What are voice disorders?

Voice disorders are vocal differences that can impact your child’s daily communication needs. They are among the most common communication disorders in children. If your child is diagnosed with a voice disorder, rest assured there are treatment options available here at Children’s Hospital of Philadelphia (CHOP).  

Causes of voice disorders

A combination of two or more factors can cause your child to experience a voice disorder:

1. Structural or physical changes to your child's vocal mechanism
   • Inflammation of the vocal cords or surrounding area
   • Growths on the vocal folds (nodules, polyps, cysts)
   • Gaps in the vocal cords
2. Changes with the nerves that help with movement of the vocal mechanism (vocal cord paralysis)
3. Misuse or overuse of the voice (with normal structure)
4. Psychological (mental or emotional) stressors

Symptoms of voice disorders

If your child experiences a voice disorder, they may sound hoarse, raspy or breathy. They may also deal with symptoms like:

• No voice, only a whisper (aphonia)
• Changes in pitch (sounding deeper or squeakier)
• Throat pain
• Increased effort needed to talk
• Muscle strain in the neck, shoulders or jaw
• A tired voice
• Increased throat clearing

Testing and diagnosis for voice disorders

Our team of professionals here at CHOP will work together to test and diagnose whether your child has a voice disorder. Our team includes otolaryngologists (ENT), nurse practitioners (NP) and speech-language pathologists (SLP). During voice evaluations, they will test and seek to diagnose your child by:

• Taking a detailed case history
• Asking about your concerns and your child’s
• Looking at their throat (specifically the larynx)
• Recording and analyzing your child’s voice
• Trying therapy techniques

Treatment for voice disorders 

At CHOP, our SLPs in the Pediatric Voice Program and the Department of Speech-Language Pathology treat children with voice disorders. Our SLPs will conduct therapy with your child using their professional knowledge of voice anatomy, voice techniques, specialty equipment and children’s voice capabilities.

Treatment for voice disorders may include therapy, medical management (like medication or dietary modification) and/or surgical procedures. Our team of professionals will determine the most appropriate treatment based on your child’s needs. Our SLPs provide voice therapy. Our ENTs guide medical management and surgery.

Therapy 

Therapy recommendations will depend on your child’s age. Children under two years old may receive family education instead of therapy. Children over two years old may receive voice therapy. If your child is a performer with a voice disorder, they may also be a candidate for voice therapy.

Long-term goals of voice therapy may include:

• Focusing on your child’s strengths in voicing
• Teaching your child skills to improve areas of concern
• Changing your child’s current voice use to fit their communication needs
• Providing support to your child and your family

Short-term goals of therapy may include our SLPs teaching your child strategies like:

• Body positioning
• Grounding techniques
• Relaxing the larynx and muscles needed to speak
• Improving breath support
• Improving self-awareness
• Vocal hygiene, including reducing misuse and overuse
• Exercises where the mouth is partially closed (also called semi-occluded vocal tract exercises)
• Vocal therapy that uses the sound vibrations in the throat, mouth and nose (also called resonant voice therapy)
• Vocal function exercises, which strengthen and increase coordination of the muscles we use for speaking

At CHOP, our goal is to identify and treat voice disorders so your child can have the best communication outcomes.