PATIENTS AND METHODS:
This is a cross-sectional questionnaire-based survey conducted randomly
in 21 early childhood and primary schools from the private and
government sectors from April 2019 to November 2019 in the Eastern
Province of Saudi Arabia. The questionnaire was answered by 428
participants, who were the parent of a child attending one of the
randomly chosen schools. These parents were approached by their child’s
class teacher, who was also chosen randomly amongst her/his selected
school, by sending them a link to an online self-completed questionnaire
using the class e-mail group. The data collection lasted for a month and
the response rate was around 50%. The survey was designed on the basis
of previously published literature as well as our clinical
observations.15,16,19
The questionnaire was completed by one of the parents of the chosen
class children and covered the following aspects: sociodemographic
features, health and related comorbidities and medications, household
pets (presence vs absence), number of children in the family and child
birth order (first vs middle vs last), number of classes the child
attends per day, number of students per class, missing days from schools
due to voice problems (yes vs no), usual degree of child’s voice tone
(low vs moderate vs high), child’s participation in school activities or
sport exercises that require a loud voice (yes vs no), family history of
voice disorders (yes vs no), past history of frequent excessive crying
during infancy (yes vs no), history of letter pronunciation problems
(yes vs no), stuttering (yes vs no), history of intubation (yes vs no),
history of having a cold or recurrent cough in the past 2 years (yes vs
no), history of hearing problems (yes vs no), parent smoking status
(smoker vs non-smoker vs ex-smoker), history of vocal fold surgery (yes
vs no), Reflux Symptom Index (RSI),16 and Children’s
Voice Handicap Index-10 for parents (CVHI-10-P).15 An
RSI with a score > 13 indicates a subjective diagnosis of
LPR and a CVHI-10-P with a score > 11 indicates a
subjective diagnosis of voice disorders.
This study was approved by the Institutional Review Board (IRB) of King
Fahd Hospital (IRB-2019-01-271) and the parents’ consents were taken in
advance and at the end of the questionnaire. We attached an optional
question for children with voice disorders who wanted to seek medical
care in our otolaryngology department for further management.
Data was entered and factors associated with hoarseness were
investigated and analyzed using the Chi-square test, Fisher’s exact
test, and adjusted and unadjusted logistic regression models using SPSS
software version 20 (IBM, Chicago, Illinois, USA). For statistical
analysis, p <0.05 was considered statistically significant.