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Symptoms of Pediatric Voice Disorders
What are the symptoms of voice disorders in children?
Many symptoms are common among the disorders that cause hoarseness, but some are more specific to the individual cause.
Laryngopharyngeal Reflux (LPR)
Laryngopharyngeal reflux often causes hoarseness that is worse in morning. LPR may be associated
with a sour taste in the mouth or bad breath. Symptoms of heartburn are
often not present. Nocturnal cough may or may not be present.
Hoarseness may fluctuate over time as the reflux events come and go.
Nodules and Cysts
Although all forms of hoarseness will worsen with overuse, nodules
and cysts typically worsen at the end of the day or during times of
high use. Severe straining to initiate voicing (aphonia) can be common.
A harsh or aggressive attack required to initiate speech is typical,
caused by the increased mass on the vibrating fold.
Papillomas
Papillomas generally cause a progressive, ever-worsening hoarseness
that leads either to aphonia or respiratory distress. Although
fluctuations may be seen with use, there is a general trend toward a
worsening voice. Sometimes snoring is also associated with the
enlarging papillomas. If snoring worsens or breathing difficulty is
encountered in patients with papillomas, medical attention should be
promptly sought.
Laryngeal Web
Congenital laryngeal webs generally do not vary in terms of the
hoarseness observed. A child may have a persistent weakness or
quietness to the voice that has been present since birth.
Vocal Fold Scarring
Scarring from airway manipulation usually peaks 4-6 weeks after the
incident. Slow, progressive worsening of voice and breathing may
accelerate at the end of the this time period as the airway narrows.
This timing of events would be typical for voice disorders caused by
intubation.
Vocal Fold Tumors
Neoplasms or tumors of the larynx act similarly to papilloma. As
they grow there may be progressive worsening of the voice, perhaps
leading to breathing difficulty or stridor.
 Red Flag
- Noisy breathing (stridor) is a sign of obstruction or narrowing of the laryngeal or tracheal parts of the airway.
- Stridor is a sign of difficulty passing air.
- Any breathing difficulty needs immediate medical attention.
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