Pediatric Hoarseness

What is hoarseness?

Hoarseness is the name for the breathy, coarse, or harsh-sounding speech produced from a variety of causes. It is important to find the cause of a hoarse voice, so the appropriate treatment plan can be developed.

What are some of the causes of a hoarse voice?

Any illness or process that directly or indirectly affects the VOCAL CORDS in the LARYNX (voice box), that does not allow the vocal cords to close completely, will result in a hoarse voice

The vocal cords can be affected directly by colds and croup or may be affected indirectly by non-infectious processes, environmental or traumatic causes, and congenital and genetic syndromes.

Hoarseness also may be caused by any process that affects the nerve that moves the vocal cords (the recurrent laryngeal nerve). This results in VOCAL CORD PARALYSIS.

What are some of the more common infectious causes of hoarseness?

Viral and bacterial infections can directly affect the throat and vocal cords, resulting in hoarseness. These illnesses are known as laryngitis, laryngotracheitis (croup), and laryngotracheobronchitis (bronchiolitis). These do not usually last more than a week or so, and can usually be identified and treated by your primary care physician. However, it is important to realize that hoarseness can continue for a month or so after the primary infection.

SINUSITIS or any infection involving a runny/stuffy nose resulting in drainage of the secretions into the throat (post-nasal drip) may also affect the vocal cords, resulting in hoarseness.

Which non-infectious processes can result in hoarseness?

Allergies are common non-infectious processes that can result in hoarseness. The secretions produced in common allergies can drip into the throat (post-nasal drip) irritating the throat and vocal cords. Allergies can also cause swelling of the vocal cords resulting in hoarseness. Successful treatment of the allergies will result in the resolution of the hoarse voice.

Excessive use or misuse of the voice leading to the formation of VOCAL CORD NODULES is another relatively common cause of hoarseness.

Gastroesophageal reflux disease (GERD) or reflux of stomach acid into the back of the throat will also cause hoarseness and may be more common than previously thought. Because reflux can be silent in many children, examination of the vocal cords and testing for reflux may be necessary to establish this cause of hoarseness.

Other non-infectious processes are many unusual causes of hoarseness. These can include vocal cord polyps, endocrine (glandular problems), and tumors of the larynx among others.

What are some of the more common traumatic causes of hoarseness?

Traumatic causes of hoarseness refers to damage to the neck or vocal cords through trauma. Some examples include caustic ingestions (acid, poisons), intubation (breathing tube placement), feeding tube placement, birth trauma, or other trauma (car or bike accidents).

What are some of the congenital and genetic causes of hoarseness?

An infant may be born with a deformity of the larynx (voice box), or a nerve problem causing hoarseness. In many cases, there may be STRIDOR or noisy breathing as well. These causes of hoarseness can include vocal cord paralysis, laryngomalacia, cysts, webs (a membrane blocking the opening), or clefts in the voice box. Some genetic (inherited) syndromes also involve deformities causing hoarseness.

What are some of the indirect causes of hoarseness?

Anything that could damage the nerve (recurrent laryngeal nerve) that moves the vocal cords may result in hoarseness. This may include many rare diseases involving the brain or nerves in the body. Occasionally a child is born with damage to this nerve. Surgery in the chest and around the heart and large blood vessels may also result in damage to the nerve.

Does an ear, nose, and throat specialist (otolaryngologist) always evaluate hoarseness?

An ear, nose, and throat specialist focuses on disorders of the head and neck (not including the eyes, brain, or spinal cord). As hoarseness results from a variety of causes, the best person to evaluate hoarseness is an ear, nose, and throat specialist. Treatment may include other specialists depending on the final diagnosis.

When should hoarseness be a concern?

In otherwise healthy children, hoarseness that has been present for four months or longer should be evaluated. In newborn children, children with a history of chest surgery, or those with other congenital problems, hoarseness should be evaluated more promptly. If your child has had a hoarse voice since they began speaking and it has not improved, it should be evaluated.

What does an evaluation consist of?

Not every child is similar, so each patient is evaluated according to their particular history. A thorough history and physical exam are performed. Your doctor may also order a hearing test to rule out hearing loss that sometimes accompanies hoarseness. Finally, an evaluation of the voice box with a special camera is performed. This is called a flexible laryngoscopy. Most often, it can be performed in the office under local (topical) anesthesia placed in the nose.