Neck
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
Pathologies in the larynx in children are caused by four main groups: acute infection, airway stenosis, tumours and foreign body. The term dysphonia includes any impairment of the voice or alteration in the sound of the voice. Hoarseness subsequent to an acute upper airway obstruction (causing croup) in association with a viral upper respiratory tract infection (URTI) is by far the most common presentation in children. Croup is characterised by abrupt onset at night, with barking cough, inspiratory stridor and respiratory distress. Mild obstruction usually causes transient symptoms (hoarseness and stridor). More severe degrees of obstruction cause more persistent symptoms of stridor and hoarseness, nasal flaring and subcostal and intercostal recession. Recovery within a few days is usually the rule. On rare occasions such an obstruction is caused by more serious underlying causes, such as Staphylococcal aureus (causing bacterial tracheitis) and Haemophilus influenzae type b (causing epiglottitis). The obstruction is more serious in infants and young children than in older children because of the smaller airway and the more likely obstruction. Persistent hoarseness usually suggests cord paralysis or tumours. In this section, abnormal or unusual voices are included.
Outcomes Research
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
There is no generally accepted objective test to serve as a ‘gold standard’ for the assessment of voice disorders. Various questionnaires have been developed for evaluation of the consequences of dysphonia. The Voice Handicap Index (VHI) was designed to assess the self-perceived effect on quality of life of voice disorders.76 It is a 30-item questionnaire divided into 3 subscales: functional handicap, emotional handicap and physical handicap. The questions use a 5-point Likert scale. It has been used to assess the impact of a number of voice disorders, including vocal cord polyps, cord palsy, spasmodic dysphonia and functional disorders. Its construct validity has been confirmed by comparing its subscales with appropriate subscales of the SF-36 in assessment of the health-related quality of life in patients after treatment for laryngeal cancer.31 A shortened version, the Voice Handicap Index-10, has been proposed as an equally effective alternative.77 Carding et al. 78 wrote a review of measures of voice outcomes.
Paediatric laryngeal disorders
Declan Costello, Guri Sandhu in Practical Laryngology, 2015
Benign laryngeal pathology also presents with vocal abnormalities and this is mostly a presenting feature in the out-patient setting unless it is accompanied by significant airway symptoms. Depending on the age of the child, vocal abnormalities may only present as abnormalities of the cry rather than of speech, as in the infant population. In the older child, dysphonia and hoarseness are the common symptoms. Isolated vocal symptoms can be thoroughly assessed in a specific paediatric voice clinic where a full assessment of the voice quality itself can be made, including the impact on quality of life. Fibreoptic laryngoscopy can again be a useful diagnostic tool and additional stroboscopy can augment the examination findings with this technique.
Voice evaluation – contribution of the speech-language pathologist voice specialist – SLP-V: part A. History of the problem and vocal behaviour data, self-assessment and auditory perceptual judgement
Published in Hearing, Balance and Communication, 2021
Mara Behlau, Glaucya Madazio, Thays Vaiano, Claudia Pacheco, Flávia Badaró
The human voice is a product perceived aurally, which immediately impacts the relationship with the listeners. Its production complexity involves three brain systems: innate vocalizations, emotional vocalizations, and highly sophisticated and volitional vocalizations, such as singing [1]. In addition, the phonation depends on a balance of aerodynamic (subglottic pressure and trans-lingual flow) and muscle forces (with highly developed interdependence and synergy). A third important aspect is the active participation of the mucosa that covers the vocal folds, a multi-laminated vibrator with different mechanical properties. Although animal vocalisation is impressive, with an open-ended, highly modifiable, and cognitively rich set of meanings [2], the use of voice by human beings is unique. It encompasses physical survival, professional exercise, cultural manifestation, and above all, identity. Therefore, having a normal voice is critical for human development. A voice disorder, called dysphonia, is usually characterised by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life [3]. Dysphonia can significantly impact different aspects of an individual’s life and deserves to be recognised, evaluated, and treated.
Voice therapy in paediatric dysphonia
Published in Hearing, Balance and Communication, 2020
Mattia Gambalonga, Davide Brotto, Niccolò Favaretto
The term dysphonia characterizes impaired voice production as recognized by a clinician and it refers to a wide spectrum of voice disorders impairing the communication skills of the affected patients [1]. Dysphonia impacts the quality of voice, loudness, pitch or vocal effort thus reducing the voice quality [2]. The estimated prevalence in paediatric population greatly varies in different reports [3–5] and this disease affects most frequently children between 8 to 14 years old [6]. Dysphonia has a tremendous impact in terms of public health resources implicated in the management of the patients and diminished work-related function [7], even if only about 6 percent of the general population (adult and children) seeks for medical intervention/support [1]. The causes of dysphonia are frequently benign or self-limiting conditions, but it may also be the symptom of serious or progressive conditions with severe neurological implications (such as Parkinson’s disease, spasmodic dysphonia, vocal tremor, or vocal fold paralysis) [7]. Consequently, a prompt medical evaluation is mandatory in order to choose the best medical, surgical or rehabilitative approach for the correction of dysphonia.
Patient reported voice handicap and auditory-perceptual voice assessment outcomes in patients with COVID-19
Published in Logopedics Phoniatrics Vocology, 2023
Emel Tahir, Esra Kavaz, Senem Çengel Kurnaz, Fatih Temoçin, Aynur Atilla
Nonetheless, the infection can also have a significant impact on the upper airway [2]. Olfactory and taste dysfunctions, in particular, have been widely described as characteristic and early signs of COVID-19. Patients infected with COVID-19 may experience typical and non-specific upper airway infection symptoms such as rhinorrhea, nasal congestion, and symptoms due to laryngeal involvement in the inflammatory process [3]. Dysphonia be caused by anything that restricts the vocal chords from vibrating normally, such as edema or inflammation. The most common cause of dysphonia is acute laryngitis prompted by an upper respiratory tract infection [3,4]. Dysphonia has previously been reported in 26.8% of patients with mild-to-moderate COVID-19 [4]. The occurrence of dysphonia with upper respiratory infections is well described in the literature. Also, it is a known fact that viral pathogens may cause vagal neuropathy and vocal cord paralysis [5]. A vagal neuropathy that results in vocal fold paresis or paralysis can impair voice quality due to paradoxical vocal fold movement, persistent coughing, laryngeal paresthesia, laryngospasm, and vocal fatigue. COVID-19 affects the same systems and structures used for voice production; therefore, it may decrease voice quality [4,5].
Related Knowledge Centers
- Dysphagia
- Laryngitis
- Shortness of Breath
- Upper Respiratory Tract Infection
- Vocal Cords
- Common Cold
- Allergy
- Influenza
- Phonation
- Shortness of Breath
- Aphonia