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.
