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Management of dysphonia in children

Published online by Cambridge University Press:  08 March 2017

A Connelly ,
W A Clement  and
H Kubba
A Connelly
Affiliation:
Department of Otolaryngology, Royal Hospital for Sick Children, Glasgow, Scotland, UK
W A Clement
Affiliation:
Department of Otolaryngology, Royal Hospital for Sick Children, Glasgow, Scotland, UK
H Kubba*
Affiliation:
Department of Otolaryngology, Royal Hospital for Sick Children, Glasgow, Scotland, UK
*
Address for correspondence: Mr H Kubba, Department of Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, UK. Fax: +44 141 2010865 E-mail: [email protected]
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Abstract

Background:

Dysphonia is common in children, but practice varies considerably regarding what, if any, investigations are performed and how the condition is managed. Although childhood dysphonia is mostly due to non-serious causes such as voice misuse, very serious pathology such as papillomatosis or malignancy needs occasionally to be excluded, and treatable congenital anomalies such as webs and cysts can be missed. Voice clinics and voice therapy services are now well established in most adult health services in the developed world, but equivalent services for children are less common, at least in the UK.

Methods:

We retrospectively reviewed the records of all children presenting to our large children's hospital with a primary complaint of dysphonia between January 2001 and October 2007, in order to determine their management, investigations and final diagnosis.

Results:

We identified 142 children. Case records were found for 137 (97 per cent). Eight-three children were male (61 per cent) and 54 female (39 per cent). Ages ranged from two months to 15 years (median 5.3 years). In 10 children (7 per cent), hoarseness was congenital, presenting as a hoarse, weak cry at birth. In 15 children (11 per cent), onset of hoarseness was related to a specific surgical procedure. The larynx was visualised by mirror alone in 23 children (17 per cent), by awake fibre-optic laryngoscopy in 27 (20 per cent) and by microlaryngoscopy-bronchoscopy under anaesthesia in 42 (31 per cent). Forty children (29 per cent) did not undergo laryngeal visualisation at any time and were diagnosed based on history alone. A further five (4 per cent) were scheduled for direct laryngoscopy but this was not performed due to resolution of symptoms. Voice abuse accounted for 62 (45 per cent) of all diagnoses.

Conclusions:

Childhood dysphonia accounts for a large number of referrals. There is considerable variation in how these children are managed. A more structured approach to diagnosis and investigation would be beneficial, perhaps within the setting of a dedicated paediatric voice clinic.

Keywords

DysphoniaChildrenPaediatricsHoarseness
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 6 , June 2009 , pp. 642 - 647
Copyright
Copyright © JLO (1984) Limited 2009

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References

1 Carding, PN, Roulstone, S, Northstone, K, ALSPAC Study Team. The prevalence of childhood dysphonia: a cross-sectional study. J Voice 2006;20:623–30CrossRefGoogle ScholarPubMed
2 De Bodt, MS, Ketelslagers, K, Peeters, T, Wuyuts, FL, Mertens, F, Pattyn, J et al. Evolution of vocal fold nodules from childhood to adolescence. J Voice 2007;21:151–6CrossRefGoogle ScholarPubMed
3 Shah, RK, Woodnorth, GH, Glynn, A, Nuss, RC. Pediatric vocal fold nodules: correlation with perceptual voice analysis. Int J Pediatr Otorhinolaryngol 2005;69:903–9CrossRefGoogle ScholarPubMed
4 Carr, MM, Nguyen, A, Nagy, M, Poje, C, Pizzuto, M, Brodsky, L. Clinical presentation as a guide to the identification of GERD in children. Int J Pediatr Otorhinolaryngol 2000;54:27–32CrossRefGoogle Scholar
5 Gumpert, L, Kalach, N, Dupont, C, Contencin, P. Hoarseness and gastroesophageal reflux in children. J Laryngol Otol 1998;112:49–54CrossRefGoogle ScholarPubMed
6 Block, BB, Brodsky, L. Hoarseness in children: the role of laryngopharyngeal reflux. Int J Pediatr Otorhinolaryngol 2007;71:1361–9CrossRefGoogle ScholarPubMed
7 Fang, TJ, Lee, LA, Li, HY, Yang, C, Huang, CG. Helicobacter pylori colonization in the larynges of patients with hoarseness. Laryngoscope 2008;118:389–93CrossRefGoogle ScholarPubMed
8 Mandell, DL, Kay, DJ, Dohar, JE, Yellon, RF. Lack of association between esophageal biopsy, bronchoalveolar lavage and endoscopy findings in hoarse children. Arch Otolaryngol Head Neck Surg 2004;130:1293–7CrossRefGoogle ScholarPubMed
9 McMurray, JS, Gerber, M, Stern, Y, Walner, D, Rudolph, C, Willging, JP et al. Role of laryngoscopy, dual pH probe monitoring, and laryngeal mucosal biopsy in the diagnosis of pharyngoesophageal reflux. Ann Otol Rhinol Laryngol 2001;110:299–304CrossRefGoogle ScholarPubMed
10 Carr, MM, Nagy, ML, Pizzuto, MP, Poje, CP, Brodsky, LS. Correlation of findings at direct laryngoscopy and bronchcosopy with gastroesophageal reflux disease in children: a prospective study. Arch Otolaryngol Head Neck Surg 2001;127:369–74CrossRefGoogle ScholarPubMed
11 Carr, MM, Nguyen, A, Poje, C, Pizzuto, M, Nagy, M, Brodsky, L. Correlation of findings on direct laryngoscopy and bronchoscopy with presence of extraesophageal reflux disease. Laryngoscope 2000;110:1560–2CrossRefGoogle ScholarPubMed