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Live from the AAP Conference

A Hoarse Voice: Reflux or not?

Parents sometimes tell me their child or teen has a deep voice or sounds hoarse. Surprisingly, a few parents of infants say the crying sounds hoarse. I have been contacted by professional singers and frustrated adults who want their voices heard so I was curious to find out more about this topic.

A hoarse voice may be a symptom of Gastroesophageal Reflux Disease (GERD), allergies, overuse of voice or the result of injury/intubation in children and teens. It is likely the primary care doctor such as a pediatrician will be the first stop for diagnosis and treatment.

Diagnosis

If a child does not respond to treatment, a referral may be made to a specialist in pediatric voice disorders called a laryngologist. The evaluation may include a careful history of the problem and an evaluation of the airway, voice and swallowing. It is important to look at the vocal cords to fully assess the symptoms. Fortunately, new technology with smaller fiber optic endoscopy probes is making it easier to see the vocal cords with less discomfort to the child. A doctor may also try a short trial of reflux medication to assess the effect of the medication on the symptoms. In addition, a speech language pathologist may conduct a voice evaluation.

Treatment

Treatment may include educating the family about voice disorders such as hoarseness and helping the child to use her voice differently without causing strain. Sometimes a cyst or other abnormality is discovered on the vocal chords so surgery or other treatments may be necessary.

Last Word

It is important to look at all causes of hoarseness and report all symptoms to the doctor. One of the case studies presented was about a teen who became hoarse after attending a rock concert and screaming all night long!


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