Saturday, June 19, 2010

Pediatric Voice Disorders - More Common Than You Might Think

Does your child have a raspy voice?  Are they very outgoing and do they like to yell and scream?  If they get a cold, do they lose their voice completely?  Do they suffer from repeat bouts of laryngitis?

Children, like adults, are prone to developing inflammation of the vocal cords from overuse.  When overuse occurs over an extended period of time, callouses may form in the middle of the vocal cords.  These callouses are referred to as vocal nodules, or vocal nodes.  Vocal nodules prevent normal vibration of the vocal cords, lead to incomplete closure of the vocal edges, and create a raspy vocal quality.  In particular, the voice declines in higher pitch phonation.  Vocal nodules are not typically associated with pain. 

Diagnosis is made by an otolaryngologist (ear nose throat surgeon) or laryngologist (voice specialist) using laryngeal endoscopy, ideally with videostroboscopy.  This is a slow motion video of the vocal cords vibrating, and is available in voice centers and some pediatric voice clinics. 

Masquerading as vocal nodules are other disorders affecting the vocal cords, including vocal cord cysts, polyps, papillomas, and sulci.  Vocal cord cysts are congenital or acquired collections of mucus or skin under the surface of the vocal cord.  Diagnosis can be made either with laryngeal videostroboscopy or with direct laryngoscopy (examining the vocal cords with the patient asleep).  Polyps are similar to vocal nodules, but are larger collections of vibrovascular tissue on one rather than both vocal cords.  Papilloma is a disease affecting children exposed to human papilloma virus (HPV). 

Treatment of vocal nodules in children is generally conservative with voice therapy and avoidance of vocal abuse.  Vocal nodes or nodules tend to regress when the child adheres to proper vocal hygeine.  In rare cases patients may benefit from minimally invasive vocal cord surgery.  For vocal cord polyps, cysts, and papilloma, the treatment is primarily surgical. 


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