Voice disorders in children Flashcards
What can be involved in the differential diagnosis for children?
Congenital and genetic disorders
Foreign body ingestion
Acute inflammatory conditions
Benign lesions
(These things can co-occur with speech and language problems).
What are the differences between children and adults?
VF are smaller (6-8mm).
Membranous and cartilaginous portions are about equal.
Softer cartilages and lax supporting ligaments.
Larynx more anterior and higher.
Minor changes in laryngeal soft tissues (oedema) leads to marked changes in airflow resistance.
What is important consideration in pre-linguistic children?
There is a close association between respiration, feeding and voice.
What is important about assessment and treatment techniques when it comes to children?
Special care taken not to be invasive or frightening.
Including parents and families.
What is different about the levels of impairment in children and adults?
In some cases the voice disorder may have a minimal effect on overall impairment.
In other cases it can be an important symptom in localising a life-threatening condition.
What is laryngeal papillomatosis?
Most common laryngeal condition in children.
Benign, wart-like growths.
Viral - aggressive and diffuse.
Medical management: surgical removal, cryotherapy, antiviral agents, carbon dioxide laser.
Voice therapy: Little role in treatment, assist with communication strategies to compensate for hoarseness.
What is a laryngeal web?
Extends across glottis obstructing airway.
Tracheotomy required to divide web.
Voice therapy: Residual voice function usually adequate, optimise loudness, pitch and quality.
What is laryngomalacia?
Most common congenital laryngeal disorder.
Immature cartilaginous development.
Supraglottic structures collapse during inspiration - inspiratory stridor. - In 90% of children if you wait the larynx will grow.
What is subglottic stenosis/subglottic haemangioma?
Stenosis - narrowing of the airway.
Haemangioma - Amalgamation of blood vessels etc that can cause blockage.
Requires surgery.
Type of procedure may affect vocal function.
What is vocal fold paralysis associated with in children?
2nd most common congenital disorder in children.
Associated with spina bifida, meningomyelocele - vagus nerve.
What are the disorders associated with vocal misuse/abuse in children?
Most common types of voice disorders in children.
Vocal nodules - 50% of children with voice disorders.
Voice therapy is the main approach.
What are psychogenic voice disorders in children?
Hysterical conversion dysphonia.
Puberphonia (even for girls).
Incomplete or delayed maturation.
How does hearing impairment affect children and their voice?
Difficulty with control of pitch, loudness, nasality, intonation
Associated features -abnormal breathing, increased laryngeal tension, excess effort
Acquired laryngeal pathologies - vocal nodules, polyps, oedema
Voice therapy - Vocal quality, pitch & loudness control, tongue position - need visual feedback
What affects premature babies?
Prolonged ventilation and intubation.
Tissue oedema –> ulceration subglottic level –> stenosis
Corrective surgery can lead to VF damage, potential recurrent laryngeal nerve palsy, arytenoid dislocation
What is involved with the tracheotomised child?
Facilitation of oral communication.
Development expressive speech dependent on ability to vocalise.
Temporary occlusion of tube with finger, flexion of neck, externally applied devices e.g. Passy-Muir speaking valve, electrolarynx, oesophageal speech
AAC devices.
