Pediatric Voice Disorders

Voice therapy can improve your child's speaking voice by teaching them strategies like vocal pacing, vocal hygiene, and behaviors that help maintain 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 speaking. 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.

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. Also known as "phonomicrosurgery," this technique reduces the risk of scarring and offers 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.

One of the following procedures may be suggested if your child has vocal cord paralysis.

• Temporary Vocal Cord Augmentation: 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.