Center for Pediatric Voice Disorders

  • Conditions We Evaluate and Treat

    The Center for Pediatric Voice Disorders at Cincinnati Children’s treats a variety of conditions. Whether your child’s voice disorder is the result of a congenital malformation, injury or the side effect of an illness, our comprehensive approach means we can develop a care plan that addresses your child’s unique needs.

    Use the following tabs to learn more about some of the conditions we treat:

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    Subglottic Stenosis

    Subglottic stenosis is a narrowing of the trachea (windpipe or lower airway). Children can be born with this condition or acquire it later in childhood.

    One of the most common causes of acquired subglottic stenosis is prolonged intubation. (Intubation is the process of placing a tube down a child’s windpipe to help her breathe). Because the narrowing can create breathing problems, children with significant narrowing often require a tracheostomy tube  to breathe. This condition is diagnosed by a procedure called a laryngoscopy / bronchoscopy.

    Reconstruction of the airway is often required to permanently remove a tracheostomy tube or create a wider airway. The two primary procedures, laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR), are designed to eliminate the need for a tracheostomy tube. Our specialists often see these patients in our voice center before and following the procedures to evaluate and treat voice changes.

    Congenital / Acquired Webs

    A vocal cord web is a band of tissue between the two vocal cords. A congenital web is caused by the failure of the vocal cords to completely separate during development. The web may also be the result of scarring from trauma or surgery to the larynx (voice box). Depending on the extent of the web, the child may have difficulty breathing and suffer from poor vocal quality (hoarseness).

    Papillomatosis

    Papillomas are persistent or recurring wartlike lesions that develop in the airway. They are thought to be caused by a virus, and typically occur between the ages of 2 and 4. Papillomas can be in various parts of the airway including the larynx (voice box), trachea (windpipe) and bronchus (large air passage). Multiple laser surgeries are often required to control these growths. Tracheotomy is sometimes required for the child to breathe.

    Congenital Vocal Cord Cysts

    Cysts are benign (not cancerous or life-threatening) growths  on the vocal cords that may be present at birth. There is no clear cause for cysts, though congenital vocal cord cysts occur when glands on the inside of the mouth become blocked. Cysts do not respond to voice therapy, so they must be surgically removed. Your child may benefit from rehabilitative voice therapy to help him  recover after surgery.

    Polyps

    Polyps are fluid-filled growths on the body that are not life-threatening. They develop quickly and increase in size due to an active blood supply. They appear in sessile (blister-like) or pedunculated (attached to a stalk) forms. In the larynx polyps are caused by voice abuse or misuse and typically occur in adults rather than children. Polyps often require phonosurgery (surgery to improve a patient’s voice) and post-operative rehabilitative voice therapy.

    Voice Strain in Singers

    Pediatric and adolescent singers are often untrained. Poor posture, inappropriate breath support, hard glottal attacks and limited pitch range can lead to vocal nodules or voice disorders. Adolescents, who are experiencing laryngeal puberty changes, can have difficulty transitioning vocal registers. Pushing, that occurs at the extreme ends of the voice range, creates vocal strain. Even excessive singing can be considered vocal misuse.

    Vocal Cord Nodules

    Vocal nodules are inflamed areas, or lesions, on the vocal folds. The lesions usually vary in size. Nodules are typically on the middle edge between the front one-third and rear two-thirds of the true vocal fold. The management of vocal nodules most often involves voice therapy. In rare cases where nodules do not respond to therapy, surgery might be needed, followed by post-surgical voice rehabilitation.

    Vocal Cord Paralysis / Paresis

    Vocal fold paralysis, or paresis, results from an injury or lesion in the peripheral (surface) or central nervous system controls for voice production. Paralysis may involve one (unilateral) or both (bilateral) vocal folds. In the case of unilateral vocal fold paralysis, one vocal fold moves appropriately but the other does not. If there is bilateral vocal fold paralysis, breathing or voice quality may be affected. When one vocal fold is weak or unable to meet at midline during speaking, air will escape too quickly and the voice will sound weak or breathy. The escape of air often requires the patient to breathe in more often during speaking and, in general, use more effort during speech. This increased effort can result in fatigue. Patients with unilateral vocal fold paralysis are also at risk for choking on foods and liquids.

    When both vocal folds are paralyzed, breathing and swallowing problems may be more serious. When the vocal folds are paralyzed in the midline position, vocal quality may be adequate, but normal breathing may be obstructed. Sometimes these patients require the placement of a tracheotomy to establish an appropriate airway. When the vocal folds are paralyzed in an open position, the patient is aphonic (does not have a voice or is just a whisper) and protection of the airway during swallowing is a serious concern.

    Paradoxical Vocal Fold Dysfunction

    Paradoxical vocal fold dysfunction is a condition in which the vocal folds come together at midline during inspiration (breathing air into the lungs). They should actually be opening at this point. This coming together during inspiration causes stridor (noisy breathing) and the feeling of gasping for air.

    This vocal fold movement is intermittent and triggered by exercise, stress or exposure to specific substances (chemicals, perfumes, smoke). Due to the severity of the breathing difficulty, patients who experience these symptoms are often treated in the emergency room. Patients with paradoxical vocal fold dysfunction are often treated incorrectly for asthma. Some patients benefit from learning breathing techniques that alleviate these symptoms.