Hoarse Voice (Dysphonia) :: Nationwide Children's Hospital

Hoarse Voice (Dysphonia)

What is Horse Voice (Dysphonia)?

Dysphonia refers to having an abnormal voice, sometimes referred to as hoarseness. Changes to the voice can occur suddenly or gradually over time. For those affected by dysphonia, the voice can be described as hoarse, rough, raspy, strained, weak, breathy or gravely. There may also be voice breaks and pitch changes. Your child may even have a complete loss of voice for a period of time and sometimes may complain of pain when speaking or singing and the difficulty of projecting the voice.

What are the causes of dysphonia?

There are many causes of dysphonia, but it is typically caused by an abnormality with the vocal cords, also known as vocal folds. However, dysphonia can also be a result of problems with airflow from the lungs or abnormalities with the structures of the throat near the vocal cords.

How is dysphonia assessed?

The best assessment for dysphonia is done by an Otolaryngologist (Ear, Nose and Throat doctor) in conjunction with a speech pathologist. An accurate history of the dysphonia and detail regarding the voice abnormalities, along with listening to the voice, will help the physician and speech pathologist understand the voice disorder.

A voice assessment is performed by the speech pathologist to determine how the dysphonia is affecting daily activities. Your child will also be asked to speak into a microphone, which records the voice and obtains results that are compared to voice standards.

A physical exam is important to visualize any abnormalities with the anatomy of the vocal cords. This exam is best done with a laryngoscope, a flexible tube with a camera attached. This flexible tube is passed gently through the nose to the back of the upper throat to avoid gagging and allows the physician and speech pathologist to visualize the entire throat and vocal cords. The exam is video recorded so that the physician, speech pathologist, parent and patient can visualize the structures of the throat and determine if there is a problem causing the abnormal voice. This exam is well tolerated in all ages and takes 1-2 minutes to complete in the clinic.

What are the causes of dysphonia?

There are numerous causes of dysphonia which are detailed below:

  • Inflammation:
    • Laryngitis: Swelling of the vocal cords from over use of the voice or a viral illness
    • Allergy: Swelling of the vocal cords from cough, post-nasal drip, sneezing
    • Laryngopharyngeal reflux: Stomach reflux causing swelling and irritation of the delicate tissues of the vocal cords and throat
  • Growths on the vocal cords:
    • Vocal cord nodules: Small calluses on the vocal cords from overuse of the voice, or vocal cord injury that occurs with yelling
    • Vocal cord polyps: Small growth on the vocal cord, similar to a blister, from overuse of the voice or vocal cord during yelling
    • Vocal cord cyst: Small growth on the vocal cord that is typically filled with mucous and causes a rough and raspy voice
    • Vocal cord papilloma: Small warts on the vocal cords that are caused by exposure to a specific virus called the human papilloma virus
  • Scarring of the vocal cords
    • Children can develop scarring of the vocal cords from trauma/injury to the vocal cords, previous breathing tubes being in place for surgery or from being on a ventilator
  • Vocal cord paralysis
    • Children can be born with a weak vocal cord or develop weakness with movement of the vocal cords from a nerve injury. The child will often have a raspy voice that is weak or breathy.

What are the treatments for dysphonia?

Patients and family members are trained on how to properly use the voice in order for effective treatment. Most voice disorders are treated with some form of voice therapy by a licensed speech pathologist.

Surgery is sometimes necessary for certain voice disorders. Your child’s physician may also prescribe medication to help with inflammation of the vocal cords.

How can I prevent dysphonia?

Understanding how to effectively use the voice without injuring the vocal cords is the most important thing your child can do to prevent dysphonia. Drinking adequate water daily, avoiding cough and throat clearing and using the voice appropriately without yelling or abusing the voice can help prevent dysphonia.

When should I seek evaluation for dysphonia?

Any child that has changes to his/her voice that last for more than three weeks and do not seem to be improving should have a complete voice evaluation.

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