Hoarseness of voice in a child

In children, hoarseness of voice occurs much more often than in adults. Consider the main causes of this symptom, types and forms, methods of treatment, prevention.

The voice is the sound waves that occur when air passes through the glottis of the larynx with closed vocal cords.

• The thinner and shorter the ligaments, the higher the voice.
• If the ligaments are even, then the tone of voice is clear.
• The thickening and irregularities of the vocal cords disrupt the air flow, creating interference in its path, which affects the pitch of the voice and is manifested by its hoarseness.

The appearance of wheezing, as a rule, is associated with the peculiarity of the structure of the upper respiratory tract of the baby. The mucous membrane of the larynx is very delicate and permeated with a large number of blood vessels. Any irritation or exposure to pathogens leads to the development of edema and dysphonia.

In some cases, there is a complete loss of voice, and even a direct threat to the life of the child. Therefore, the appearance of this symptom should be taken seriously. This is due to the fact that an unpleasant condition may be due to congenital diseases of the larynx (papillomatosis, cysts), requiring surgical intervention.

Epidemiology

The voice is a combination of various sounds that occur when the elastic vocal folds vibrate. The sound of a voice is a vibration of air particles that propagate in the form of waves of rarefaction and condensation. The main source of voice is the larynx and vocal cords.

According to medical statistics, voice disorders in a child have a prevalence of 1 to 49%, and in adults from 2 to 45%. The main cause of dysphonia is a decrease in local immunity. An unpleasant symptom can develop against the background of diseases of the upper respiratory tract (ARVI, acute respiratory infections, colds), various viral, bacterial and infectious processes in the body and respiratory organs, as well as in stressful situations, congenital pathologies and injuries.

Voice disorders have a significant impact on the general and speech development of the child. The negative impact of this problem affects the formation of personality and the process of social adaptation of the baby. Several disciplines are involved in the study of voice disorders and hoarseness: pediatrics, psychology, speech therapy, endocrinology, neurology, physiology, phoniatrics.

Causes of the hoarseness in a child

Voice impairment in children is not an independent disease, but occurs due to the action of certain causes and factors. Some of them are harmless, others require careful diagnosis and treatment.

The main causes of hoarseness in a child:

• Overstrain of the vocal cords - the mucous membrane of the larynx is very sensitive, so children's crying, loud screaming or singing cause microtraumas with ruptures of small capillaries and swelling. Because of this, wheezing and hoarseness occur.
• SARS, influenza - one of the complications of colds is inflammation of the larynx. Laryngitis is of viral and bacterial origin. In addition to disturbing the sound, body temperature rises, a runny nose, cough, and sore throat appear. [1]
• Intoxication - inhalation of chlorine vapors and other chemicals causes spasms and swelling of the larynx, coughing. If the body is affected by ammonia, then there are pains behind the sternum, sputum discharge. Fluorine provokes convulsions, a strong cough, redness of the eyes.
• Allergic reactions - contact with an allergen, an insect bite, inhalation of irritating odors causes an allergy with swelling of the soft tissues. In especially severe cases, Quincke's edema develops, which is manifested by stenosis of the larynx, shortness of breath and suffocation. The stages of an allergic reaction change very quickly, so you should immediately seek emergency medical help. [2]
• Foreign objects entering the larynx - this condition requires emergency diagnosis and treatment. Since the foreign body interferes with the passage of air into the lungs. Against this background, a paroxysmal cough develops, the face becomes pale or with a bluish tint. The child suffocates and loses consciousness. If the airways are not released in time, then this is dangerously fatal. [3]
• Burns - chemical and thermal damage to the mucous ligaments and the respiratory tube causes severe swelling, tissue damage and subsequent scarring. This is dangerous not only by changing the sound, but also by the loss of the ability to talk. [4]
• Injuries of the larynx - hoarseness develops when struck in the anterior or lateral region of the neck. [5]
• Metabolic disorders - a change in the production of certain hormones is displayed on the sound. Due to fluid retention in the tissues, swelling of the ligaments occurs. Treatment is hormone replacement therapy.
• Dehydration of the body - if you do not drink liquid for a long time, this causes dryness of the mucous membranes and the appearance of wheezing. [6]
• Stress, strong fear and excitement cause changes in the sound. After some time, the voice apparatus is restored without outside help.
• Paresis and paralysis - a violation occurs when the nerve endings of the vocal apparatus are damaged. The child feels numbness of the larynx and difficulty breathing.
• Tumor neoplasms - if they are located in the larynx, they can compress blood vessels and nerve endings. Against this background, there is a periodic cough, sore throat, wheezing in the voice.
• Dysphonia is a qualitative violation of the voice (change in pitch, timbre, duration, strength). It develops due to overstrain of the vocal cords, respiratory diseases, congenital pathologies, psychological and behavioral factors. It is manifested by gradual fatigue of the voice and a feeling of tightness / sore throat. It can cause problems in expressing thoughts and cause anxiety due to the child's limited communication. [7]

These are far from all the possible causes of hoarseness, so you should not ignore an unpleasant symptom, as it may indicate serious pathological processes in the body.

Hoarseness of voice during teething

The appearance of teeth from the gums is a painful process. In some children, the first teeth begin to be cut at 3-6 months, and in others at a year. The process of teething is individual, but almost all babies experience the following symptoms:

• Redness and swelling of the gums.
• Increased body temperature.
• Increased salivation.
• Itchy gums.
• Bad appetite.
• Digestive disorders.
• Sleep disturbance.
• Hoarseness of voice.

The appearance of the first teeth does not affect the state of the immune system. But the formation of a large amount of saliva leads to the fact that it loses its protective properties. This negatively affects the state of immunity and can accelerate the development of infectious diseases. Also, against the background of a change in sound, pain in the nose and ears, redness of the cheeks, and a runny nose may occur.

To alleviate unpleasant symptoms, various painkillers, drugs to reduce body temperature are used. There is a special teething gel. In this case, it is contraindicated to massage the gums with alcohol-containing preparations or rub the tablets into the inflamed mucosa. As the child's condition improves, his voice, appetite, and sleep are restored.

The child has a hoarse voice after a cold

The most common cause of a hoarse voice in a child is a cold. This concept includes more than 200 respiratory viruses that are transmitted by airborne droplets. The disease state is manifested by the following symptoms:

• Increased body temperature.
• Runny nose.
• Increased lachrymation and pain in the eyes.
• Headaches.
• Cough
• Voice change.

Often a cold is complicated by damage to the vocal apparatus. Because of this, the patient's voice becomes hoarse, hoarse. But as you recover, the sound is restored.

There are several simple methods that will help you quickly restore a hoarse voice after a cold:

1. Silence - ligaments need rest and warmth. Wrap the baby's throat with a scarf, the child should talk in a whisper or play silent with him.
2. Plentiful drink. The best way to restore the sound is warm milk with honey, warm tea, herbal decoctions. Such drinks can be consumed throughout the day and always before bedtime.
3. Rinsing - for these purposes, you can use pharmaceutical preparations or decoctions / infusions of medicinal herbs. Chamomile flowers have antiseptic properties, while eucalyptus leaves are antimicrobial. Take 1 tbsp. Dry raw materials, mix thoroughly and pour 300 ml of water. Boil the broth over low heat for 1-2 minutes. After cooling, strain and let the child gargle. Procedures are carried out every 2 hours until the violations are completely eliminated.

4. Inhalations - herbal remedies are suitable for these purposes. You can prepare a decoction based on chamomile, eucalyptus, calendula, coltsfoot. Dilute a tablespoon of herbs in a liter of boiling water, cover your head with a towel and breathe.

If the main symptoms of a cold have disappeared, and hoarseness persists for a long period of time, then the child should be shown to the pediatrician.

Osip voice with stomatitis in a child

Stomatitis is an inflammation of the oral mucosa. Most often it appears on the inner surface of the cheeks, lips and palate, under the tongue.

Stomatitis develops due to the conditionally pathogenic flora of the oral mucosa. Under the action of certain factors, the immune defense of the body is reduced, and viruses / bacteria are activated. Also, possible causes of the disease include:

• Violation of the integrity of the oral mucosa.
• Unbalanced nutrition.
• Violation of hygiene - eating unwashed vegetables, fruits, licking dirty fingers, improper dental care.
• Taking drugs that reduce salivation.
• Chronic diseases.
• Gastrointestinal disorders.
• Endocrine pathologies.
• Anemia.

Depending on the nature of the damaging effect, several types of stomatitis are distinguished: bacterial, fungal, viral, radiation, chemical. But regardless of the cause, stomatitis is manifested by an acute intoxication syndrome, which includes:

• Redness and swelling of the mucosa.
• The formation of rounded sores (the wound is covered with a white film, and redness around it).
• Pain and burning on contact with the affected mucosa.

Against the background of the disease, the body temperature rises, the submandibular lymph nodes increase. If a child has a hoarse voice with stomatitis, then this indicates the spread of the pathological process to the mucous membrane of the larynx.

For treatment, rinsing with disinfectants, taking antimicrobials, avoiding aggressive foods (hard, sour, spicy, hot, cold), proper oral hygiene are prescribed. Therapy takes 5-10 days. The voice is restored as it recovers.

After a sore throat, the child's voice is hoarse

One of the most common otolaryngological diseases in children is acute tonsillitis. Angina is an infectious and inflammatory process with lesions of the palatine tonsils. Its main etiological agent is beta-hemolytic streptococcus, pneumococci and staphylococci are less common. There is also monocytic angina caused by cytomegalovirus and agranulocytic, which develops with pathologies of the hematopoietic system.

The main symptoms of the disease:

• High body temperature.
• General weakness and malaise.
• Pain in the throat, aggravated by swallowing.
• Enlarged submandibular and cervical lymph nodes.

Such a symptom as a change in voice (hoarseness, wheezing) deserves special attention. It develops due to inflammation and swelling of the larynx, tonsils.

For the diagnosis of tonsillitis, the patient is examined and a complex of laboratory tests is carried out (smear microscopy, bacteriological culture of the tonsils discharged from the surface, a smear for hemolytic streptococcus, PCR). Treatment consists of strict bed rest, sparing nutrition, and plenty of fluids. Patients are prescribed rinses with antiseptic and painkillers.

For the speedy restoration of the voice, it is necessary to provide peace to the vocal cords, drink plenty of warm liquids, and refuse food that irritates the mucous membranes. To enhance blood circulation and speed up the healing process, dry heat will help (a warm scarf on the throat or mustard baths in the absence of temperature). At night, the child can be given a glass of warm milk, dissolving a piece of butter and honey in it.

If voice problems and other painful symptoms persist for a long period of time, then this may indicate the development of complications of angina (rheumatism, glomerulonephritis, arthritis, paratonsillar abscess, etc.), which require serious medical attention.

Risk factors

Since hoarseness in a child can occur due to various reasons, the risk factors also depend on each specific case.

The main factors contributing to the change in sound include:

• Voice strain.
• Hypothermia of the body.
• Prolonged silence.
• Colds and viral diseases of the upper respiratory tract.
• Psychotraumatic factors (neurosis, severe fear, stress, depression).
• Hormonal disorders.
• Traumatic brain injury.
• neurological diseases.
• Violation of cerebral circulation.
• The influence of drugs.
• Allergic reactions.
• Neoplasms (polyps, nodules of the vocal cords).
• Diseases of the gastrointestinal tract.

The above factors provoke a decrease in local immunity and irritation of the mucous membrane of the vocal cords.

Pathogenesis

The mechanism of development of hoarseness is directly related to the structure of the vocal apparatus. The following bodies and structures take part in the process of voice formation:

• Lungs
• Bronchi
• Trachea
• Pharynx
• nasal cavity
• Nasopharynx and larynx.

The vocal cords are located inside the larynx. They are two folds of mucous membrane covering muscles and cartilage. Normally, their opening and closing occurs smoothly, due to which sounds are formed during the passage of air.

When exposed to pathogens, mucosal damage occurs. The infection causes local swelling and an inflammatory reaction. This in turn leads to difficulty breathing and loss of voice. A similar pathogenesis has hoarseness due to the intense tension of the vocal cords. But unlike infectious processes, in this case, the sound is restored while resting the vocal cords.

Allergic reactions in the larynx provoke swelling of the throat, which causes not only a violation of the voice, but also life-threatening suffocation. In some cases, the pathogenesis is associated with weakness of the vocal cords and neoplasms in the respiratory system.

Symptoms of the hoarseness in a child

There are many different factors and causes that cause sound disturbances. If an unpleasant condition is due to laryngitis, then its first signs are manifested by hoarseness, barking cough and other symptoms :

• Labored breathing.
• Painful sensations when swallowing.
• Dry, barking cough.
• Swollen and red throat.
• Increased body temperature.
• Spasms of the muscles of the larynx.
• Feeling of dryness and itching in the mouth.

Many other infectious diseases have similar symptoms.

There are also a number of symptoms that occur against the background of hoarseness and require emergency medical care:

• Low, deep voice.
• Dry, barking cough.
• Difficulty breathing with whistling and retraction of the intercostal spaces.
• Expressed respiratory movements of the chest.
• Difficulty swallowing.
• Increased salivation.

The children's larynx is very narrow, therefore, with severe swelling of the tissues of the subglottic space (observed with allergic reactions, infections, viruses and bacteria), its lumen is completely blocked, causing asphyxia.

Stages

Hoarseness of voice in a child is not an independent disease, but is one of the symptoms of various pathological processes in the body. Based on this, the stages of dysphonia depend on its root cause.

For example, if the change in sound is due to laryngitis, then the disorder has the following stages:

• Acute - sore throat, burning, painful swallowing, dry (barking cough) develop sharply. Against this background, there is a change in voice, he sits down, becomes hoarse. The vocal cords are swollen and hyperemic.

• Chronic - characterized by slow development. The patient has problems with the throat and vocal cords for a long period of time. There is a constant desire to cough. The voice is hoarse with pronounced wheezing.

In this case, the methods of diagnosis and treatment depend on the stage of the disease. In this case, the acute form responds better to therapy than the chronic form. The latter can be complicated by frequent relapses.

Forms

Based on the etiopathogenetic mechanism, voice disorders, which include hoarseness in children, can be organic and functional.

1. Functional disorders - they are not associated with anatomical changes in the vocal apparatus. Most often, their appearance is caused by neurotic disorders, which in turn are divided into:
   1. Central - due to the action of a strong stimulus, a center of inhibition occurs in the cerebral cortex, which disrupts the regulation of the process of voice formation.
   2. Peripheral - the disorder is caused by a decrease / increase in the muscle tone of the vocal cords, a violation of coordination between breathing and the function of the resonator cavities.

Functional voice disorders are characterized by violations of secretory functions with a sensation of a foreign body in the larynx, the motor function of the larynx increases sharply, and discoordination between speech breathing, articulation and voice formation is possible. In some cases, neurological symptoms are observed: sleep disturbances, high tendon reflexes.

2. Organic types of dysphonia include anatomical anomalies in the structure of the vocal cords, inflammatory, infectious and other pathological processes in the body.

Complications and consequences

The lack of timely diagnosis and proper treatment of hoarseness in a child is dangerous for the development of very serious complications. The consequences of an unpleasant symptom depend on the cause of its origin. If the sound disturbance is provoked by an acute form of laryngitis, then this threatens with such complications as:

• Respiratory pathologies due to narrowing of the walls of the larynx.
• Complete loss of voice.
• Neoplasms on the vocal cords (granulomas, polyps).
• Tumor lesions of the larynx.

Another common complication of inflammatory processes in the larynx, which occurs in 90% of children, is stenosis or false croup. There is also a risk of developing purulent forms of laryngitis, which in turn can lead to inflammation in the chest cavity, lung abscesses, purulent inflammation of the neck tissues, infection of the bloodstream.

Diagnostics of the hoarseness in a child

A pediatrician is engaged in diagnosing the problem of violation and hoarseness of the voice in pediatric patients. To determine the cause of the disorder, a complex of various studies is carried out:

• Collection of anamnesis and analysis of patient complaints.
• General examination of the child (palpation of the lymph nodes, the presence of pain in the throat).
• Visual examination of the larynx with an endoscope (reveals narrowing of the lumen of the larynx, the presence of edema and hyperemia, purulent or mucous plaque on the mucosa).
• Laboratory tests (general and biochemical blood tests, urinalysis, smear sampling from the mucous membrane).
• Instrumental research.

If the disease state is not caused by viral or infectious processes in the body, then the otolaryngologist, phoniatrist, neurologist, speech therapist are engaged in further diagnosis of the causes of the sound disturbance.

Based on the studies carried out, a final diagnosis is made, and treatment tactics are determined. If hoarseness is caused by respiratory pathologies or narrowing of the larynx, then there is a risk of developing croup, so the child is hospitalized. Inpatient treatment is indicated for hoarseness due to allergic reactions, diseases of the central nervous system.

Analyzes

Laboratory diagnosis of the causes of dysphonia in children includes the following studies:

1. General and biochemical blood tests.

Blood acts as a multifunctional liquid, so its analysis reveals various deviations in the functioning of the body. Most often, patients are prescribed a general blood test, which within a short period of time reveals bacterial, viral and other pathogenic microorganisms.

Particular attention is paid to the level of leukocytes, which act as indicators of the immune system. If their level is increased, it means that the immune defenses are activated and there is a pathogen in the body.

Another important indicator is the erythrocyte sedimentation rate. During inflammation, a large amount of protein is formed, which leads to an increase in ESR.

2. Analysis of urine

Urine is an important product of human life. It removes toxic substances, decay products, hormones, salts and other compounds from the body. The analysis takes into account the physical, chemical and organoleptic properties of a given biological fluid. The laboratory assistant focuses on color indicators, density, smell, transparency and acidity. A macroscopic examination of the released fluid is also carried out.

3. Taking a smear from the mucous membrane of the larynx to determine the pathogen and sputum analysis.

Sputum is a pathological secret separated from the respiratory tract (lungs, trachea, bronchi). A general sputum analysis is a laboratory study and assessment of the general properties and microscopic characteristics of the separated secret.

A smear from the mucosa, as well as sputum analysis, make it possible to diagnose pathological processes in the lungs and respiratory tract. Assess the nature of the pathological process in the respiratory organs. Conduct dynamic monitoring of the state of the respiratory tract to assess the effectiveness of the therapy.

Based on the results of the tests, the doctor draws up a plan for further diagnosis or prescribes therapeutic measures.

Instrumental diagnostics

Another component of the examination of the body to determine the causes of hoarseness in the voice is instrumental methods. They include the following diagnostic procedures:

• Stroboscopy - evaluation of the function of the vocal cords.
• Laryngoscopy - performed to detect anatomical or inflammatory changes in the vocal apparatus.
• Radiography and MSCT of the larynx - reveal tumor lesions of the larynx.
• Electromyography - assessment of the functions of the muscles of the larynx.
• Electroglottography - assessment of changes in the vocal apparatus in dynamics.

In addition to the above examinations, tomography of the larynx, densitometry of the bones of the cervical spine, and acoustic examination of the voice are performed.

Also, children are shown a speech therapy examination, which includes an assessment of the characteristics of the voice, physiological and phonation breathing, the nature of voice formation.

Depending on the results of the diagnostics, the surgeon, endocrinologist, phoniatrist and other specialists can deal with further consultation of the child.

Differential diagnosis

There are many reasons for hoarseness in a child's voice. To determine the true cause of the pathological condition, differential diagnosis is carried out.

Differentiation is carried out with such pathologies:

• Viral and bacterial diseases.
• Laryngitis.
• Diphtheria of the larynx.
• Obstruction of the larynx.
• Dysphonia.
• Abdominal abscess.
• body intoxication.
• Allergic reactions.
• Acute epiglotitis (inflammation of the epiglottis and surrounding tissues of the larynx and pharynx).
• Overexertion of the vocal cords.
• Entry into the larynx of foreign objects.
• Burns and herbs of the larynx.
• exchange violations.
• Paresis and paralysis.
• Stress, intense fear and excitement.

When making a final diagnosis, the results of differential, instrumental and laboratory diagnostics are taken into account.

Treatment of the hoarseness in a child

An obligatory component of treatment is silence, that is, rest for the vocal cords. When a person is silent, the glottis is open, and the ligaments are as far apart as possible. When talking, the ligaments come close and rub against each other, which leads to their microdamages. Therefore, if the ligaments are inflamed, then talking will only aggravate their condition and cause additional painful symptoms.

 Read more about the treatment of hoarseness in children in these publications:

• Methods for treating hoarseness in a child
• Inhalations for hoarseness in a child
• Syrups for hoarseness in a child

Prevention

There are several recommendations that allow you to maintain the health of the respiratory system and act as an excellent prevention of hoarseness:

• Avoid yelling, as this is the main cause of a broken, hoarse voice.
• Control the humidity level in the room.
• Annual flu vaccination.
• Avoid contact with people with colds and other airborne illnesses.
• Wash your hands often.
• Timely treatment of inflammatory lesions of the respiratory system.
• Use of respirators when in contact with allergens or work with toxic substances.
• Limit your child's stay in places where people smoke.
• Limit the consumption of spicy and direct foods, as they cause increased secretion of hydrochloric acid in the stomach and its entry into the esophagus and pharynx.

In addition to the above tips, it is not recommended to sleep without a pillow, as this leads to the backflow of acidic contents from the stomach into the throat, which, in addition to disturbing the sound, can cause heartburn.

Forecast

Hoarseness of voice in a child in most cases has a favorable prognosis. The earlier the diagnosis was made, the causes of the disease condition were established and the treatment was prescribed, the less the risk of developing various consequences and complications. At the same time, it should be taken into account that voice disorders in pediatric patients negatively affect their general and speech development. Violation affects the formation of personality and the process of social adaptation.