Hoarseness
Hoarseness is a common complaint in the pediatric population. Voice disorders occur in children with 6–9% incidence. History and presentation determine need for diagnostic and therapeutic intervention. Evaluation of stridor and airway obstruction takes precedence over that of voice disturbances.
Differential Diagnosis
-
Congenital
–Glottic webs
–Laryngeal clefts
–Laryngocele
–Tracheoesophageal fistula
–Hemangiomas
-
Inflammatory/infectious
–Viral URI
–Diphtheria
–Laryngotracheobronchitis
–Gastroesophageal reflux disease: Posterior laryngitis, vocal cord edema
–Fungal laryngitis: Consider in an
immunocompromised patient
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Tumors
–Respiratory papillomas
–Squamous cell carcinoma
–Hemangioma
–Lymphangioma
- Trauma
–Traumatic birth
–Postintubation: May result in cord edema, granulomas, vocal cord webbing, cricoarytenoid joint dislocation, or ankylosis
–Laryngeal fracture
–Iatrogenic: Neck or cardiopulmonary surgery
may cause injury to the recurrent laryngeal nerve, leading to vocal cord paralysis
–Vocal abuse: Vocal cord nodules or polyps
- Endocrine
–Hypothryoidism
- Neurogenic
–Idiopathic vocal cord paralysis
–Arnold-Chiari or Dandy-Walker malformations may lead to brainstem compression of the vagal nerve roots, leading to vocal cord paralysis
–Peripheral nerve: Recurrent laryngeal nerve injury or invasion by tumor, myasthenia gravis
–Spasmodic dysphonia: Dystonia of the laryngeal muscles
-
Systemic disease
–Rheumatoid arthritis: Fixation of the cricoarytenoid joint
–Relapsing polychondritis
-
Functional
Workup and Diagnosis
History
–Onset, severity, progression, quality of cry, recent URI, fluctuations, time preference, stridor, dysphagia, regurgitation, aspiration, exercise tolerance, sick contacts
–Immunization history
–Trauma history
–PMH: Traumatic birth, neck or chest surgery,
prolonged or repeated intubations
-
Physical exam
–Head and neck lymphangioma or hemangioma (possible similar airway lesion)
–Neck masses, tracheal shift
–Cardiac exam, abnormal muscle tone
-
Workup
–Flexible fiberoptic nasopharyngoscope: Office exam of the larynx and vocal cord mobility; cannot see subglottis; requires patient cooperation
-
Direct laryngoscopy: affords better exam of larynx but requires general anesthesia; subtle structural changes are visible, palpation of cricoarytenoid joint to differentiate paralysis vs fixation is possible
–Chest X-ray: Mediastinal lesion, cyst
–CT or MRI: Indicated with congenital cyst, tumors, or trauma
–MRI of head when intracranial pathology suspected
Treatment
- Medical
–Reflux changes: Behavioral and diet modification, anti-reflux treatment, prokinetics, Nissen fundoplication for severe cases
–Vocal cord nodules: Limit vocal abuse, voice therapy, antireflux treatment
–Supportive or antibiotic treatment for infectious causes
-
Voice therapy
–Abuse reduction; vocal hygiene; tension reduction; resonance and pitch training
-
Hoarseness with airway distress may require immediate intubation or tracheostomy
-
Tumors or congenital lesions are treated with surgical resection.
-
Brainstem causes may require neurosurgical decompression
-
Botox (botulinum toxin) for spasmodic dysphonia
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Incoherent speech
Read excerpts from these other book chapters related to Incoherent speech:
Medical Books Excerpts
- DYSARTHRIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- HOARSENESS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Dysarthria
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Hoarseness
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Dysarthria
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Hoarseness
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Hoarseness
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Dysarthria
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Dysarthria
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Hoarseness
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Hoarseness
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Incoherent speech
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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» Next page: HOARSENESS (Differential Diagnosis in Primary Care)
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