Pediatric Voice Disorders
Whether your child was born with a voice disorder or developed one in childhood, the Duke Voice Care Center can help. Our pediatric voice care specialists -- with clinic locations in Durham and Raleigh -- have the expertise to work with your child and family to diagnose vocal disorders and develop a customized treatment plan. We restore your child's voice to the best it can be and help them learn healthy ways to use their voice for life.
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 growth on the vocal cord (nodule, cyst, polyp)
- Papilloma -- a small, usually benign wart-like growth -- on the vocal cord
- Vocal cord dysfunction and chronic cough
- Vocal strain
- Vocal cord paralysis, sometimes following heart or lung surgery
These can affect your child's ability to speak and cause breathing and swallowing problems.
Consider a professional evaluation if your child has frequent laryngitis, seems to strain when talking, or complains of a scratchy throat.
Choosing a Voice Care Specialist for Your Child
At Duke, we use the latest techniques to evaluate your child and recommend the most appropriate treatment, based on their age and condition.
- We are one of the few voice centers in the Southeast with a comprehensive team of voice specialists with expertise in children's voice problems.
- Your child's care team will include pediatric laryngologists -- ear, nose, and throat (ENT) doctors who specialize in voice disorders -- and speech pathologists, all trained to evaluate and treat children with voice problems, swallowing disorders, and upper-airway breathing problems.
- If your child needs surgery, it will be performed by a pediatric laryngologist skilled in surgeries of children's voice boxes, which are different than an adult's. Our pediatric laryngologists' expertise ensures your child receives appropriate treatment for their current stage of development.
- Our 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.
- If your child's voice disorder is related to a medical condition such as allergies or asthma, we'll coordinate your child's care with the right specialists throughout Duke Health.
- Our ongoing research ensures your child receives the best, most up-to-date care for their voice disorder.
PEDIATRIC VOICE DISORDERS
Treatments
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Improves your child's speaking voice technique, pacing, and vocal hygiene. Your child works with a speech pathologist who guides them through vocal exercises to improve breathing, reduce throat strain, and find their 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.
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In rare cases, surgery may be recommended to remove noncancerous vocal cord cysts or polyps. While your child is under general anesthesia, tiny surgical instruments are inserted through his or her 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 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 after microsurgery is essential for optimal recovery.
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Injectable dissolvable fillers add bulk to vocal cords that have lost muscle tone due to vocal cord paralysis. A tiny needle is inserted into one or both vocal cords. The injection creates a stronger voice. This can be done in the operating room and is usually an outpatient procedure. The fillers are reabsorbed by your child's body over time.
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An implant (like a tiny shim) is placed through the voice box to reposition the paralyzed vocal cord and produce a stronger voice. Also known as "medialization laryngoplasty" or "laryngeal framework surgery," this procedure requires a small incision in the neck. Thyroplasty may be recommended if your child's vocal cord paralysis appears permanent and his or her voice is weak and breathy. This procedure is recommended for older children who have gone through puberty, to minimize dislodgement due to growth.
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Surgically reconnects a nerve to the weakened vocal cord muscle. This restores the vocal cords' tone and bulk, which makes the voice stronger. Full results can take two to six months. An injection into the vocal cord to move it to the center may be done at the same time.
PEDIATRIC VOICE DISORDERS
Tests
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 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 laryngologist 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 as well as a visual examination of your child's voice box. If chronic cough is a concern, your child's breathing or cough symptoms and other triggers will also be evaluated. Additional tests may be necessary to complete the evaluation.
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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 allows your child's team to look for any lesions, stiffness, paralysis, irregular movements, throat strain, or incomplete closure of the vocal cords. Videostroboscopy is often 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 good experience for your child and family. Your child's nose will be sprayed with a numbing medicine to minimize discomfort. A Child Life Specialist can be on hand for children who benefit from additional comfort measures before and during medical procedures or exams.
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Creates a visual display on a computer screen as your child speaks into a microphone. This allows the speech pathologist to see characteristics of your child's voice, including pitch, loudness, and vocal quality. It is used to identify abnormalities, including subtle vocal problems that cannot be detected with the unaided ear. This assessment is usually done at the beginning of voice therapy, and it may be repeated during treatment to monitor your child's progress.