Voice and Resonance Disorders

Voice disorders refer to conditions that affect the quality, pitch, loudness, or resonance of a child's voice,

Understanding and Treating Voice Disorders in Children

Voice disorders in children can significantly impact their daily lives, affecting their self-esteem, social skills, and overall communication abilities. Recognizing these issues early and implementing appropriate treatments can significantly improve the quality of life for these young individuals.

What are Voice Disorders?

Voice disorders refer to conditions that affect the quality (e.g., rough, hoarse), pitch (e.g., higher or lower than expected), loudness, or resonance (i.e., proper airflow through the mouth and nose) of a child's voice, making them different from those of their peers [1]. These disorders may stem from a variety of underlying causes, including structural abnormalities of the vocal cords, misuse or overuse of the voice, and other physical health conditions.

Causes of Voice Disorders in Children

Voice disorders can stem from either physiological or behavioral causes, or a combination of both.

In many cases, voice disorders are due to physiological problems related to the vocal cords or the larynx (also known as the voice box). For example, changes in voice may be due to growths on the vocal cords, inflammation or swelling of the vocal cords, and nerve problems [1].

For instance, children might develop growths like nodules, polyps, or cysts on their vocal cords. These growths can interfere with the proper vibration of the vocal cords, which can impact the sound and efficiency of their voice. Inflammation or swelling of the vocal cords, often associated with allergies, reflux, or infection, can also lead to vocal changes. Lastly, nerve problems like vocal cord paralysis or weakness may impact the functioning of the vocal cords.

Moreover, voice disorders may also result from vocal misuse, such as yelling, excessive talking, or chronic cough. These behaviours put additional strain on the vocal cords, leading to voice changes and problems.

Diagram of healthy vocal cords, also known as vocal folds

Our voice is produced as air flows through vocal cords vibrating against one another.

Lesions on the vocal cords, such as polyps or nodules, impact how the vocal cords are able to vibrate together. This changes the sound and quality of the voice, as well as the efficiency of an individual’s breathing.

Common Symptoms of Voice Disorders

Recognizing voice disorders in children involves paying attention to the sound and quality of their voices. Children with voice disorders may show the following symptoms:

  • Hoarseness: This is characterized by a rough, scratchy voice. Hoarseness often indicates irritation or injury to the vocal cords.

  • Breathiness: If a noticeable amount of air escapes during speech, making the voice sound weak, the child may be experiencing breathiness. This often results from the vocal cords not being able to close fully.

  • Strained or harsh voice: If a child's voice sounds forced or effortful, or if it sounds excessively harsh or rough, this might be a sign of a voice disorder.

  • Inappropriate pitch or loudness: If a child speaks in a pitch or loudness that's not suitable for their age and sex, they might be experiencing a voice disorder [8].

If a child exhibits any of these symptoms for an extended period, it's important to seek professional help for a proper evaluation.

Diagnosing Voice Disorders

Diagnosing voice disorders in children is a process that involves several key steps, including a physical examination, a review of the child's medical history, and a practical voice assessment [3].

During the physical examination, the healthcare provider might check the child's throat, neck, and mouth for any visible abnormalities. They will also ask about the child's symptoms and voice use habits.

The child's medical history provides valuable information about their overall health, any previous illnesses they might have had, and any family history of voice disorders. This information can help pinpoint potential causes of the voice disorder. It will be important to consider the child’s voice habits (e.g., excessive yelling), sleeping habits (e.g., snoring, open-mouth posture at rest) and

Finally, specialized diagnostic procedures such as laryngoscopy may be used. This involves using a laryngoscope, an instrument that allows healthcare professionals to closely inspect the vocal cords and larynx. This can help in identifying any physical abnormalities like growths or inflammation [3]. When these tools are not available but recommended for assessment, the child may be referred to a specialty voice clinic or in-hospital clinic. Speech-Language Pathologists often work with Ear, Nose & Throat doctors to assess and treat voice and resonance disorders.

Resonance Disorders

Resonance refers to the quality of voice that is affected by the cavities of the mouth, nose, and throat. It plays a important role in how speech sounds are formed and projected. For example, in English we have several sounds that are produced through the nasal cavity (e.g., n, m). If you block air from moving through your nose, these sounds will sound significantly different! Resonance problems when speaking can arise from various factors:

  • Structural Differences: Conditions like cleft palate or a deviated septum may alter the physical structure of the vocal tract, leading to improper resonance. This results in speech that may sound nasal or hollow, as the sound waves are not shaped correctly within the cavities.

  • Neurological or Muscular Disorders: Issues with the nerves or muscles controlling the soft palate and other speech structures can affect how the sound resonates. For example, in conditions like Parkinson's disease or cerebral palsy, the control of muscles required for appropriate resonance may be compromised.

  • Behavioural Factors: Improper speech habits or techniques can lead to resonance issues. For example, speaking too softly or misplacing the tongue in a way that impacts the airflow during speech.

Speech therapists work to diagnose these problems and develop individualized strategies to correct them, improving the quality and intelligibility of speech.

Cleft Lip and Palate

Cleft lip and palate is a congenital condition characterized by an opening or gap in the upper lip and/or roof of the mouth (palate). This occurs in approximately 1 in 1,000-1,5000 life births, depending on ethnicity and geographical location. The cleft can be partial or full, affecting speech resonance and sound development.

Resonance refers to how air flows during speech - through the oral cavity (mouth) or nasal cavity (nose) as needed.

A partial cleft palate may lead to nasal sounding speech due to improper closure between the nose and mouth, whereas a full cleft palate can severely impede the development of speech sounds, requiring professional intervention. Feeding challenges are common for infants and children with cleft lip and palate. Treatment usually involves surgical intervention and speech therapy to aid in proper development. Children with repaired cleft lip and palate will benefit from speech therapy to support clear production of speech sounds and to address any ongoing resonance challenges.

Father holds young daughter in a field of flowers

Speech Therapy

Speech and voice therapy is part of treatment for children who experience chronic hoarseness due to lesions on their vocal cords [9]. This type of therapy involves exercises and techniques that can help children learn to use their voices in a more efficient and less damaging way, reducing strain on the vocal cords [9]. The effectiveness of voice therapy relies on exercises being done in a safe and correct way, and that they are done regularly, as outlined by the SLP or health provider.

A speech therapist works with the child to improve their overall vocal health and to teach them habits and techniques that can prevent further voice disorders. Depending on a child’s unique situation, the therapy approach might involve a combination of exercises to improve articulation, fluency, and language use, as well as guidance on the appropriate use of pitch, loudness, and voice quality.

Lifestyle Changes

Healthy voice habits can make a significant difference in managing and preventing voice disorders[6]. Encouraging children to take regular talking breaks, stay hydrated, and avoid irritants such as smoke or excessive noise can help maintain the health of their vocal cords. Teaching vocal hygiene is also an important part of speech and voice therapy.

Medical Treatment

In some cases, medication or surgical intervention may be required. If the voice disorder stems from an underlying medical condition like acid reflux disease or laryngeal tumors, medical or surgical treatments may be necessary [3]. In these cases, your child will be supported by a team of professionals, including an SLP and ENT, as well as your family doctor.

For example, acid reflux disease, which can cause stomach acid to irritate the vocal cords, is often treated with lifestyle modifications and medications. Other conditions, such as laryngeal tumors or vocal cord paralysis, may require surgical intervention.

Parental Involvement

Parental involvement is key in the treatment of voice disorders in children. Parents, caregivers, and the voice care team need to have a clear line of communication and need to be aligned on the treatment goals and expected outcomes[5]. Active parental involvement can significantly improve the child's adherence to the treatment plan and overall progress.

Conclusion: The Importance of Early Diagnosis and Treatment

The early diagnosis and treatment of voice disorders in children can significantly improve their voice quality and reduce the impact of the voice disorder on their daily lives. Persisting voice disorders can affect a child's academic performance, social interaction, and self-esteem, making early intervention essential.

Voice disorders in children can seem daunting, but with a proper understanding of these conditions, their causes, and treatment options, they can be effectively managed. It's important to consult with a healthcare professional if you suspect your child has a voice disorder. With the right evaluation and treatment, most children with voice disorders can regain their normal voice function and continue to thrive.

At Ruby Speech Therapy, our team is trained to support treatment for a variety of voice disorders. For a physiological assessment (e.g., laryngoscopy) or consultation for surgical or medical interventions, we will be happy to collaborate with your child’s doctor or medical team.

Links & Resources for Fluency Disorders

  • Straw Phonation Exercises

    Ingo Titze is a voice scientist and executive director of the National Center for Voice and Speech and Adjunct Professor in the Department of Otolaryngology/Head and Neck Surgery at the University of Utah in Salt Lake City. In this video, he demonstrates some helpful exercises to help stretch and relax your vocal cords. These exercises are great for anyone who wants to practice good vocal hygiene and ensure their voice is well-cared for!

    stuttering foundation_drawings and letters from kids who stutter

  • Support for children with Voice Disorders through Alberta Health Services

    Children ages 0-18 may be eligible for support with Alberta Health Services if they require treatment for voice disorders. Parents can self-refer by calling their local public health unit number found here under “Services Locations”.

  • Voice Therapy resources for SLPs

    Kristie Knickerbocker, CCC-SLP, is a voice and swallowing specialist. She shares tons of free education content on her instagram page (@kristie_voice) and has amazing resources for clinicians wanting to better support their voice therapy clients. Check out her website and resources at https://www.atempovoicecenter.com/

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