Voice Problems

Children can develop problems with their voice. The most common symptom of a vocal cord problem is hoarseness or breathiness. The pediatric voice center was established to help children and their families evaluate, diagnose, and treat problems of the pediatric voice.

What are voice problems?

Voice and speech are not the same thing. Voice problems are difficulties with sound production, not with formation of words. Most of these problems originate in the larynx (“voice box”), and are characterized by a hoarse or quiet voice.
The causes of voice problems include:

• Vocal nodules or polyps
• Vocal cord paralysis
• Laryngeal tumors
• Acid reflux disease
• Papillomas
• Neurologic disease
• Vascular malformations
• Vocal cord webs
• Scarring of the larynx or vocal cords from disease or previous surgery

How are voice problems diagnosed?

Most evaluations of voice problems will include a laryngeal video stroboscopic exam. This special test utilizes a thin, flexible laryngeal endoscope, which is passed down the child’s nose into the back of the throat, revealing the vocal cords.* The beauty of a laryngeal video stroboscope (LVS) is that it allows health professionals to view your child’s voice box while in motion. It emits a rapidly flashing light, which slows down the apparent movement of each vocal cord, revealing specific problems such as scarring, small tumors, and incomplete vocal cord closure.

This 5-10 minute procedure can be done in the office without medication or shots. Doctors and speech pathologists will then evaluate the videographic record and make appropriate recommendations.

*Adult voice centers use rigid scopes which most children cannot tolerate.

What can I and my child expect at our visit?

First you and your child will meet with one of the physicians in our office. The doctor will ask you a number of questions about your child's voice and discuss your concerns.

An exam at the Pediatric Voice Center will most likely include insertion of a thin, flexible fiberoptic scope down your child’s nose and into the back of the throat. It is a bit uncomfortable, but it does not hurt. Most children tolerate this procedure very well. In children over 4 years old, exams using the LVS have a 90% first-time success rate for tolerance and high quality diagnostic information.

Here are the steps of the exam:

• Drops may be put in your child’s nose to help decongest or numb the nasal passage.
• The child may sit alone or on a parent’s lap.
• The scope (about the size of a spaghetti noodle) will be passed through one side of the nose and down the throat. This scope will illuminate the larynx.
• With the child’s vocal cords visible on a TV monitor, he or she will be asked to say certain words and sounds (most frequently “eeeee”).
• The scope will be removed. There is no after-pain. In rare cases, a slight nosebleed may occur.

How are voice problems treated?

Depending on the results of your child’s exam, the following treatments might be recommended:

• In-office voice therapy with a speech therapist of your choice
• At-home voice therapy with a home therapist
• A more in-depth exam under anesthesia (direct laryngoscopy)
• Surgery on the larynx

For additional information or to schedule an appointment for your child’s voice evaluation, please contact our office.

This information is provided as a service to our patients. The information is for educational and informational purposes only and should NOT be used as a substitute for the advice of your child's physician.