You've assumed that your son's voice is constantly raspy because he's been playing Wii and screaming at the television like a crazy person for weeks now. But should you be a little more concerned? Is there an underlying cause for the hoarseness? Today, Parents Ask expert Dr. Adam Friedman, an Ear, Nose and Throat specialist, explains and answers:

Q: Why Does My Child Always Have Such a Hoarse Voice?

A:  There are many reasons why children can develop hoarse or raspy voices.  Infections such as tonsillitis, pharyngitis, and laryngitis can all result in temporary voice changes but these changes typically resolve as the infections get better.  Still, however, some children always seem to be hoarse.  In addition to infection, there are numerous uncommon causes of voice problems such as cysts or polyps of the vocal cords, tumors on the vocal cords, or even weakness or paralysis of the muscles that move the vocal cords.  The most common cause of hoarseness in children is, by far, the development of nodules on the vocal cords.  Nodules, which are also often referred to as “singer’s nodes” or “screamer’s nodules” are the result of excessive, improper voice use.

As young children become more excitable and verbally expressive, they have a tendency to use their voices in such a way that there is excess trauma to the vocal cords.  Frequent, continual yelling and screaming (which we all know children are prone to!) results in excessively forceful closure of the vocal cords during the process of sound formation.  Over a prolonged period of time this excess force causes swelling which can ultimately turn into scar tissue.  This scar tissue is what comprises the nodules and it disrupts the delicate vibrations of the vocal cords that contribute to the formation of a “normal” voice.  The resulting voice is often characterized as “hoarse”, “raspy”, or “froggy” in nature. 

Voice problems in children can be easily evaluated by most ear, nose, and throat doctors.  After administering a small amount of numbing medicine to the nose and throat, a small telescope can be passed through the nose or mouth to look at the vocal cords themselves to make a diagnosis.  The procedure takes only a minute or two and is done in the office with ease.  If a diagnosis other than nodules is made, your doctor will then be able to institute the appropriate treatment.  If nodules are present, treatment is simple.

Vocal cord nodules are due to voice abuse and irritation of the vocal cords from stomach acid.  Your doctor will likely prescribe a medication to reduce the amount of stomach acid that is produced to prevent irritation of the voice box.  Additionally, your child should probably be referred to a speech pathologist who is experienced in treating children.  The speech pathologist will help your child develop healthy vocal habits that prevent excessively forceful closure of the vocal cords.  Most children tend to do very well after only a few sessions.

Although nodules are very common, the good news is that they respond very well to therapy.  With acid-suppressing medicine and voice therapy, nodules tend to disappear over 90% of the time and the voice typically returns to a completely normal state.