Pediatric Voice Disorders

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About Children's Voice Disorders

Children can develop voice problems from overusing 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 cord dysfunction and chronic cough
Vocal strain
Vocal cord paralysis, sometimes following heart or lung surgery

These conditions can affect your child's ability to speak and can cause breathing and swallowing problems. Consider a professional evaluation if your child has frequent laryngitis, seems to strain when talking, or complains often of a scratchy throat.

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Pediatric Voice Disorder Treatments

Voice Therapy

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.

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. 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.

Procedures for Vocal Cord Paralysis in Children

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.

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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

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). A flashing strobe light simulates slow motion video images of your child's vocal cords. This test allows your child's team to look for any growths, paralysis, irregular movements, or throat strain involving the vocal cords. Videolaryngostroboscopy is essential to reach an accurate diagnosis and determine the best treatment for your child.

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. At the Duke Children’s Health Center, a Child Life Specialist is available to help explain what will happen during the exam and provide additional comfort.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in nine pediatric specialties.

Why Choose Duke

We use the latest techniques to evaluate your child and recommend the most appropriate treatment, based on their age and condition.

Comprehensive Team of Voice Specialists
We are one of the few voice centers in the Southeast with a comprehensive team of voice specialists who have expertise in children's voice problems.

Pediatric ENT Experts
Your child's care team will include a pediatric otolaryngologist -- an ear, nose, and throat (ENT) doctor who specializes in voice disorders -- and speech pathologists, all trained to evaluate and treat children with voice problems, swallowing disorders, and airway problems.

Skilled Pediatric Surgeons
If your child needs surgery, our surgeons are skilled in operating on children's voice boxes. Our pediatric otolaryngologists have the necessary expertise and experience, ensuring your child receives the very best care.

Singing Voice Rehabilitation
Our clinical singing voice specialists -- speech pathologists with additional training in vocal performance and singing voice rehabilitation -- are experienced performers, singers, and singing teachers who understand the special needs of the young singer. They bring empathy and clinical expertise to evaluating and providing specialized therapy to singers and performers of all ages.

Coordination with Other Specialists
If a child has other medical conditions that may contribute to voice strain -- such as allergies, asthma, or acid reflux -- we work with other providers throughout Duke Health to ensure you receive the best care from an integrated team.

Access to the Latest Research
Our ongoing research ensures your child receives the best, most up-to-date care for their voice disorder.