Children with a history of upper airway obstruction present with varied diagnoses related to congenital and/or acquired conditions. Causes of obstruction are heterogeneous in nature and include glottic webs, vocal fold immobility, subglottic stenosis, trauma due to prolonged intubation or other injuries, and neurological impairment. Medical management is generally required for these children. A tracheotomy may be necessary, and some children undergo surgical reconstruction of the airway. When a tracheotomy is necessitated, decannulation, or removal of the tracheostomy tube and closure of stoma, is achieved in most cases.

Objective data regarding the voice and communication outcomes for this diverse population of children is limited. It is reported in the literature that children with a prolonged tracheostomy during early development are at risk for experiencing speech and language delays (Simon, Fowler, & Handler, 1983; Smith, Marsh, Cotton, & Myer, 1993). Incidence of voice disorders in children who have had laryngotracheal reconstructive surgery is also documented (Luft, Wetmore, Handler, & Postic, 1989; Sell & MacCurtain, 1988; Smith & Catlin, 1991; Zalzal, Loomis, Derkay, Murrray, & Thomsen, 1991), and it is recognized that children with altered laryngeal structure or function may compensate for voicing limitations (Jackson & Albamonte, 1994). While this information is general, it supports the need for intervention with this population. To date, however, there is limited objective data regarding the vocal characteristics and information regarding treatment for voice impairments with this population. The speech-language pathologist’s work with children who experience voice impairment concurrent with upper airway pathology is guided by the work of others in the area of voice treatment (Boone & McFarlane, 2000; Case, 1996; Colton & Casper, 1996; Stemple, Glaze, & Gerdemann, 2000; Verdolini, 1998).