Reliability of GRBAS evaluation of voice quality in children who have a history of airway reconstruction surgery and how this compares to parental report of voice-related quality of life

Voice evaluation includes laryngoscopy, perceptual judgement of voice quality, evaluation of respiratory function, acoustic analysis of the voice signal and patient reported subjective impact of voice on quality of life. This is recommended in adults (Dejonkere et al 2001) and children (Cohen et al 2012). Perceptual evaluation of voice often follows the CAPE-V (ASHA 2002) or GRBAS (Hirano 1981). Children requiring laryngotracheal reconstruction (LTR) surgery tend to have this procedure during infancy, where subglottic stenosis forms following intubation in medically fragile or premature infants. Clinicians require reliable measures, particularly where there is a degree of subjectivity. Aspects of the CAPE-V show a high degree of reliability in rating of severity, pitch, breathiness and roughness (Krival et al 2007, Kelchner et al 2008). UK clinicians favour the GRBAS though there is little published information about reliability in a paediatric population. Comparison of clinician perceptual evaluation with patient report shows weak agreement in adults (Karnell et al 2006) reinforcing the need for both measurements. The extent to which the same is the case in children needs further exploration.