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Common causes of hoarseness in children

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


Common causes of hoarseness in children (table 1) and an overview of their management will be reviewed here. Other related issues, including laryngeal anatomy, the physiology of phonation, and the evaluation of the child with hoarseness are discussed separately. (See "Hoarseness in children: Evaluation".)


"Hoarseness" or "dysphonia" are terms used to describe a change in the quality of the voice. The voice quality can be raspy, breathy, strained, fatigued, rough, tremulous, or weak. There may be a change in pitch, restriction of range, voice breaks, decreased projection, 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. (See "Hoarseness in children: Evaluation", section on 'Physiology'.)

Etiologic categories of hoarseness include infection, inflammation, trauma, obstruction or infiltration, and congenital anomalies (table 1) [4]. In children, hoarseness is most often due to a benign or self-limited cause (eg, viral upper respiratory infection or vocal abuse and 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.


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 [5]. The majority of these lesions occur in boys, particularly at the age of nine years [6]. 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) (picture 1). 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 bilateral and can range in size from slightly raised hyperkeratotic lesions to larger broad-based lesions that prevent closure of the vocal folds. Stroboscopy can best examine and define the nature of laryngeal lesions. In the case of vocal fold nodules, the mucosal wave should remain intact. Nodules can be confused with mid-vocal fold fibrotic lesions and congenital lesions with contralateral reactive lesions.

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Literature review current through: Nov 2017. | This topic last updated: May 02, 2017.
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