Voice Disorder Analysis in Children with Connective Tissue Disease Using Pediatric Voice Handicap Index and Fiber Optic Laryngoscopy

Background: Connective Tissue Disease (CTD) in children may involve the laryngeal muscles and structures, leading to voice disorders that can significantly affect communication and quality of life. Objectives: This study aimed to assess voice disorders in children with CTD using the Pediatric Voice Handicap Index (pVHI) score and Fiber Optic Laryngoscopy (FOL), and to analyze the association between these two parameters. Methods: This study included children aged 1–18 years diagnosed with CTD. The pVHI was used as a subjective tool for voice assessment (scores ≥10.5 indicated pathology), while FOL was used as an objective tool to evaluate the anatomy and physiology of the vocal folds and surrounding cartilages. The association between pVHI and FOL findings was assessed using the chi-square test with kappa agreement analysis. Results: There were 33 patients with SLE and 5 patients with other CTDs. Eight out of 38 children demonstrated high pVHI scores, while 30 out of 38 demonstrated low pVHI scores. Arytenoid hyperemia was the most frequent inflammatory finding (n = 7), followed by hyperemia of the vocal folds (n = 5). Edema was observed in the arytenoids (n = 2), as well as in the vocal folds and ventricular folds (n = 1 each). Hyperemia of the epiglottis and ventricular folds was each noted in one patient. A pVHI score ≥10.5 showed a significant association with abnormal FOL findings (OR = 8.250; 95% CI: 1.373–49.574; p = 0.012). The agreement between pVHI scores ≥10.5 and abnormal FOL findings was moderate (Kappa = 0.379, p = 0.012). Conclusions: The prevalence of voice disorders was identified in a substantial proportion (36.8%) of children with CTD. pVHI scores ≥10.5 were significantly associated with abnormal findings on fiber optic laryngoscopy. However, the pVHI alone cannot be used to diagnose voice disorders because its agreement with FOL findings was only moderate.