Childhood Voice Disorders Flashcards
Laryngeal papillomatosis
- Laryngeal warts (similar to HPV)
- Most common laryngeal growth in children
- Benign, wart-like growths
- Viral: agressive & diffuse
- Hoarseness
- Poor vibration
Medicosurgical management of laryngeal papillomatosis
- Surgical removal
- Cryotherapy
- Antiviral agents
- Carbon dioxide laser
Voice therapy for laryngeal papillomatosis
Little role in treatment (assist with communication strategies to compensate for hoarseness)
Laryngeal papillomatosis
Laryngeal web
Extends across glottis, obstructing airway
Medicosurgical management of laryngeal web
Tracheotomy (above the vocal folds (as opposed to tracheostomy - under the vocal folds)) required to divide the web (above the vocal folds)
Voice therapy for laryngeal web
- Residual voice function usually adequate
- Optimise:
- Loudness
- Pitch
- Quality
Laryngeal web
Laryngomalacia
- Most common congenital laryngeal disorder
- Immature cartilaginous development
- Inspiratory stridor: Supraglottic structures collapse during inspiration
- Noticeable when running around, crawling etc.
- Soft larynx (moves in and out when breathing creating stridor)
Medical management of laryngomalacia
- 90%: wait and it will resolve itself
- 10%: surgery required
Subglottic stenosis
- Narrowing of the airway
- Requires surgery
- The type of surgical procedure may affect vocal function
Subglottic haemangioma
- Requires surgery
- The type of surgical procedure may affect vocal function
Vocal fold paralysis
- 2nd most common congenital disorder
- Associated with spina bifida, meningomyelocele
- Vagus nerve (CNX) - recurrent laryngeal branch
Disorders associated with vocal abuse & misuse
- Most common voice disorder
- 50% of children with voice disorders have vocal nodules
- Main approach is voice therapy (some, just wait and see)
Psychogenic voice disorders
- Hysterical conversion dysphonia (an event happens, causes conversion)
- Puberphonia
- Incomplete & delayed maturation
Hearing impairment
- No exposure to sound
- Difficulty with control of pitch, loudness, nasality, intonation
- Associated features:
- Abnormal breathing
- Increased laryngeal tension
- Excessive effort
- Acquired laryngeal pathologies:
- Vocal nodules
- Vocal polyps
- Oedema (swelling)
Voice therapy for hearing impairment
- Vocal quality
- Pitch & loudness control
- Tongue position
- Need visual feedback
Prematurity
- Prolonged ventilation & intubation (endotracheal tube - through the mouth & vocal cords)
- Tissue oedema, leading to ulceration at the subglottic level, leading to stenosis
- Corrective surgery can cause:
- Vocal fold damage
- Potential recurrent laryngeal nerve palsy
- Arytenoid dislocation
Tracheotomised child
- Facilitation of oral communication
- Development of expressive speech depends on the ability to vocalise
- Temporary occlusion of the tube with a finger, flexion of neck, externally applied devices (e.g. Passy-Muir speaking valve, electrolarynx), oesophageal speech (burping)
- AAC devices (includes iPad etc.)
Disorders of nasal resonance (2)
- Hypernasality
- Hyponasality
Causes of hypernasality
- Cleft palate/submucous cleft (most common)
- Congenitally short palate
- Velar paralysis
- Adenoidectomy (hypernasality 1 in 500)
- Tonsillectomy (hypernasality self corrects between 3-6 months)
Voice therapy for hypernasality
- Mild:
- Increase oral to nasal resonance
- Increase palate strength
- Severe:
- Pharyngoplasty
Causes of hyponasality
Structural changes lead to anterior & posterior nasal flow obstruction:
- Adenoidal hypertrophy
- Septal deviation
- Stenosis
- Bone/cartilage
Treatment of hyponasality
Medical/surgical
