defined to the children. We identified 27 different complaints related to the voice, out of which 17 were significantly more expressed by dysphonic than by normophonic children (P<0.05). Three of the 27 identified complaints show significant discordances between the mothers and the dysphonic children. The results suggest that children are capable of making a subjective and autonomous evaluation of their voice and that dysphonic children experience significantly more voice-related discomfort than nondysphonic children. The complaints expressed by the dysphonic children and their mothers are not all in concordance. The main conclusion is that a standardized subjective evaluation of the voice, not only by the parents but also by the child him/herself, would be relevant in the assessment of pediatric dysphonia.

Mutational falsetto voice is considered to be a psychogenic disorder associated with the rejection of adulthood. The initial treatment must include speech therapy and psychotherapy. However, delayed treatment and denial of the problem can cause the disorder to become recalcitrant to behavioral treatment. Modified relaxation (type III) thyroplasty was proposed by Isshiki to shorten the vocal folds and release tension by incising and depressing the anterior segment of the thyroid cartilage. This procedure is called relaxation thyroplasty by a medial approach (anterior commissure retrusion) in the European Laryngological Society classification system. It results in a lowering of the vocal pitch. The surgery can be performed under local or general anesthesia. It should only be considered for cases not improved by speech therapy and psychological counseling. Our series included 7 male patients with a mean age of 21 years who underwent modified relaxation thyroplasty after failure of behavioral management. The assessment of outcomes was based on changes in the fundamental frequency of the voice and the Voice Handicap Index. The mean fundamental frequency was lowered from 187 Hz to 104 Hz (p < 0.001), and the mean Voice Handicap Index was improved from 70 to 21. There were no postoperative complications. The voice results were consistent over a mean follow-up of 17 months. Modified relaxation Isshiki (type III) thyroplasty is a successful treatment option for lowering vocal pitch in cases of mutational falsetto voice recalcitrant to conservative therapy.

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