"Hoarseness" or "dysphonia" is the term used to describe a change in the quality of the voice. The voice quality can be breathy, strained, fatigued, rough, tremulous, or weak. It may have a change in pitch or abnormal resonance. The prevalence of hoarseness in children ranges from 4 to 23 percent [1-3]. Hoarseness can be caused by any process that affects the structure or function of the larynx. Etiologic categories include infection, inflammation, trauma, obstruction or infiltration, and congenital anomalies (table 1) .
In children, most hoarseness has a benign or self-limited cause (eg, vocal abuse or misuse) and can be managed with education, watchful waiting, and voice therapy. In addition, the growth of the vocal folds and laryngeal apparatus, change in habits, and change in the hormonal milieu that occur during puberty often contribute to improved voice quality. Surgery is reserved for persistent lesions with noted anatomic alterations.
The etiology and management of hoarseness in children will be reviewed here. The evaluation of the child with hoarseness is discussed separately. (See "Hoarseness in children: Evaluation".)
Hoarseness in children is most often because of benign lesions of the vocal folds (eg, nodules, polyps, hemorrhage, hematoma).
Nodules — Vocal fold nodules are the most common cause of chronic hoarseness in school-aged children . The majority of these lesions occur in boys, particularly at the age of nine years . Vocal fold nodules usually are located on the anterior-free edge of the vocal fold at the point of greatest amplitude of vibration (the junction of the anterior one-third and the posterior two-thirds of the vocal fold). They develop from repeated trauma and abuse to the vocal folds (eg, screaming or shouting) that cause an inflammatory reaction with fibrotic healing. Vocal fold nodules are usually bilateral and can range in size from slightly raised hyperkeratotic lesions to larger broad-based lesions that prevent closure of the vocal folds.