About Children's Voice Disorders
Children can develop voice problems from how they use their voices or from medical conditions like allergies, asthma, and acid reflux. Less often, children may be born with a voice disorder. Common voice problems in children include:
- Benign swelling or lesions (edema, nodules, cysts, or polyps) on the vocal cords, also known as vocal folds
- Papilloma -- a small, usually benign, wart-like growth -- on the vocal cords
- Vocal strain
- Vocal cord paralysis, sometimes following heart or lung surgery
These conditions can affect the clarity of your child's voice and can cause breathing and/or swallowing problems. Consider a professional evaluation if your child has frequent hoarseness, seems to strain when talking, or complains often of a scratchy throat.
Pediatric Voice Disorder Treatments
Voice therapy can improve your child's voice by teaching them exercises and behaviors that support a healthy voice. Your child works with a speech pathologist who guides them through vocal exercises to improve breathing, reduce throat strain, and find an optimal pitch and volume for strong, healthy voicing. We increase awareness of healthy voice use and encourage your child to avoid harmful vocal behaviors such as yelling and screaming. We involve your whole family in the process in order to help your child implement good strategies at home.
Microsurgery for Non-Cancerous Lesions
Most of the time, vocal fold lesions in children do not need surgery and respond very well to specific voice therapy. In rare cases, surgery may be recommended to remove non-cancerous vocal cord lesions. While your child is under general anesthesia, tiny surgical instruments are inserted through their mouth into the throat. The surgeon makes a very small incision away from the vibrating edge of the vocal cord, and a tiny flap of tissue is lifted so the lesion -- often a cyst or polyp -- can be removed. This technique reduces the risk of scarring and supports the best voice outcomes. A period of complete voice rest is required after surgery, so your child's age and maturity are factors in deciding whether to proceed with surgery. Voice therapy is essential for optimal recovery after microsurgery.
Procedures for Vocal Cord Paralysis in Children
One of the following procedures may be suggested if your child has vocal cord paralysis.
- Injectable Fillers: Injectable, dissolvable fillers add bulk to vocal cords that have lost muscle tone due to vocal cord paralysis. A tiny needle is inserted into the area next to one or both vocal cords. The injection creates a stronger voice. This is done in the operating room under general anesthesia and is usually an outpatient procedure. The fillers are reabsorbed by your child's body over time, so it is possible the procedure may need to be repeated if the improvement does not last. In some cases more permanent fillers such as fat can be used to move the vocal cord and allow for a stronger voice and better swallowing.
- Thyroplasty: While your child is under light anesthesia, an implant (like a tiny shim) is placed next to the paralyzed vocal cord to reposition it to produce a stronger voice. This procedure requires a small incision in the neck. Thyroplasty may be recommended if your child's vocal cord paralysis appears permanent and their voice is weak and breathy. This procedure is recommended for older children who have already gone through puberty to avoid the shim being dislodged as the child grows.
- Laryngeal Reinnervation: This procedure is performed under general anesthesia and connects a nerve to the weakened vocal cord. This restores tone and bulk to the vocal cords, which makes the voice stronger. Full results can take two to six months to become evident. An injection into the vocal cord to move it may be done at the same time to provide temporary improvement of the voice while waiting for the full effects of this procedure.
Tests for Pediatric Voice Disorders
A pediatric otolaryngologist and speech pathologist will conduct a comprehensive voice evaluation of your child. Together, our experts will assess the causes of your child's voice problem to ensure you receive an accurate diagnosis. We evaluate your child's voice use patterns -- how much they speak, sing, or use a loud voice -- as well as what their voice sounds like. Our pediatric otolaryngologist will evaluate whether your child's voice changes have a medical cause such as illness, allergies, acid reflux, or recent surgery.
We perform a head-and-neck examination and a visual examination of your child's voice box. If chronic cough is a concern, your child's breathing or cough symptoms will also be evaluated. Additional tests may be necessary to complete the evaluation.
Videolaryngostroboscopy
The gold standard for evaluating the vocal cords and voice box, this detailed visual exam helps us evaluate how your child's vocal cords vibrate while they make sounds. A tiny camera attached to a small tube called an endoscope is inserted through the nose and allows us to see your child's vocal cords and larynx (voice box). The camera records while a flashing strobe light simulates slow motion video capture of the vocal cords moving. Compared to a still photo, this video allows your child’s provider to see subtle changes in how the voice box and throat function when your child makes different sounds. This test allows your child's team to look for any growths, paralysis, irregular movements, or throat strain involving the voice box. Videolaryngostroboscopy is essential to reach an accurate diagnosis and determine the best treatment for your child. It is typically only available at highly specialized voice care centers, like those at Duke.
The exam takes just a few minutes, and every effort is made to provide a positive experience for your child and family. Your child's nose will be sprayed with a numbing medicine to minimize discomfort and enlarge the space inside the nose, making it more comfortable to pass the camera. At our Duke Children’s Health Center location, a child life specialist is available to help explain what will happen during the exam and provide additional comfort.
