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WHEN SHOULD A CHILD BE
EVALUATED FOR HOARSENESS? HOW IS THE CAUSE OF HOARSENESS
FOUND? DOES MY CHILD NEED
SPEECH/VOICE THERAPY?
Irritation
of the voice box may cause swelling which can lead to hoarseness.
Cigarette smoke or noxious fumes from paint may be prime factors. Chronic
nose and sinus disease may contribute to irritation because of postnasal
drip. Chronic cough and throat clearing will then further damage already
irritated vocal cords. Allergies
may also increase mucous drainage, which worsens swelling of the vocal
cords. Air conditioning in the summer and dry heat in the winter can
contribute to dryness of vocal cords and lead to irritation. Other factors
contributing to irritation are mouthbreathing from chronic nasal
congestion, over usage of decongestants, and in older children, smoking
and alcohol ingestion. Other
less common causes of hoarseness include: 1.
Warts possibly obtained from the birth canal during the child's birth 2.
Scarring due to having a breathing tube placed into the voice box for
sickness or for routine surgery, 3.
Injury to the vocal cord nerves, 4.
Generalized nerve or muscle diseases, 5.
Injury to the neck and voice box, 6.
Tumors and cysts, 7.
Abnormal development of the voice box, 8.
Stomach acid, which spills up onto the voice box, 9.
Foreign body swallowed or inhaled, 10.
Infection. WHEN SHOULD A CHILD BE
EVALUATED FOR HOARSENESS? Hoarseness
is a term used to describe a problem of the voice box, which causes an
unpleasant rough sounding voice. A sudden onset of hoarseness is usually
more alarming to parents and this leads to an urgent doctor evaluation.
More commonly, parents themselves often do not notice the hoarseness until
teachers, friends or relatives point it out to them. Therefore the time of
initial occurrence of hoarseness is usually hard to determine. Your
child's history is extremely important in making the correct diagnosis.
The most common cause of hoarseness in children is due to excessive voice
use, which leads to the formation of vocal nodules. An accurate assessment
of how much stress your child puts on his voice box can be determined by
asking if your child screams, imitates loud sounds, or cries, sings, or
speaks loudly. These questions may give a general idea of the potential
for voice abuse. Hoarseness
should be evaluated when the hoarseness is persistent or interferes with
the ability of others to understand the child. Certainly if the symptoms
are worsening significantly, treatment should be sought immediately. Hoarseness
in children may vary in severity and in cause. It is important to
completely evaluate the child and not assume that the problem is due to
voice abuse. Although voice abuse is the most common cause of hoarseness
in children, serious underlying problems may also lead to hoarseness. HOW IS THE CAUSE OF
HOARSENESS FOUND? A
complete evaluation of the entire head and neck areas is very important.
Examining the ear may find ear fluid which causes a hearing loss and leads
the child to speak louder and irritate the voice box. Examination of the
nose may show evidence of allergies, sinus infections and other causes of
nasal blockage, which may lead to postnasal drip and mouth breathing, both
of which contribute to voice box irritation. Examination of the mouth may
reveal enlarged tonsils, which muffle the voice and is mistakenly thought
of as hoarseness. Neck masses and scars may give clues about other
possible diseases or potential for nerve injury. Fiberoptic
flexible endoscopy is a technique using a flexible telescope to look at
your child's voice box in the doctor's office using local anesthesia. It
is useful to assess the voice and look for diseases in children over the
age of 4 years. In younger children, this procedure is mostly a tool to
diagnose diseases because younger children tend to not cooperate with
speech assessment while a telescope is inserted into their noses. Treatment
will obviously depend upon the diagnosis. The most common cause of
hoarseness in children is vocal nodules (small calluses on the surface of
the vocal cords).
DOES MY CHILD NEED
SPEECH/VOICE THERAPY? In
every case, early involvement with the speech therapist is important. Even
the child whose major problem is vocal cord irritation may benefit from
speech therapy. Children with voice abuse need cooperation from speech
therapists, teachers and family members. Attention must be placed on
finding the areas of voice abuse and changing the child's habits with
behavior modification. With maximal treatment of voice abuse, the vocal nodules usually resolve. Back to TopDO VOCAL NODULES HAVE TO
BE REMOVED? If
in spite of the treatment and behavioral changes, the vocal cord nodules
and hoarseness remain, the nodules can be removed with surgery. If
long-term speech therapy has been unsuccessful, the removal of the nodules
may improve the voice. However, if the voice abuse patterns are not
changed, there is a good chance that the nodules will come back. Continued
speech therapy after surgical removal of vocal nodules is always helpful. The information provided on
this web site is not intended to take the place of consultation with your
physician. You should always consult a physician whenever you require
diagnosis or treatment. |
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Copyright © 2008 Atlanta Children's ENT. | |||
