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Hoarseness in children: Evaluation

Craig H Zalvan, MD
Jacqueline Jones, MD
Section Editor
Glenn C Isaacson, MD, FAAP
Deputy Editor
Carrie Armsby, MD, MPH


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) [4]. 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.


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Literature review current through: Sep 2016. | This topic last updated: Mar 17, 2016.
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