“My five-year-old son constantly loses his voice, and has sounded hoarse for a long time. His teacher has a hard time hearing him and I’m concerned something is physically wrong. What should I do?”
If this sounds familiar, you are not alone. Chronic hoarseness is the most common voice problem in children. Unlike short-lived hoarseness typically caused by upper respiratory viral infections, chronic hoarseness can persist for months or even years if not treated. This can lead to communication difficulties in the classroom, on the playground, or in other noisy environments.
Why Some Kids Get Chronically Hoarse
Some children are hoarse from birth because of how their vocal cords developed. But most chronic hoarseness is caused by overuse or misuse of the voice.
Kids who are naturally loud or scream and yell a lot may incur injury of the vocal cords, the bands of tissue that vibrate to make sound. Speaking with injured vocal cords takes extra effort, and rather than resting their voices, kids typically get even louder. This sets off a repetitive cycle of increasing injury and pushing the voice, eventually causing bumps—also called nodules—to develop on the vocal cords, producing chronic hoarseness.
If your youngster experiences long-term hoarseness or has been hoarse longer than two or three weeks after getting over a respiratory infection, it’s time for an evaluation. Your pediatrician can refer you to a specialist to find the underlying cause and recommend the best course of treatment.
How It Is Diagnosed
Diagnosis involves laryngoscopy, a simple, 30-second procedure that allows inspection of the vocal cords. Older kids and those young enough to be held by a parent usually undergo laryngoscopy at the specialist’s office. After applying a topical anesthetic inside the nose, the doctor will insert a thin tube with a tiny camera through the child’s nose, down into the throat. Children between the ages of about four and seven may struggle and need to have it done in the operating room under anesthesia.
The most common finding is nodules, related to injury and chronic non-healing wounds of the vocal cords. Sometimes cysts or polyps are found, which are more advanced types of growths caused by overuse of the voice. Occasionally, examination will reveal papillomas, or warts, which generally occur in younger children and are usually related to a viral infection acquired in the birth canal.
Treatments for Chronic Hoarseness
Voice therapy. Most kids, particularly those with nodules, can be treated with voice therapy, where a voice therapist trains them how to speak and use their voices more efficiently. This might include teaching how air pressure affects the vocal cords, how to control the energy they put into their voices, and exercises to practice less abusive vocal behaviors.
Medication. In addition to voice therapy, some kids need steroid medication to calm down the bumps.
Voice rest. Your doctor might also recommend the child not talk for a period, but that may be difficult for younger children.
Surgery. Therapy alone may not be enough to treat cysts and polyps, which often must be removed surgically in an outpatient procedure. Papillomas typically require surgery as well. Pain is minimal and kids are generally up and active later in the day. It usually takes a couple of weeks for the voice to recover, so if surgery is performed during the academic year, children will have to miss some school to allow their voices to rest. It may be more practical for them to undergo surgery during summer break to minimize overusing their voices during recovery.
Temporary hoarseness is nothing to worry about, but don’t ignore longstanding hoarseness. Evaluation and treatment are essential for healing your child’s voice and improving his or her ability to communicate with the world.
Milan R. Amin, MD, is Director of NYU Langone’s Voice Center, specializing in the treatment of vocal cord problems, voice disorders, and swallowing and airway concerns. He is chief of the Division of Laryngology at NYU Langone, as well as president of the New York Laryngological Society.