Hoarseness in children: Evaluation
- Craig H Zalvan, MD
Craig H Zalvan, MD
- Associate Professor
- New York Medical College
- Jacqueline Jones, MD
Jacqueline Jones, MD
- Pediatric Otolaryngology
- Private Practice
The evaluation of the child with hoarseness will be presented here. The etiology and management are discussed separately. (See "Common causes of hoarseness in children".)
"Hoarseness" or "dysphonia" are the terms 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]. The causes of hoarseness in children vary by age (table 1) . Most of these disease processes are benign and respond well to medical and speech therapy.
The history and physical examination, including laryngoscopy, and if possible, stroboscopy, will determine the etiology in the majority of cases.
The larynx is part of the anterior hypopharynx. In newborns, the larynx is situated at the level of C3-C4, where it facilitates simultaneous respiration and swallowing during infant feeding. It gradually descends to the level of C6-C7 by the age of 15 years. The hyoid bone, a mobile, crescent-shaped bone, forms the anterior upper limit of the larynx, which is divided into three regions relative to the level of the vocal cords:
●The supraglottic region encompasses the area above the vocal folds and includes the epiglottis, arytenoids, aryepiglottic folds, and false vocal folds.
- Silverman EM. Incidence of chronic hoarseness among school-age children. J Speech Hear Disord 1975; 40:211.
- Duff MC, Proctor A, Yairi E. Prevalence of voice disorders in African American and European American preschoolers. J Voice 2004; 18:348.
- Carding PN, Roulstone S, Northstone K, ALSPAC Study Team. The prevalence of childhood dysphonia: a cross-sectional study. J Voice 2006; 20:623.
- Cohen SR, Thompson JW, Geller KA, Birns JW. Voice change in the pediatric patient. A differential diagnosis. Ann Otol Rhinol Laryngol 1983; 92:437.
- Chait DH, Lotz WK. Successful pediatric examinations using nasoendoscopy. Laryngoscope 1991; 101:1016.
- Levitsky SE. Hoarseness. In: Primary pediatric care, 4th ed, Hoekelman RA (Ed), Mosby, St. Louis 2001. p.1156.
- Kenna MA. Consultation with the specialist. Hoarseness. Pediatr Rev 1995; 16:69.
- Nastasi KJ, Howard DA, Raby RB, et al. Airway fluoroscopic diagnosis of vocal cord dysfunction syndrome. Ann Allergy Asthma Immunol 1997; 78:586.
- Shao W, Chung T, Berdon WE, et al. Fluoroscopic diagnosis of laryngeal asthma (paradoxical vocal cord motion). AJR Am J Roentgenol 1995; 165:1229.
- Hirschberg J, Dejonckere PH, Hirano M, et al. Voice disorders in children. Int J Pediatr Otorhinolaryngol 1995; 32 Suppl:S109.