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20Q: Pediatric Voice Disorders: Diagnostic and Treatment Approaches

20Q: Pediatric Voice Disorders: Diagnostic and Treatment Approaches
Susan Baker Brehm, PhD, CCC-SLP, Barbara (Derickson) Weinrich, PhD, CCC-SLP, Lisa Nelson Kelchner, PhD, CCC-SLP, BCS-S
August 21, 2019

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From the Desk of Ann Kummer

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I am particularly excited to introduce this article on Pediatric Voice Disorders, written by my good friends, Drs. Brehm, Weinrich, and Kelchner! As a team, they were very instrumental in developing the Center of Pediatric Voice Disorders at Cincinnati Children’s Hospital Medical Center when I was serving as the Senior Director of the Division of Speech-Language Pathology. Through their research and multiple publications and presentations, our Center obtain national and international recognition for excellence in the management of voice disorders. Because I am personally aware of their knowledge and expertise in this area, I am so thrilled that they agreed to do a 20Q for all of you.

Here is more information about these incredible professionals:

Susan Baker Brehm, Ph.D., is Professor and Chair of the Department of Speech Pathology and Audiology at Miami University. She is also a Research Affiliate at the Center of Pediatric Voice Disorders at Cincinnati Children’s Hospital Medical Center. Her research focuses on clinical assessment and voice outcomes in children with laryngeal and other upper airway disorders. She teaches coursework in the area of speech anatomy and physiology and speech and hearing science.

Barbara (Derickson) Weinrich, PhD, is Professor Emerita in the Department of Speech Pathology & Audiology (Miami University - Ohio), Research Associate at the Center for Pediatric Voice Disorders (Cincinnati Children’s Hospital Medical Center), and Fellow of the American Speech-Language-Hearing Association.  Dr. Weinrich began her clinical career in 1968 and maintains an active private practice.  She initiated her 39-year career in academia in 1975, teaching courses and providing clinical training in a variety of communication disorders, with a focus on voice and child language disorders.  Her current clinical research focuses on the assessment and treatment of voice disorders in children and adults, including a variety of approaches to unique voice problems and treatment efficacy.

Lisa Nelson Kelchner, PhD, BCS-S is a Professor in the Department of Communication Sciences and Disorders at the University of Cincinnati, a Research Associate at the Center for Pediatric Voice Disorders (Cincinnati Children’s Hospital Medical Center), and a Fellow of the American Speech-Language-Hearing Association. Dr. Kelchner joined the faculty at UC 2001 where she teaches or has taught courses in Dysphagia, Voice Disorders, and Neuro Bases of Communication Disorders, among other topics. She served as Interim Chair of the Department of Communication Sciences and Disorders for almost three years and Director of Graduate Studies for four years. Her current clinical research focuses on the assessment and treatment of voice disorders in children and adults with co-occurring swallowing disorders and topics in telehealth. Dr. Kelchner’s partnership with colleagues at Cincinnati Children’s Hospital Medical Center has resulted in successful grant funding and development of innovative treatment approaches for children with complex voice disorders.

In this article, Drs. Brehm, Weinrich, and Kelchner discuss how pediatric voice disorders differ from adult voice disorders, including differences in anatomy and etiology. This article provides information on the various causes of pediatric voice disorders. They discuss a comprehensive evaluation protocol, including medical assessment by an otolaryngologist. The treatment of specific types of voice disorders is discussed. Other topics include the impact of a voice disorder in a school setting on academic performance, social issues as a result of a voice disorder and even the evaluation and treatment of child vocal performers. I think you are going to love this article.

Now…read on, learn, and enjoy!

Ann W. Kummer, PhD, CCC-SLP, FASHA, 2017 ASHA Honors
Contributing Editor 

Browse the complete collection of 20Q with Ann Kummer CEU articles at www.speechpathology.com/20Q

20Q:  Pediatric Voice Disorders: Diagnostic and Treatment Approaches

Learning Outcomes

After this course, readers will be able to: 

  • Identify the multiple causes of voice disorders in children
  • Describe the diagnostic considerations for evaluating a voice disorder in a child
  • Identify the literature that supports the effectiveness of behavioral treatment of voice disorders in children

1. Why is it important to talk about pediatric voice disorders as distinguished from adult voice disorders?

There are several important reasons to talk about pediatric voice disorders and how they differ from adult voice disorders including but not limited to: (a) differences related to anatomy, (b) etiologic correlates, (c) development and learning, (d) social awareness, and (e) family considerations. For example, while the vocal and upper airway anatomy of the infant and child have all the same parts as an adult, the size and proximity of structures to each other and even their tissue make-up (e.g., vocal fold layers and cartilages) differ. The larynx of the infant and child is much higher in the neck, and the laryngeal cartilages (e.g., arytenoids) are softer. With the growth of the child, the relationship of head and neck structures more closely resemble that of an adult by about age seven years.  However, the larynx and vocal tract continue to grow and change throughout childhood with dramatic changes occurring during puberty, particularly for males. The layers of the vocal folds for both males and females are not fully differentiated until the early teens. Innervation of the larynx is, of course, the same as an adult (Cranial Nerve 10 and its branches), but the central controls for voice that allow discreet vocal motor control to support speech develop over time during the first few years.

Broadly the etiologies of pediatric voice disorders do parallel those found in the adult population. There are voice disorders that can be of an organic type and are due to structural, congenital, neurological, systemic, inflammatory, infectious, and traumatic (including iatrogenic) circumstances. Also, there are voice disorders that occur secondary to an inorganic type, such as the range of functional disorders (e.g., overuse, muscle tension dysphonia, paradoxical vocal fold dysfunction). When working with the pediatric population it is also necessary to have knowledge of how the various congenital and complex airway disorders can have a unique and life-long impact on a child’s voice. Regardless of the underlying etiology, it is often the case that the presentation, duration, and treatment approaches to pediatric voice disorders vary significantly from those in adults (Kelchner, Brehm, & Weinrich, 2012).

2. Why must the child be evaluated by a physician, preferably an otolaryngologist, prior to treatment of a voice disorder? 

The underlying etiology of a voice disorder must be identified prior to the start of any treatment for any individual at any age. The vocal folds and larynx must be inspected to determine the presence of lesions or other structural and physiological abnormalities. The nature and degree of dysphonia, or simply listening, will not provide the clinician with that information. In children, while bilateral lesions (i.e., nodules) are common, it is also not uncommon for a child to present with a cyst and contralateral edema, recurrent respiratory papillomatosis or unilateral vocal fold paralysis. Each of these requires different treatment approaches. Optimally the larynx needs to be visualized via a laryngeal mirror, nasoendoscopy (or distal chip endoscope), transoral nasal endoscope, or even a direct laryngoscopy performed in the operating room. These visualization procedures and knowledge of laryngeal structure and physiology are best handled by an otolaryngologist (Hartley, Braden & Thibeault, 2017; Kelchner, Brehm, & Weinrich, 2014).

3. Who are potential members of an interdisciplinary evaluation and treatment team?

An interdisciplinary evaluation and treatment team consists of multiple professionals from varied disciplines. These professionals complement one another to provide a comprehensive evaluation and management plan of care. The specific members of this pediatric team will be determined by the patient’s intake history. Potential members of the interdisciplinary team are speech-language pathologists, general medical practitioners (pediatricians), gastroenterologists, surgeons (pediatric otolaryngologists), medical (and possibly radiation) oncologists, pulmonologists, allergists, nurses, social workers, occupational therapists, dieticians, and pharmacists. The speech-language pathologist is the primary treatment provider and may manage the interdisciplinary team treatment following the comprehensive evaluation.

4. What are the standard evaluation tools use to assess pediatric voice disorders?

A comprehensive pediatric voice evaluation needs to inform the clinician of the circumstances leading to the development or discovery of the voice disorder, as well as the essential components of the child’s phonatory function. That is, how flexible is the child’s voice? How efficient is the child’s voice? What type of effort is needed for voicing? How much does the sound of the child’s voice interfere with social, academic, and family routines?  These data are needed for an informed approach to care and documentation of baseline abilities. The evaluation should include a thorough intake (background and history); handicapping indices; standardized perceptual assessment, like the Consensus Auditory Perceptual Assessment of Voice (CAPE-V); acoustic analysis including measures of average fundamental frequency as possible, frequency range, cepstral peak prominence, and intensity; aerodynamic measures, such as average airflow, estimated subglottal pressure, and maximum phonation time; and stroboscopic imaging via use of flexible nasal or transoral endoscopes. Often the sophisticated instrumentation necessary to obtain some of the aforementioned physiologic parameters related to airflow is not available to clinicians. Reasonable substitutes, carefully calibrated and applied systematically, can be useful for gathering meaningful data. 

5. Can a child tolerate a laryngeal exam?

In most cases, children are able to tolerate a rigid laryngoscopic examination or a flexible nasoendoscopic laryngeal exam without significant discomfort. Major medical centers that perform these examinations frequently with children often have a preparatory protocol for the child and their family which might include a coloring book/child-focused information book sent prior to an appointment. At a minimum, the procedure will be explained to the child (as appropriate to the child’s age) and topical anesthetics can be used in some cases to increase the tolerance of the exam. 

6. What are some ways to evaluate voice without instrumentation for acoustics and aerodynamics?

It is definitely recognized that most speech-language pathologists in a school setting or sometimes other pediatric settings will not have access to instrumentation for acoustic/aerodynamic measures, but still desire to document baseline function and have a means to track progress over time. While “low tech” options due exist, it is important for clinicians to understand their limitations and critiques of the methods. One of these lower technology measures is maximum phonation time (MPT). MPT is obtained by asking a child to sustain a vowel at a comfortable loudness and pitch level for as long as possible after taking the largest breath possible. The sustained phonation can be measured on any electronic device with a stopwatch (e.g., smartphone). The reliability of this measure is very much tied to the child breathing in to total lung capacity and breathing out to residual volume, which obviously cannot be measured in most environments. As with any maximum performance task, multiple measures (e.g., 3 attempts) should be obtained. Another lower technology measure is s/z ratio in which the child is asked to sustain a /s/ and then a /z/ for as long as possible, similar to the manner described for MPT. Again, multiple trials are essential, but one of the major difficulties with this measure is that the time of the /s/ is compared to the /z/. In general, the literature shows that children who have healthy vocal folds have a 1.0 s/z ratio (Tavares, et al., 2012), however, if the /s/ is much longer than the /z/ this can indicate that there is glottal incompetence due to a lesion or other abnormality of the vocal folds. Tavares and colleagues provide one study in which normative values are given for both MPT and s/z ratio. 

7. What is the most common voice disorder diagnosed in children? 

Vocal fold nodules are by far the most common cause of dysphonia in a child. Vocal fold nodules are bilateral, subepithelial, callus-like lesions that are generally the result of repeated trauma from voice misuse. However, as stated above, children may also have congenital laryngeal disorders which can include vocal fold cysts, laryngeal webs, and vocal fold paralysis. Furthermore, children can develop vocal fold polyps and granulomas similar to adults. Functional disorders, such as puberphonia, are described later in this article. 

8. Can gastroesophageal reflux and eosinophilic esophagitis cause voice problems in children? 

Yes, they can, particularly acid irritation from reflux. Any irritant like gastroesophageal reflux (GER) that breeches the laryngeal airway can inflame laryngeal tissue or exacerbate an existing condition. As part of the history, the pediatric patient and their parent are always asked about symptoms of reflux (throat clearing, lots of burps, stomach aches, difficulty swallowing, etc.). Examination of the laryngeal and hypopharyngeal area tissue are part of any laryngeal examination. Commonly described indirect evidence of acid irritation to the tissue in that area is erythema (redness), edema, and hypertrophy or thickened tissue. Otolaryngologists (OTL) frequently prescribe anti-reflux medications and diet regimens to treat GER.  OTLs may treat a patient for GER, regardless of a formal GER diagnosis, prior to any type of laryngeal/airway surgery to be sure the area is as “quiet” as possible during the peri- and post-operative period. Eosinophilic esophagitis (EE) is an allergic inflammation of the esophagus thought to be an allergic reaction to certain food groups. EE can aggravate symptoms of reflux and add to the child’s discomfort. A tissue biopsy is needed to formally diagnose eosinophilic esophagitis. If diagnosed, EE is treated with medication and diet change (Kelchner, Brehm, & Weinrich, 2012).

9. What are the challenges to seeing a child for a voice disorder in a school setting? 

The primary challenges associated with treating pediatric voice disorders in the school system include the ability of the clinician to provide compelling evidence that the presence of a voice disorder is educationally handicapping for the child; clinician caseload burden and perception that a voice disorder is a lower priority communication disorder; and limited clinician confidence with treating a voice disorder (Hartley, Braden & Thibeault, 2017).

10. How does a voice disorder impact academic performance? 

There are no clear data on exactly how the presence of a voice disorder impacts specific academic abilities unless there is an underlying etiology that is common to both the voice disorder and cognitive abilities that support a particular academic skill set (i.e., math, science, etc.). However, there are published data that show female children with voice disorders, particularly those that are more severe, can be viewed as less healthy, sociable, happy, intelligent, and employable by teachers (Zacharias, Kelchner & Creaghead, 2013). Intelligibility of connected speech is often compromised in children with voice disorders, particularly in the presence of background noise. Children may be asked to repeat themselves more often, not be called on in class, or may withdraw from classroom participation and other activities, such as music and theatre. Parents are often quite concerned about their child’s school experiences and their ability to fully participate in academic and related activities.

11. Is surgery recommended to treat vocal fold nodules or other lesions of the vocal folds? 

Surgery for a vocal fold lesion may be considered under certain circumstances if a course of therapy has been attempted (and the child has been compliant with recommendations) and no improvement is observed. Additionally, there are lesions that cannot be resolved with voice therapy alone including vocal fold cysts, some vocal fold polyps, particularly fibrous vocal fold nodules, and respiratory papillomas. There are many factors to consider prior to a recommendation for vocal fold surgery for a child. The child must demonstrate an ability to follow post-operative recommendations in terms of limited voice use, as well as any recommended follow-up therapy. It is preferable to have an otolaryngologist with specialized training in pediatrics and microflap techniques for optimal outcomes.   

12.  Will nodules just go away over time, as a child gets older?

Each child with vocal fold nodules will have varying precipitating factors and varying biological and environmental factors that will influence the evolution of the vocal nodules over time. Past studies have attempted to address this issue and in one such study it was found that in 21% of the study population (children with vocal fold nodules), voice complaints, including hoarseness, persisted post-puberty (deBodt et al., 2007). There are times when a “wait and see” approach may be appropriate if the child is too young or not cognitively able to participate in behavioral therapy or if the family feels they cannot attend or be compliant with voice therapy at the current time. In general, for those lesions that are amenable to voice therapy, it is generally thought that voice therapy should be attempted in children. 

13. So does voice therapy work in children? Are there any evidence-based therapy programs for children?

There is a growing body of literature that documents positive outcomes for children, primarily with vocal fold nodules, who have undergone behavioral voice therapy. Several studies have demonstrated improvements in acoustic measures and voice quality measures in children with vocal fold lesions after a course of voice therapy (e.g.,    Senkal & Ciyiltepe, 2013; Tezcaner et al., 2009; Trani et al., 2007; Valadez et al., 2012). One of the most recent contributions to the evidence-base for voice therapy in children was a randomized clinical trial by Hartnick and colleagues (2018) which examined the impact of voice therapy treatment methods in 114 children with vocal fold nodules ages 6 to 10 years old. Two therapy methods were examined. One focused more on direct therapy techniques for modifying the voice and the other was more of an indirect program that focused on modifying voice use and the child’s environment. Both techniques demonstrated positive outcomes which did not differ significantly on a voice quality of life scale. 

14. What is the youngest age that a child can participate in voice therapy?

Children typically speak their first words by 12 months, but they vocalize when they produce their first cry. If the pediatrician, pediatric nurse, and/or parents are concerned about the child’s vocal quality (breathiness, roughness, strain, pitch, loudness), a speech-language pathologist and pediatric otolaryngologist should be consulted. With children who are pre-toddlers, indirect treatment procedures can be performed by instructing the parents. Both indirect and modified, direct treatment approaches can be used with toddlers.

15.  What are some ways to modify voice therapy for children? 

All therapy modifications are personalized for the individual needs of the child with a voice disorder. The indirect treatments to eradicate vocal trauma must specifically address the voicing behaviors, and those behaviors beyond voicing, that exacerbate vocal abuse. For hygienic voice therapy to be effective, the clinician must obtain a thorough intake history that identifies all the abusive behaviors (e.g., vocal use, phonotrauma, hydration, gastroesophageal or laryngopharyngeal reflux) and are pertinent to the child with a voice disorder. The child, parent, and educators must all be active participants in modifying these behaviors, including using charts and reward systems that are meaningful to the child. Direct treatment approaches can be modified for young child by using visual imagery, such as, “gliding upward or downward with a toy airplane” for vocal glides or using technology with apps and/or gaming options for various voice parameters. Additionally, meaningful verbal representations, such as “buzz like a bee” for lip buzzes can enhance task performance. Rather than matching notes for vocal exercises, young children can produce comfortable low, middle, and high-pitched notes. Sentence and phrase lengths can be shortened for resonance therapy. Blowing bubbles and straw phonation are useful for semi-occlusion of the vocal tract. It is important to consider the personality of the child and combine vocal exercises with kinesthetic movement in creative manners that engage the child and increase compliance.

16. What are some aspects of voice that an SLP could evaluate in a child who is a singer with a voice disorder?

An SLP’s voice assessment of child who is a singer would not vary notably from a child who is a non-singer. A comprehensive voice history is imperative and should highlight¬¬ voice use, aberrant vocal symptoms, type/amount of singing, medications, allergies, and extensive vocal hygiene information. The assessment protocol should examine perceptual, acoustic, and aerodynamic features of voice, as well as the endoscopic/stroboscopic characteristics of the laryngeal system to assess glottic closure patterns, supraglottic activity, vocal fold edge, mucosal flexibility, laryngeal movement patterns, etc. An SLP with training in vocal performance could provide a technical voice assessment to evaluate voice breaks during vocal slides and within a singing passage, as well as use of registers, overall breathiness, overall timbre, and voice/vocal quality in the singing passage. Any dysphonia, loss of frequency range, throat pain, resonance abnormalities, or abnormal vocal/physiologic findings in the formal assessment should warrant referral to an otolaryngologist to evaluate possible laryngeal pathology.

 

17. Is it beneficial for a child to take private voice lessons?

Children with an aptitude and enthusiasm for singing may benefit from private or group lessons. Professional children’s choirs can be found in larger populated regions. These can enhance good vocal techniques. Some community theater productions are designed for child performers. Private voice instructors should provide vocal training that enhances flexible laryngeal musculature to train neuromuscular patterns using repetitive vocal drills. These drills promote agility and flexibility; therefore, they should be enticing to the children so that they perform them in daily practice. Whether it is a private lesson, group lesson, or vocal studio, the objective should be to promote a healthy, efficient singing voice and prevent vocal injury.

18. I have a high school athlete on my caseload with paradoxical vocal fold dysfunction (PVFD) – what do I do?

PVFD occurs when the vocal folds involuntarily adduct during the inspiratory phase of breathing and create an obstruction in the airway. It is typically seen in individuals ages 10 to 40 years, and is related to physical exercise, laryngeal hyperreactivity, or emotions. Common characteristics include neck or upper chest tightness and inspiratory stridor. Breathlessness, coughing, and voice change may be observed. It is important to identify the triggers for episodes, and these events should be journaled for stressors, foods, and environmental conditions. When the behaviors are identified, strategies, such as progressive relaxation techniques, should be developed to improve function. Respiratory training techniques should include abdominal breathing, panting, and pursed-lip inhalation. Finally, the high school athlete needs to gain independence through self-awareness to use the learned techniques when a stimulus arises.

19. What is puberphonia and how do I treat it?

Puberphonia is a functional voice disorder that is characterized by a high-pitched voice, more commonly seen in males following puberty. Also, the voice may be breathy with a soft volume. There may be a psychological cause (e.g., emotional/social immaturity or gender identification issues) and/or a medical cause. Therefore, a medical evaluation should be performed to identify whether the cause is hearing loss, delayed maturation of laryngeal structures due to endocrine disorder, or neuromuscular control issues. Treatment techniques could include laryngeal massage therapy, reduction of tension during speech, and visual biofeedback with speech software to mark acceptable frequency ranges during speech. When the lower-pitched voice is accomplished in unstructured speech tasks, the use of the appropriate voice with family members and peers may require support from the clinician. 

20. I have a child on my caseload who had airway reconstruction at age 2 years. The child now vocalizes with his false vocal folds. Why does he do that? How can I help him? 

There are a number of reasons that a child who has undergone airway reconstruction might utilize the false vocal folds for phonation. Following airway surgery, there may be laryngeal nerve damage that causes paresis or paralysis to one or both true vocal folds. Children are highly skilled at utilizing other laryngeal structures to establish a vibratory source. Often the goal of voice therapy for children who must use supraglottic structures to phonate is to help them find the best sounding voice that is also the most efficient (high subglottal pressures to initiate phonation with these structures are often needed). Semi-occluded or modified resonant voice exercises may assist in finding these voicing patterns and extending them into connected speech. In some cases, depending on the voice demands for the child, amplification devices may be appropriate in some classroom situations (e.g., presentations). A team-based approach that involves the child, family, hospital-based otolaryngologist/SLP, and the SLP treating in the community will generally provide the best outcomes. More information can be found on evaluation and intervention recommendations for this special population in the text Pediatric Voice: A Modern, Collaborative Approach (Kelchner, Brehm, & Weinrich, 2014). 

References

De Bodt, M.S., Ketelslagers, K., Peeters, T., Wuyts, F.L., Mertens, F., Pattyn, J., et al. (2007). Evolution of vocal fold nodules from childhood to adolescence. Journal of Voice, 21(2), 151-156.

Hartley, N.A., Braden, M., & Thibeault, S.L. (2017). Practice patterns of speech-language pathologists in pediatric vocal health. American Journal of Speech-Language Pathology, 26, 281-300.

Hartnick, C., Ballif, C., De Guzman, V., Sataloff, R., Campisi, P., Kerschner, J., et al. (2018). Indirect vs direct voice therapy for children with vocal nodules: A randomized clinical trial. JAMA Otolaryngology-Head & Neck Surgery. 144(2): 156-163.

Kelchner, L., Baker Brehm, S., & Weinrich, B. (2014). Pediatric Voice: A Modern, Collaborative Approach to Care. Plural Publishing, San Diego, CA.

Senkal, A. & Ciyiltepe, M. (2013). Effects of voice therapy in school-age children. Journal of Voice, 27(6), 787.e19-e25.

Tavares, E.L.M., Brasolotto, A.G., Rodrigues, S.A., Benito Pessin, A.B., & Garcia Martins, R.H. (2012). Maximum phonation time and s/z ratio in a large child cohort. Journal of Voice, 26, 675.e1-675.e4.

Tezcaner, C. Z., Karatayli Ozgursoy, S., Sati, I., & Dursun, G. (2009). Changes after voice therapy in objective and subjective voice measurements of pediatric patients with vocal nodules. European Archives of Oto-Rhino-Laryngology266(12), 1923-1927.

Trani, M., Ghidini, A., Bergamini, G., & Presutti, L. (2007). Voice therapy in pediatric functional dysphonia: a prospective study. International Journal of Pediatric Otorhinolaryngology71(3), 379-384.

Valadez, V., Ysunza, A., Ocharan-Hernandez, E., Garrido-Bustamante, N., Sanchez-Valerio, A, & Pamplona, M. (2012). Voice parameter and videonasolaryngoscopy in children with vocal nodules: A longitudinal study, before, and after therapy. International Journal of Pediatric Otorhinolaryngology, 76, 1361-1365

Zacharias, S. Kelchner, L., & Creaghead, N. (2013). Teachers’ perceptions of adolescent females with voice disorders. Journal of Speech-Language Hearing Services in Schools, 44, 174-182.

Citation

Brehm, S.B., Weinrich, B., & Kelcher, L. (2019). 20Q: Pediatric Voice Disorders: Diagnostic and Treatment Approaches. SpeechPathology.com, Article 20228. Retrieved from www.speechpathology.com

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susan baker brehm

Susan Baker Brehm, PhD, CCC-SLP

Susan Baker Brehm, PhD, is Professor and Chair of the Department of Speech Pathology and Audiology at Miami University. She is also a Research Affiliate at the Center of Pediatric Voice Disorders at Cincinnati Children’s Hospital Medical Center. Her research focuses on clinical assessment and voice outcomes in children with laryngeal and other upper airway disorders. She teaches coursework in the area of speech anatomy and physiology and speech and hearing science.


barbara derickson weinrich

Barbara (Derickson) Weinrich, PhD, CCC-SLP

Barbara (Derickson) Weinrich, PhD, is Professor Emerita in the Department of Speech Pathology & Audiology (Miami University - Ohio), Research Associate at the Center for Pediatric Voice Disorders (Cincinnati Children’s Hospital Medical Center), and Fellow of the American Speech-Language-Hearing Association.  Dr. Weinrich began her clinical career in 1968 and maintains an active private practice.  She initiated her 39-year career in academia in 1975, teaching courses and providing clinical training in a variety of communication disorders, with a focus on voice and child language disorders.  Her current clinical research focuses on the assessment and treatment of voice disorders in children and adults, including a variety of approaches to unique voice problems and treatment efficacy.


lisa nelson kelchner

Lisa Nelson Kelchner, PhD, CCC-SLP, BCS-S

Lisa Nelson Kelchner, PhD, BCS-S is a Professor in the Department of Communication Sciences and Disorders at the University of Cincinnati, a Research Associate at the Center for Pediatric Voice Disorders (Cincinnati Children’s Hospital Medical Center), and a Fellow of the American Speech-Language-Hearing Association. Dr. Kelchner joined the faculty at UC 2001  where she teaches or has taught courses in Dysphagia, Voice Disorders, and Neuro Bases of Communication Disorders, among other topics. She served as Interim Chair of the Department of Communication Sciences and Disorders for almost three years and Director of Graduate Studies for four years. Her current clinical research focuses on the assessment and treatment of voice disorders in children and adults with co-occurring swallowing disorders and topics in telehealth. Dr. Kelchner’s partnership with colleagues at Cincinnati Children’s Hospital Medical Center has resulted in successful grant funding and development of innovative treatment approaches for children with complex voice disorders.



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