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Navigating Pediatric Voice Disorders

Using actual patient cases, doctors discussed findings and recommended treatments for various disorders in “Pediatric Voice Disorders: Diagnosis and Management” during the Annual Meeting. They focused the presentation on vocal cord nodules, paralysis, papilloma, and airway reconstruction dysphonia.

Alessandro de Alarcon, MD, of Cincinnati Children’s Hospital Medical Center, and moderator of the panel, reported a six to 24 percent incidence of childhood dysphonia, and more than one million children with voice disorders.

In the past, family physicians took a wait-and-see approach to pediatric voice disorders, suggesting children would simply grow out of them. However, changes in pitch, loudness, and overall vocal quality can interfere with communication skills.

Dr. Alarcon pointed to research showing that voice disorders could have a significant negative effect on a child’s life. Today, there is concern that children with dysphonia are judged more negatively than their peers.

Children and adolescents feel that their voice disorders result in negative attention and limit their participation in activities, according to some reports. Further, parents have expressed concern that their children might not ever have a “normal” voice.

When evaluating children with voice disorders, the panel encouraged a combined effort between a pediatric otolaryngologist and speech language pathologist (SLP) as a first step in a child’s care, with referrals to other medical specialties as needed. They recommended a complete pediatric voice assessment, underscoring the need for a thorough medical history, observations of voice quality during spontaneous speech, laryngeal visualization, and physician examination.

The session provided patient examples in which children presented with dysphonia. The doctors ticked off their concerns, recommending an effective history, reliable recording and voice analyses for thorough assessment, as well as for measuring treatment outcomes following behavioral or surgical management. Although surgical management came up, they said they preferred to exhaust all other forms of treatment before resorting to surgical fixes.

One example they provided was a five-year-old child presenting with hoarseness. Her pediatrician recommended a pediatric otolaryngologist because her voice was rough. Her mother reported her voice had been rough since birth, she wasn’t a vocal abuser, and she didn’t typically lose her voice.

They agreed the first step should be to make certain there is no other medical condition causing it, such as papilloma. Following that, they recommended visualizing the issue, investigating if there is something obvious like excessive throat clearing, and then investigate for nodules and cysts.

Another discussion point was if nodules ever really needed to be eliminated. Scott M. Rickert, MD, NYU Langone Health, said, “Nodules are like callouses. Less use and they will go away.”

Julina Ongkasuwan, MD, Baylor College of Medicine, agreed. “The larynx has all kinds of lumps and bumps. It is less about what they look like and more about function.”

“Remember that kids are developing until they are 13 years old,” said Karen B. Zur, MD, Children’s Hospital of Philadelphia Pediatric Otolaryngology. “It is rare to take kids to the OR. The case must be extreme.”