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Introduction The pediatric voice handicap index (pVHI) has been developed to provide a better insight into the parents' perception of their child's voice related quality of life. The purpose of the present study was to validate the Dutch pVHI by evaluating its internal consistency and reliability. Furthermore, we determined the optimal cut-off point for a normal pVHI score. Methods All items of the English pVHI were translated into Dutch. Parents of children in our dysphonic and control group were asked to fill out the questionnaire. For the test re-test analysis we used a different study group who filled out the pVHI twice as part of a large follow up study. Internal consistency was analyzed through Cronbach's α coefficient. The test-retest reliability was assessed by determining Pearson's correlation coefficient. Mann-Whitney test was used to compare the scores of the questionnaire of the control group with the dysphonic group. By calculating receiver operating characteristic (ROC) curves, sensitivity and specificity we were able to set a cut-off point. Results We obtained data from 122 asymptomatic children and from 79 dysphonic children. The scores of the questionnaire significantly differed between both groups. The internal consistency showed an overall Cronbach α coefficient of 0.96 and an excellent test-retest reliability of the total pVHI questionnaire with a Pearson's correlation coefficient of 0.90. A cut-off point for the total pVHI questionnaire was set at 7 points with a specificity of 85% and sensitivity of 100%. A cut-off point for the VAS score was set at 13 with a specificity of 93% and sensitivity of 97%. Conclusions The Dutch pVHI is a valid and reliable tool for the assessment of children with voice problems. By setting a cut-off point for the score of the total pVHI questionnaire of 7 points and the VAS score of 13, the pVHI might be used as a screening tool to assess dysphonic complaints and the pVHI might be a useful and complementary tool to identify children with dysphonia.

To provide an overview of current practice patterns with regard to Robin sequence (RS) patients in Europe, a survey was conducted among European clinicians. This online survey consisted of different sections assessing characteristics of the respondent and clinic, definition, diagnosis, treatment, and follow-up. In total, surveys from 101 different European clinics were included in the analysis, and 56 different RS definitions were returned. The majority (72%) of the respondents used a sleep study system to determine the severity of the airway obstruction. A total of 63% used flexible endoscopy and 16% used rigid endoscopy in the diagnostic process. Treatment of the airway obstruction differed considerably between the different countries. Prone positioning for mild airway obstruction was the treatment modality used most often (63%). When prone positioning was not successful, a nasopharyngeal airway was used (62%). Surgical therapies varied considerably among countries. For severe obstruction, mandibular distraction was performed most frequently. Three-quarters of the respondents noted the presence of catch-up growth in their patient population. This first European survey study on definition and management of RS shows that there are considerable differences within Europe. Therefore, we would encourage the establishment of national (and international) guidelines to optimize RS patient care.

Summary Objective: The postoperative management of children undergoing single stage laryngotracheoplasty (SSLTP) includes intubation and muscle paralysis to secure the airway and protect the wound. We reduced the period of postoperative muscle paralysis in an attempt to decrease the incidence of pulmonary complications. The objective of this study was to evaluate the influence of the duration of muscle paralysis on pulmonary complications and outcome. Methods: Medical records of all children admitted, between 1994 and 2002, to the pediatric intensive care unit following SSLTP were analysed. Children were grouped according to the number of days muscle paralysis was used. Results: Thirty-six children (15 male, 21 female, mean age 32 months (9–162 months)) underwent SSLTP for laryngeal stenosis. Prior to surgery 29 needed a tracheotomy (mean duration 11.1 months). Shorter muscle paralysis leads to shorter intubation and mechanical ventilation and therefore PICU and hospital length of stay were 12.4 and 9.9 days shorter in the group with short use of muscle paralysis ( p p = 0.002, respectively). There was no significant difference in postoperative complications, but a trend towards fewer atelectases in children with short muscle paralysis could be recognised. Postoperatively we observed no auto-extubations in either group and success rate of SSLTP was comparable in both groups (94 and 95%). Conclusion: Children undergoing SSLTP can safely benefit from a postoperative strategy using a short duration of muscle relaxants. They have fewer days on mechanical ventilation with a concomitant decrease in duration of hospital stay.

Background: Insertion of ventilation tubes in children with otitis media with effusion (OME) is an accepted procedure. Laser myringotomy can be performed in the office but little is known about the outcome and influences of co-variables compared with the tube. Methods: Prospective and randomised trial with enrolment of children with chronic OME, indicated for placement of ventilation tubes. At random, laser myringotomy was performed in one ear and a ventilation tube was placed in the other ear. Follow-up was scheduled for 6 months. Success was defined as absence of effusion or aural discharge. Results: Two hundred eight children received the allocated intervention. The mean closure time of the laser perforation was 2.4 weeks and the mean patency time of the tube was 4.0 months. The mean success rate was 40% for the laser and 78% for the ventilation tube. Known variables of influence on the course of OME were used to create a logistic regression model to predict treatment effect for both therapies. Conclusion: Laser myringotomy is less effective than insertion of a ventilation tube in the treatment of chronic OME. The logistic model enables the otolaryngologist to identify the patients suitable for laser myringotomy.

Twenty-five complications (of which 2 were lethal) occurred in 1332 rigid laryngobronchoscopies performed under general anesthesia in the Sophia Children's Hospital during an 8 year period (1982–1990). The nature and circumstances of these complications were studied retrospectively. Important intraoperative complications were hemorrhage and cardiac arrhythmia; postoperative complications were intoxication and respiratory complications. Three risk factors: tetralogy of Fallot, biopsy/drainage, and extraction of an aspirated foreign body appeared to be significantly associated with complications. The results of this study were compared with those reported in studies of rigid and flexible laryngobronchoscopies in children.

Six children with a Subglottic hemangioma were treated in the Sophia Children's Hospital in the period 1982–1987 by means of intralesional corticosteroid injection, followed by intubation. After treatment all children were symptomfree. In 3 patients this result was attained after 1 injection, in 2 after 3 injections. One patient needed 5 injections. The average duration of intubation was 19 days (7–36). Three months ( 1 2 –7 1 2 ) after the onset of therapy all patients were free of symptoms. No serious complications were observed. No patient needed a tracheotomy. The average follow-up period was 3.3 years (1 1 2 –5 1 2 ). The authors feel that not only the effect of intralesional corticosteroids, but also local gentle pressure by the tube is of therapeutic importance. The above-mentioned treatment of subglottic hemangioma in children is now the treatment of choice in our clinic.

In the Sophia Children's Hospital we perform fiberoptic laryngoscopy in neonates under general anesthesia without the use of muscle relaxants in the diagnostics of functional laryngeal disorders. The necessary diagnostic and anesthetic equipment is described. Special attention is paid to the way in which the fiberscope is introduced into the breathing circuit and into the child's airway. Several advantages over other methods are discussed. The procedure has proved to be easy, safe and informative.