Childhood Voice Disorders

1
Childhood Voice Disorders

• Hyperfunctional Disorders
• vocal nodules and vocal strain
• By Mary Beth Dehn

2
Prevalence

• Boone McFarlane stated that about 7 of
  school-aged children experience continuing voice
  disorders.
• Lecoq Drape (1996) looked at primary school
  children and found that 10 of them at the time
  of examination had dysphonic voices related to
  laryngeal or resonance disorders.

3
Signs symptoms to look for in children who may
have voice disorders

• Dysphonia, a hoarse, breathy, or rough voice, may
  have excessive glottal fry
• Intermittent aphonia, recurring temporary loss of
  voice (first thing in the morning, end of the
  day, or after a specific event, for example a
  sports event)
• Voice breaks, fleeting interruptions in voice
  during singing or speech.
• Pitch breaks, abrupt changes in pitch of voice,
  usually when going from lower to higher pitch.

4
Signs and symptoms cont.

• An excessively loud voice for no reason
• An inability to sustain a note when singing
• An effortful or strained voice, voice sounds as
  if it takes special effort to produce and is not
  efficient.

5
Causes of childhood voice disorders(Voice
strain and nodules)

• Stress to the larynx, specifically the vocal
  folds
• This is referred to as vocal abuse.
• Hyperfunctional means overused
• Rare to find just one abusive behavior.
• Most common habits Talking too long, too
  loudly, and with too much effort.

6
Activities in children that may cause development
of vocal nodules or vocal strain

• Talking and singing in excess, for example in a
  school play, concert, choir shouting in the
  playground against background noise overusing
  the voice when sick cheerleading overusing
  voice when emotionally upset or tired.
• Glottal attack, use of forceful voice can really
  damage vocal folds.
• Coughing, an loud forceful sneezing, children who
  do not rest voice when they have sore throat,
  asthma, or post nasal drip.
• Crying, laughing, loud and long outbursts of
  emotions, tantrums, inability to cope properly
  with negative emotions, related to loud, forceful
  use of voice.
• Shouting, cheering, and screaming

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Causes cont.

• Grunting, during sports activity or weight
  training, this puts a sudden shock to the vocal
  folds.
• Throat clearing, vocal folds are slammed together
  every time the throat is cleared.
• Making sound effects or character voices,
  especially when breathing IN, this puts more
  strain on the vocal folds.
• Dryness, caused by overuse of certain medicines
  (cough drops and antihistamines), allergies,
  caffeine, and mouth breathing.
• Restricted fluid intake, for healthy vocal
  system good hydration is necessary.

8
Children at risk for voice disorders may have one
or more of the following

• Families with loud voice habits
• Chronic asthma or allergies
• Frequent upper respiratory tract infections
• Gastric reflux
• Affective disorders, ADD, hyperactivity,
  temperamental personality
• Behavioral problems
• Excessive stress or tension in childs life
• (internal, external, or interpersonal factors)
• Loud, outgoing competitive personality with
  tendency to act out emotionally

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Treatment for voice disorders

• Child must first see an ENT, to determine if
  voice therapy is recommended.
• Record detailed case history (childs early
  development, family relationships, ways disputes
  are resolved, behavior management, peer
  relationships, health history, childs
  personality)
• Aim for therapy is to teach a healthy,
  non-abusive voice production pattern
• Educate child and family about nature of problem,
  symptoms, causes, and risk factors
• Explain normal anatomy and physiology of larynx
  in relation to childs pathology

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Treatment cont.

• Identify abusive behaviors and reduce or
  eliminate them
• Teach child about voice production phonation
  (how sound is produced by vocal folds),
  respiration (breathing), resonance (loudness)
• Teach child about correct breathing style
• Explain how to recognize excessive neck tension
  around the larynx
• Provide a foundation for learning to produce the
  best voice with the least effort
• Resonance training teaches child to project
  voice to achieve loudness , rather than straining
  voice
• Teach voice exercises and relaxation techniques

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Boone Voice Program for Children

• Designed to give children insights into why they
  may have voice problems related to vocal abuse.
• Provides guidelines and materials for evaluation
  and remediation of voice disorders
• Based on philosophy and procedures in The Voice
  and Voice Therapy
• http//www.psycan.com
• Video Voice Speech Training- comprehensive
  computerized speech therapy tool to aid in speech
  therapy.
• http//www.videovoice.com

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Resources

• Boone, D.R. McFarlane, S.C. (2000). The voice
  and voice therapy (6th ed.). Boston Allyn and
  Bacon.
• http//members.tripod.com/Caroline_Bowen
• http//www.psycan.com
• http//www.videovoice.com
• http//www.unc.edu/chooper/clinprog/childvoice/tr
  eatment.html
• http//www.superduperinc.com/P_Pages/pe9878.htm