Symptoms of Pediatric Voice Disorders

Key Glossary Terms

Stridor
Noisy breathing

Larynx
Highly specialized structure atop the windpipe responsible for sound production, air passage during breathing and protecting the airway during swallowing

Glossary

Many symptoms are common among the disorders that cause hoarseness, but some are more specific to the individual cause.

Laryngopharyngeal reflux often causes hoarseness that is worse in morning. LPR may be associated with a sour taste in the mouth or bad breath. Symptoms of heartburn are often not present. Nocturnal cough may or may not be present. Hoarseness may fluctuate over time as the reflux events come and go.

Although all forms of hoarseness will worsen with overuse, nodules and cysts typically worsen at the end of the day or during times of high use. Severe straining to initiate voicing (aphonia) can be common. A harsh or aggressive attack required to initiate speech is typical, caused by the increased mass on the vibrating fold.

Papillomas generally cause a progressive, ever-worsening hoarseness that leads either to aphonia or respiratory distress. Although fluctuations may be seen with use, there is a general trend toward a worsening voice. Sometimes snoring is also associated with the enlarging papillomas. If snoring worsens or breathing difficulty is encountered in patients with papillomas, medical attention should be promptly sought.

Congenital laryngeal webs generally do not vary in terms of the hoarseness observed. A child may have a persistent weakness or quietness to the voice that has been present since birth.

Scarring from airway manipulation usually peaks 4-6 weeks after the incident. Slow, progressive worsening of voice and breathing may accelerate at the end of the this time period as the airway narrows. This timing of events would be typical for voice disorders caused by intubation.

Neoplasms or tumors of the larynx act similarly to papilloma. As they grow there may be progressive worsening of the voice, perhaps leading to breathing difficulty or stridor.

Red Flag

• Noisy breathing (stridor) is a sign of obstruction or narrowing of the laryngeal or tracheal parts of the airway.
• Stridor is a sign of difficulty passing air.
• Any breathing difficulty needs immediate medical attention.