Measurement reliability of phonation threshold pressure in pediatric subjects
Matthew R. Hoffman MD, PhD  Austin J. Scholp BS  Calvin D. Hedberg BS  Jim R. Lamb BS  Maia N. Braden MS, CCC‐SLP  J. Scott McMurray MD  Jack J. Jiang MD, PhD
First published: 08 November 2018 https://doi.org/10.1002/lary.27418 Cited by: 1
Editor's Note: This Manuscript was accepted for publication on June 4, 2018.
Presented as a poster at the American Broncho‐Esophagological Association Annual Meeting, National Harbor, Maryland, U.S.A., April 18–22, 2018.
j.j.j. held a patent on the mechanical interruption device used in this study that has since expired; he has not received any financial benefit from it.
This study was funded by grant number R01 DC008153 from the National Institutes of Health, National Institute on Deafness and other Communicative Disorders, and the Diane M. Bless Endowed Chair, Division of Otolaryngology–Head and Neck Surgery at the University of Wisconsin–Madison, Madison, Wisconsin, U.S.A.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objectives/Hypothesis
Phonation threshold pressure (PTP), the minimum subglottal pressure (Ps) required for phonation, is sensitive to changes in laryngeal biomechanics and is often elevated with pathology. Little is reported on PTP in children; challenges with task performance and measurement reliability represent barriers to routine clinical assessment.

Study Design
Pilot study evaluating PTP and Ps measurement reliability in children using labial and mechanical interruption.

Methods
Twenty‐two subjects aged 4 to 17 years (10.7 ± 3.9 years) participated. Ten trials were performed for each method; task order was randomized. For labial interruption, subjects produced /pα/ five times at softest (onset PTP) and comfortable amplitude. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times for 250 ms each; mechanical interruption was performed with a mouthpiece and mask. PTP was recorded as the difference between Ps and supraglottal pressure at phonation cessation (offset PTP). Mean PTP and Ps and intrasubject coefficients of variation were compared. Correlations with age were evaluated.

Results
Mean PTP (P < .001) and Ps (P = .005) were higher for labial interruption. Intrasubject coefficients of variation for PTP (P = .554) and Ps (P = .305) were similar across methods. Coefficient of variation was related to age for mechanical‐mask trials only (r = −0.628, P = .00175).

Conclusions
Differences in means are likely related to differences in task and PTP hysteresis effect. Reliability is comparable with all methods; using a mouthpiece may be preferable to a mask for mechanical interruption. Measurement of PTP is noninvasive, reliable, and may be a useful adjunct in pediatric voice assessment.

Level of Evidence
3b

Laryngoscope, 129:1520–1526, 2019