Hoarseness in children–understanding the common causes and management Flashcards
How severe are most causes of hoarseness or dysphonia in children from?
Most causes of pediatric hoarseness are benign and self-limited, however some can be progressive and malignant.
What are the common broad etiologic categories for hoarseness?
- Infection
- Trauma
- Neurologic
- Obstruction
- Congenital/structural
What are the most common causes of hoarseness in children?
- Acute laryngitis
- Chronic laryngitis
- Laryngotracheitis or croup
- Vocal cord nodules
- Granulomas
- Vocal cord paralysis
- Gastroesophageal reflux/laryngopharyngeal reflux
- Laryngomalacia
- Tumors
What are the common causes of acute laryngitis?
Acute laryngitis is typically related to an upper respiratory tract infection but can be due to acute vocal cord strain leading to edema in the larynx.
What are the common symptoms of infections causing acute laryngitis?
Acute infections can lead to low-grade fever, hoarseness, rhinorrhea, cough, malaise.
How is acute laryngitis treated?
Acute laryngitis usually self-limited and treated conservatively with hydration, humidification, and vocal cord rest. Antibiotics and steroids are rarely needed. Of note whispering can actually increase the trauma to the vocal cords and should be avoided.
What are some of the common causes of chronic laryngitis?
Chronic laryngitis is more commonly associated with environmental irritants (dry air, smoke exposure, allergens), some medications (long-term inhaled steroids), dehydration, or malignancy.
What are treatment options for chronic laryngitis?
Treatment depends on the etiology however they may include limiting exposures to allergens, increasing hydration, humidifiers, correction of the underlying disease, and generally avoiding the environmental irritants.
What is the common etiologic cause of hoarseness from laryngotracheitis or croup in children?
Generally occur in children 6 years of age and younger and most common etiologic viruses the parainfluenza virus.
What are the common symptoms and x-ray findings in a child with laryngotracheitis or croup?
They usually present with a barky cough, low-grade fever, rhinorrhea. And on x-ray there is a steeple sign.
How is viral laryngotrachitis treated in children?
Mild croup is treated conservatively at home with humidifier, hydration, mist/steam or cold air.
Steroids may also be included including dexamethasone or prednisolone which can shorten the duration of symptoms and given with troubles breathing.
For moderate to severe croup which leads to stridor at rest, retractions or respiratory distress then nebulized epinephrine can be administered in an ED setting with oral or IV steroids.
What is a common cause of chronic hoarseness in school-aged children and how do these develop?
Vocal cord nodules are typically benign lesions on the vocal cord and develop from overuse/trauma of the vocal cords i.e. screening.
What are the common symptoms of vocal cord nodules?
They may present with a raspy voice or even difficulty breathing depending on how large the nodules are. Typically hoarseness is better in the morning and worsens with use.
How are vocal cord nodules treated?
Treatment is variable and ranges from watchful waiting to voice therapy to surgical correction.
What are granulomas and how do they develop causing hoarseness?
They are highly vascular growths and most commonly occur secondary to trauma from intubation or prolonged intubation. However, they have been seen from longstanding laryngopharyngeal reflux disease or habitual throat clearing.
What are some of the common causes of vocal cord paralysis?
Most commonly caused from the recurrent laryngeal nerve during cardiac surgery or after compression injury to the nerve after delivery (i.e. stretching the neck during a breech delivery, or compression from a cardiac malformation)
How does a patient present with vocal cord paralysis?
Newborns tend to have a weak cry and chronic aspiration possibly leading to recurrent pneumonias.
What are treatment options for vocal cord paralysis?
Treatment options vary from surgical intervention in reinnervation of the nerve to tracheostomy if vocal cord paralysis is bilateral and severe.
What are common symptoms of gastroesophageal reflux/laryngal pharyngeal reflux in children with hoarseness?
Symptoms include chronic cough, dysphagia, recurrent vomiting, globus sensations, bitter taste in mouth, chronic throat clearing.
What are the treatments for gastroesophageal reflux/laryngal pharyngeal reflux disease?
They include reflux medications (PPI or H2 blocker), diet modifications.
What is the most common congenital anomaly leading to stridor and infants?
Laryngomalacia
In laryngomalacia what is the mechanism causing the noise?
There is a collapse of the supraglottic airway during inspiration.
What are the symptoms of someone with laryngomalacia?
Main symptoms include monophasic, inspiratory stridor during the neonatal period (as opposed to tracheomalacia causing biphasic stridor from malformations like vascular ring).
What is the typical onset of age for laryngomalacia and symptom course?
Typical onset of stridor occurs around 4 to 6 weeks of age, gets louder around 4 to 8 months of age, and resolves by 12 to 18 months. Classically the stridor gets worse in the supine position and improves when in the prone position.
What is the treatment for laryngomalacia?
Watchful waiting when it is mild when its not causing any significant symptoms.
What tumors are common and how do they develop in children with hoarseness?
Papillomatosis is a benign tumor. Diagnosed between ages 2 to 3 years of age. It is felt to be caused by the HPV virus, only HPV 6 and HPV 11 and acquired during passage through the birth canal of an infected mother. Treatment typically involves surgical resection.
