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Objectives/hypothesis: Professional voice users of any age are often concerned about nodules, particularly in pediatric singers. However, an accurate diagnosis allows formulation of an optimal management plan and a successful continuation of these young patients' careers. There is very little literature regarding pediatric professional singers; we aimed to share our experience of over a decade of referrals to our tertiary pediatric voice clinic., Study Design: This was a retrospective review., Methods: A retrospective review was undertaken of all consecutive patients aged 0-18 years who self-identified as professional voice users and attended our tertiary pediatric voice clinic between December 2010 and December 2021. We analyzed demographics, professional singing status, diagnosis, management, and clinical voice scores. The patients were subdivided into those aged 0-9, 10-16, and 17-18 years., Results: A total of 113 pediatric professional voice users attended the tertiary voice clinic in the study period. The commonest self-reported voice use was as a singer. Within the 0-9 years age group, there was a strong male predominance (22 males and three females) and mostly organic (52%) causes. For ages 10-16 years, there was a noted female predominance (15 males and 29 females). In the 17-18 years age group, there was a strong female predominance (10 males and 34 females), with predominantly functional diagnoses (48%). Of significance, only five of the 113 patients had nodules (4.4%)., Conclusions: We present a large data set of pediatric professional voice users and demonstrate the numerous underlying diagnoses for their dysphonia, particularly functional disorders. Our experience highlights the need for adequate vocal training for pediatric professional voice users and the need for a multidisciplinary diagnostic and management approach., Competing Interests: Declaration of Competing Interest None., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)

Introduction: To determine the consistency and accuracy of preoperative diagnosis in the voice clinic with intraoperative diagnosis and to suggest a standardized laryngeal examination protocol in the UK that is supported by evidence-based findings., Method: From January 2011-September 2014, 164 patients were referred to the Multidisciplinary Team voice clinic and diagnosed with laryngeal pathology that required phonosurgery. The visualization (videostrobolaryngoscopy) in clinic was performed using either rigid laryngoscope or a video-naso-laryngoscope. Intraoperatively, laryngeal visualization and surgical procedure was conducted using Storz Aida HD system, 10-mm rigid laryngoscope 0° or 5-mm rigid laryngoscope 0°/30° and a Zeiss S7 microscope., Results: Of the 164 patients seen in the multidisciplinary voice clinic, 86 clinic diagnoses were confirmed intraoperatively (52.4%), 15 patients had the diagnosis confirmed intraoperatively with additional lesion found (9.1%). The clinic diagnosis changed intraoperatively in 63 cases (38.4%). 61 (37.2%) patients seen in the voice clinic were diagnosed with cyst, in 39.3% the diagnosis was confirmed intraoperatively with 5 cases (8.2%) having an additional diagnosis. Twenty (12.2%) patients were diagnosed with polyps, with 80% confirmation intraoperatively; 3 patients (10%) had an additional diagnosis., Conclusion: Videolaryngostroboscopy imaging of the larynx provides an outpatient tool for accurately diagnosing more than 50% of laryngeal pathologies when interpreted by multidisciplinary voice clinicians. However direct laryngeal examination under general anesthesia remains the gold standard when obtaining accurate diagnoses of laryngeal pathology. Patients diagnosed with nonorganic voice disorders should be considered for direct laryngoscopy under general anesthetic should they fail to respond to conservative management., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The treatment of unilateral vocal fold palsy (UVFP) or bilateral vocal fold palsy (BVFP) has been the subject of debate and experiment for 150 years. To date, dozens of different surgical methods have been described to reinnervate this most complex of organs, the larynx. As yet, there is no consensus on the most functionally effective method of reinnervation. However, it is a rapidly expanding area of research and remains an area of controversy. Indications for reinnervation for both UVFP and BVFP are still evolving and our understanding of the neuromuscular supply to the larynx continues to expand. What may have been considered unacceptable results from previous studies with one pathology may actually be of benefit in patients with different pathologies. This uncertainty of treatment options and potential outcomes can be confusing. In addition alternative techniques have been postulated as mainstays or adjuncts of treatment to the stalwart of reinnervation, neurorrhaphy. Determining what the correct treatment for an individual patient should be is still a gray area. With this in mind, this article reviews the evolution of laryngeal reinnervation, reviews the current state of the science, and suggests directions in which it might move in the future., (Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: We believe that we have described the first instance of long-term follow-up of a bilateral Isshiki type IV thyroplasty in a 58-year-old woman after bilateral superior laryngeal nerve (SLN) damage., Method: Comparison of voice handicap index-10 (VHI-10) questionnaire and electrolaryngographic measurements pre- and post-thyroplasty (type IV)., Results: VHI-10 scores reduced from 25 pre-thyroplasty to seven and five at 6 and 34 months, respectively. Mean, mode, and median dynamic frequency range (DFx-1) scores increased from 118, 125, and 124 Hz preoperatively to 144, 172, and 163 Hz at 6 months and 167, 167, and 169 Hz, at 34 months, respectively (a subjectively higher voice). Range of tones produced while speaking reduced from an 80% range of 2.48 octaves and 90% range of 3.52 octaves to scores of 1.46 and 2.75 octaves for 80% and 90%, respectively at 6 months and 0.82 and 1.73 octaves at 34 months (a more defined voice). Ninety percent spectrum of single tone production increased from 0.17 octaves preoperatively to 0.55 octaves at 6 months and 0.49 octaves at 34 months., Discussion: Type IV thyroplasty is most commonly performed for the male-to-female transsexual patient. Bilateral SLN palsy can be effectively treated with this approach with good long-term results., Conclusion: Three-year follow-up for bilateral type IV thyroplasty reveals increased pitch, definition, and clarity but decreased range overall., (Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)