A child's voice is hoarse

Hoarseness occurs much more often in children than in adults. Let's consider the main causes of this symptom, types and forms, methods of treatment, prevention.

Voice is the sound waves produced by air passing through the glottis of the larynx with the vocal cords closed.

• The thinner and shorter the ligaments, the higher the voice.
• If the ligaments are even, then the tone of the voice is clear.
• Thickening and unevenness of the vocal cords disrupt the flow of air, creating obstacles in its path, which affects the pitch of the voice and manifests itself as hoarseness.

The appearance of wheezing is usually associated with the peculiarity of the structure of the baby's upper respiratory tract. The mucous membrane of the larynx is very delicate and penetrated by a large number of blood vessels. Any irritation or exposure to pathogenic microorganisms leads to the development of edema and dysphonia.

In some cases, there is a complete loss of voice, and even a direct threat to the child's life. Therefore, the appearance of this symptom should be taken very seriously. This is due to the fact that the unpleasant condition can be caused by congenital diseases of the larynx (papillomatosis, cysts), requiring surgical intervention.

Epidemiology

The voice is a combination of different sounds that occur when elastic vocal folds vibrate. The sound of the voice is the vibration of air particles that spread in the form of rarefaction and condensation waves. The main source of the voice is the larynx and vocal cords.

According to medical statistics, voice disorders in children have a prevalence of 1 to 49%, and in adults from 2 to 45%. The main cause of dysphonia is a decrease in local immunity. An unpleasant symptom can develop against the background of diseases of the upper respiratory tract (ARI, ARI, colds), various viral, bacterial and infectious processes in the body and respiratory organs, as well as in stressful situations, congenital pathologies and injuries.

Voice disorders have a significant impact on the general and speech development of a child. The negative impact of this problem affects the formation of personality and the process of social adaptation of the baby. Several disciplines study voice disorders and hoarseness: pediatrics, psychology, speech therapy, endocrinology, neurology, physiology, phoniatrics.

Causes hoarseness of voice

Voice disorder in children is not an independent disease, but occurs due to the action of certain causes and factors. Some of them are harmless, others require careful diagnosis and treatment.

The main reasons for hoarseness in a child:

• Overstraining of the vocal cords – the mucous membrane of the larynx is very sensitive, so a child’s crying, loud shouting or singing causes microtrauma with ruptures of small capillaries and swelling. This causes wheezing and hoarseness.
• ARI, flu - one of the complications of colds is inflammation of the larynx. Laryngitis can be of viral and bacterial origin. In addition to the sound disturbance, the body temperature rises, a runny nose, cough, and sore throat appear. [ 1 ]
• Intoxication – inhalation of chlorine vapors and other chemicals causes spasms and swelling of the larynx, coughing. If the body is exposed to ammonia, pain behind the breastbone and sputum discharge occur. Fluorine provokes convulsions, severe coughing, and reddening of the eyes.
• Allergic reactions – contact with an allergen, an insect bite, inhalation of irritating odors causes an allergy with swelling of soft tissues. In particularly severe cases, Quincke's edema develops, which is manifested by laryngeal stenosis, difficulty breathing, and suffocation. The stages of an allergic reaction change very quickly, so you should immediately seek emergency medical care. [ 2 ]
• Foreign objects getting into the larynx – this condition requires emergency diagnosis and treatment. Since the foreign body disrupts the passage of air into the lungs. Against this background, a paroxysmal cough develops, the face becomes pale or has a bluish tint. The child suffocates and loses consciousness. If the airways are not cleared in time, this is dangerous and can result in death. [ 3 ]
• Burns – chemical and thermal damage to the mucous membrane of the ligaments and respiratory tube causes severe swelling, tissue damage and subsequent scarring. This is dangerous not only because of the change in sound, but also because of the loss of the ability to speak. [ 4 ]
• Laryngeal injuries – hoarseness develops from a blow to the front or side of the neck. [ 5 ]
• Metabolic disorders - changes in the production of some hormones are reflected in the sound. Due to the delay in the tissues of fluid, swelling of the ligaments occurs. For treatment, hormone replacement therapy is carried out.
• Dehydration – if you do not drink liquid for a long time, this causes dry mucous membranes and wheezing. [ 6 ]
• Stress, severe fear and anxiety cause changes in sound. After some time, the vocal apparatus is restored without outside help.
• Paresis and paralysis – the disorder occurs when the nerve endings of the vocal apparatus are damaged. The child feels numbness in the larynx and difficulty breathing.
• Tumor neoplasms - if they are located in the larynx area, they can compress the vessels and nerve endings. Against this background, periodic coughing, sore throat, and wheezing in the voice appear.
• Dysphonia is a qualitative voice disorder (change in pitch, timbre, duration, strength). It develops due to overstrain of the vocal cords, respiratory diseases, congenital pathologies, psychological and behavioral factors. It manifests itself as gradual fatigue of the voice and a feeling of tightness/soreness in the throat. It can cause problems in expressing thoughts and cause anxiety due to the child’s limited communication. [ 7 ]

These are far from all the possible causes of hoarseness, so you should not ignore the unpleasant symptom, as it may indicate serious pathological processes in the body.

Hoarseness of voice during teething

The emergence of teeth from the gums is a painful process. Some children begin to cut their first teeth at 3-6 months, while others begin to cut their first teeth at one year. The process of teething is individual, but almost all children experience the following symptoms:

• Redness and swelling of the gums.
• Elevated body temperature.
• Increased salivation.
• Itchy gums.
• Poor appetite.
• Digestive disorders.
• Sleep disturbance.
• Hoarseness of voice.

The appearance of the first teeth does not affect the state of the immune system. But the formation of a large amount of saliva leads to the fact that it loses its protective properties. This negatively affects the state of the immune system and can accelerate the development of infectious diseases. Also, against the background of a change in sound, pain in the nose and ears, reddening of the cheeks, and a runny nose may occur.

To relieve unpleasant symptoms, various painkillers and drugs to reduce body temperature are used. There is a special gel for teething. At the same time, it is contraindicated to massage the gums with alcohol-containing drugs or rub tablets into the inflamed mucous membrane. As the child's condition improves, his voice, appetite, and sleep are restored.

The child has a hoarse voice after a cold

The most common cause of a hoarse voice in a child is a cold. This concept includes more than 200 respiratory viruses that are transmitted by airborne droplets. The disease manifests itself with the following symptoms:

• Elevated body temperature.
• Runny nose.
• Increased lacrimation and stinging in the eyes.
• Headaches.
• Cough
• Voice change.

Often, a cold is complicated by damage to the vocal apparatus. Because of this, the patient's voice becomes hoarse and raspy. But as the patient recovers, the sound is restored.

There are several simple methods that will help you quickly restore your voice, which has become hoarse after a cold:

1. Silence – the vocal cords need rest and warmth. Wrap the baby’s throat with a scarf, the child should speak in a whisper or play the silent game with him.
2. Drink plenty of fluids. The best way to restore sound is warm milk with honey, warm tea, herbal infusions. Such drinks can be consumed throughout the day and always before bed.
3. Gargling – for these purposes, you can use pharmaceutical preparations or decoctions/infusions of medicinal herbs. Chamomile flowers have antiseptic properties, and eucalyptus leaves have antimicrobial properties. Take 1 tbsp. of dry raw materials, mix thoroughly and pour 300 ml of water. Boil the decoction over low heat for 1-2 minutes. After cooling, strain and let the child gargle. The procedures are carried out every 2 hours until the disorders are completely eliminated.

4. Inhalations – herbal remedies are suitable for these purposes. You can prepare a decoction based on chamomile, eucalyptus, calendula, coltsfoot. Dilute a tablespoon of herbs in a liter of boiling water, cover your head with a towel and breathe in.

If the main symptoms of a cold have passed, but hoarseness persists for a long period of time, then the child should be shown to a pediatrician.

Hoarse voice with stomatitis in a child

Stomatitis is an inflammation of the mucous membrane of the oral cavity. Most often, it appears on the inner surface of the cheeks, lips and palate, under the tongue.

Stomatitis develops due to opportunistic flora of the oral mucosa. Under the influence of certain factors, the body's immune defense decreases, and viruses/bacteria are activated. Possible causes of the disease also include:

• Violation of the integrity of the oral mucosa.
• Unbalanced diet.
• Poor hygiene – eating unwashed vegetables and fruits, licking dirty fingers, improper dental care.
• Taking medications that reduce salivation.
• Chronic diseases.
• Gastrointestinal disorders.
• Endocrine pathologies.
• Anemia.

Depending on the nature of the damaging effect, there are several types of stomatitis: bacterial, fungal, viral, radiation, chemical. But regardless of the cause, stomatitis manifests itself as an acute intoxication syndrome, which includes:

• Redness and swelling of the mucous membrane.
• Formation of round ulcers (the wound is covered with a white film, and there is redness around it).
• Pain and burning upon contact with the affected mucous membrane.

Against the background of the disease, the body temperature rises, the submandibular lymph nodes enlarge. If a child has a hoarse voice with stomatitis, this indicates the spread of the pathological process to the mucous membrane of the larynx.

Treatment includes rinsing with disinfectants, taking antimicrobial drugs, avoiding aggressive foods (hard, sour, spicy, hot, cold), and proper oral hygiene. Therapy takes 5-10 days. The voice is restored as recovery progresses.

After a sore throat, the child's voice became hoarse

One of the most common otolaryngological diseases in children is acute tonsillitis. Tonsillitis is an infectious and inflammatory process with damage to the palatine tonsils. Its main etiologic agent is beta-hemolytic streptococcus, pneumococci and staphylococci are less common. There is also monocytic tonsillitis caused by cytomegalovirus and agranulocytic, which develops with pathologies of the hematopoietic system.

The main symptoms of the disease:

• High body temperature.
• General weakness and malaise.
• Sore throat that gets worse when swallowing.
• Enlargement of the submandibular and cervical lymph nodes.

A symptom that deserves special attention is a change in voice (hoarseness, wheezing). It develops due to inflammation and swelling of the larynx and tonsils.

To diagnose tonsillitis, the patient is examined and a set of laboratory tests are performed (smear microscopy, bacteriological culture of discharge from the surface of the tonsils, smear for hemolytic streptococcus, PCR). Treatment consists of strict bed rest, gentle nutrition, and plenty of fluids. Patients are prescribed rinses with antiseptic and painkillers.

To restore your voice as quickly as possible, you need to rest your vocal cords, drink plenty of warm liquids, and avoid food that irritates the mucous membrane. Dry heat (a warm scarf on your throat or mustard baths if there is no fever) will help to improve blood circulation and speed up the recovery process. At night, you can give your child a glass of warm milk with a piece of butter and honey dissolved in it.

If voice problems and other painful symptoms persist for a long period of time, this may indicate the development of complications of angina (rheumatism, glomerulonephritis, arthritis, peritonsillar abscess, etc.), which require serious medical attention.

Risk factors

Since hoarseness in a child can occur due to various reasons, the risk factors depend on each specific case.

The main factors that contribute to sound changes include:

• Voice strain.
• Hypothermia.
• A long silence.
• Colds and viral diseases of the upper respiratory tract.
• Psychotraumatic factors (neuroses, severe fear, stress, depression).
• Hormonal disorders.
• Traumatic brain injury.
• Neurological diseases.
• Cerebral circulatory disorder.
• Influence of drugs.
• Allergic reactions.
• Neoplasms (polyps, vocal cord nodules).
• Diseases of the gastrointestinal tract.

The above factors provoke a decrease in local immunity and irritation of the mucous membrane of the vocal cords.

Pathogenesis

The mechanism of hoarseness development is directly related to the structure of the vocal apparatus. The following organs and structures participate in the process of voice formation:

• Lungs
• Bronchi
• Trachea
• Pharynx
• Nasal cavity
• Nasopharynx and larynx.

The vocal cords are located inside the larynx. They are two folds of mucous membrane covering muscles and cartilage. Normally, they open and close smoothly, which is why sounds are formed when air passes through.

When exposed to pathogenic microorganisms, the mucous membrane is damaged. The infection causes local swelling and an inflammatory reaction. This in turn leads to difficulty breathing and loss of voice. A similar pathogenesis has hoarseness due to intense tension of the vocal cords. But unlike infectious processes, in this case the sound is restored when the vocal cords are provided with rest.

Allergic reactions in the larynx provoke swelling of the throat, which causes not only a voice disorder, but also life-threatening suffocation. In some cases, the pathogenesis is associated with weakness of the vocal cords and neoplasms in the respiratory system.

Symptoms hoarseness of voice

There are many different factors and causes that can cause sound disturbances. If the unpleasant condition is caused by laryngitis, its first signs are hoarseness, barking cough and other symptoms:

• Difficulty breathing.
• Painful sensation when swallowing.
• Dry, barking cough.
• Swollen and red throat.
• Elevated body temperature.
• Spasms of the laryngeal muscles.
• A feeling of dryness and irritation in the mouth.

Many other infectious diseases have similar symptoms.

There are also a number of symptoms that occur against the background of hoarseness and require emergency medical care:

• Low, deep voice.
• Dry, barking cough.
• Difficulty breathing with whistling and retraction of the intercostal spaces.
• Pronounced respiratory movements of the chest.
• Difficulty swallowing.
• Increased salivation.

The child's larynx is very narrow, therefore, with severe swelling of the tissues of the subglottic space (observed in allergic reactions, infections, viruses and bacteria), its lumen is completely blocked, causing asphyxia.

Stages

Hoarseness in a child is not an independent disease, but is one of the symptoms of various pathological processes in the body. Based on this, the stages of dysphonia depend on its underlying cause.

For example, if the change in sound is caused by laryngitis, then the disorder has the following stages:

• Acute - sore throat, burning, painful swallowing, dry (barking) cough develop rapidly. Against this background, the voice changes, it becomes hoarse and hoarse. The vocal cords are swollen and hyperemic.

• Chronic – characterized by slow development. The patient has problems with the throat and vocal cords for a long period of time. There is a constant desire to cough. The voice is hoarse with pronounced wheezing.

In this case, diagnostic and treatment methods depend on the stage of the disease. The acute form is more amenable to therapy than the chronic one. The latter can be complicated by frequent relapses.

Forms

Based on the etiopathogenetic mechanism, voice disorders, which include hoarseness in children, can be organic and functional.

1. Functional disorders – they are not associated with anatomical changes in the vocal apparatus. Most often, their appearance is caused by neurotic disorders, which in turn are divided into:
   1. Central - due to the action of a strong stimulus, a focus of inhibition arises in the cerebral cortex, which disrupts the regulation of the voice formation process.
   2. Peripheral – the disorder is caused by a decrease/increase in muscle tone of the vocal cords, a violation of coordination between breathing and the function of the resonator cavities.

Functional voice disorders are characterized by disorders of secretory functions with a sensation of a foreign body in the larynx, the motor function of the larynx increases sharply, and there may be a lack of coordination between speech breathing, articulation, and voice production. In some cases, neurological symptoms are observed: sleep disorders, high tendon reflexes.

2. Organic types of dysphonia include anatomical abnormalities in the structure of the vocal cords, inflammatory, infectious and other pathological processes in the body.

Complications and consequences

The lack of timely diagnosis and proper treatment of hoarseness in a child is dangerous due to the development of very serious complications. The consequences of an unpleasant symptom depend on the cause of its origin. If the sound disorder is provoked by an acute form of laryngitis, then this threatens such complications as:

• Respiratory pathologies due to narrowing of the laryngeal walls.
• Complete loss of voice.
• Neoplasms on the vocal cords (granulomas, polyps).
• Tumor lesions of the larynx.

Another common complication of inflammatory processes in the larynx, occurring in 90% of children, is stenosis or false croup. There is also a risk of developing purulent forms of laryngitis, which in turn can lead to inflammation in the chest cavity, lung abscesses, purulent inflammation of the neck tissue, and infection of the bloodstream.

Diagnostics hoarseness of voice

A pediatrician diagnoses the problem of voice disorder and hoarseness in children. To establish the cause of the disorder, a range of different studies are conducted:

• Collection of anamnesis and analysis of patient complaints.
• General examination of the child (palpation of the lymph nodes, presence of sore throat).
• Visual examination of the larynx using an endoscope (reveals narrowing of the lumen of the larynx, the presence of edema and hyperemia, purulent or mucous plaque on the mucous membrane).
• Laboratory tests (general and biochemical blood tests, urine tests, taking a smear from the mucous membrane).
• Instrumental research.

If the painful condition is not caused by viral or infectious processes in the body, then further diagnostics of the causes of the sound disorder is carried out by an otolaryngologist, phoniatrist, neurologist, speech therapist.

Based on the conducted studies, a final diagnosis is made, and treatment tactics are determined. If hoarseness is caused by respiratory pathologies or narrowing of the larynx, then there is a risk of developing croup, so the child is hospitalized. Inpatient treatment is indicated for hoarseness due to allergic reactions, diseases of the central nervous system.

Tests

Laboratory diagnostics of the causes of dysphonia in children includes the following studies:

1. General and biochemical blood tests.

Blood is a multifunctional fluid, so its analysis allows us to identify various deviations in the functioning of the body. Most often, patients are prescribed a general blood test, which in a short period of time identifies bacterial, viral and other pathogenic microorganisms.

Particular attention is paid to the level of leukocytes, which act as indicators of the immune system. If their level is elevated, it means that the immune system's defenses are activated and there is a pathogen in the body.

Another important indicator is the erythrocyte sedimentation rate. During inflammation, a large amount of protein is formed, which leads to an increase in ESR.

2. Urine analysis

Urine is an important product of human life. It removes toxic substances, decay products, hormones, salts and other compounds from the body. The analysis takes into account the physical, chemical and organoleptic properties of this biological fluid. The laboratory technician focuses on the color, density, smell, transparency and acidity. A macroscopic examination of the excreted fluid is also carried out.

3. Taking a smear from the mucous membrane of the larynx to determine the pathogen and analyzing sputum.

Sputum is a pathological secretion, separated from the respiratory tract (lungs, trachea, bronchi). General sputum analysis is a laboratory study and assessment of the general properties and microscopic characteristics of the secreted secretion.

A smear of mucous, as well as sputum analysis, allow diagnosing pathological processes in the lungs and respiratory tract. Assessing the nature of the pathological process in the respiratory organs. Conducting dynamic monitoring of the respiratory tract to assess the effectiveness of the therapy.

Based on the test results, the doctor draws up a plan for further diagnostics or prescribes treatment measures.

Instrumental diagnostics

Another component of the body examination to determine the causes of hoarseness in the voice is instrumental methods. They include the following diagnostic procedures:

• Stroboscopy – evaluation of vocal cord function.
• Laryngoscopy is performed to detect anatomical or inflammatory changes in the vocal apparatus.
• X-ray and MSCT of the larynx reveal tumor lesions of the larynx.
• Electromyography – assessment of the functions of the laryngeal muscles.
• Electroglottography is an assessment of changes in the vocal apparatus over time.

In addition to the above examinations, tomography of the larynx, densitometry of the bones of the cervical spine, and acoustic examination of the voice are performed.

Children are also shown a speech therapy examination, which includes an assessment of the characteristics of the voice, physiological and phonatory breathing, and the nature of voice formation.

Depending on the results of the diagnostics, the child may be further consulted by a surgeon, endocrinologist, phoniatrist and other specialists.

Differential diagnosis

There are many reasons that can cause hoarseness in a child's voice. Differential diagnostics are performed to determine the true cause of the pathological condition.

Differentiation is carried out with the following pathologies:

• Viral and bacterial diseases.
• Laryngitis.
• Diphtheria of the larynx.
• Laryngeal obstruction.
• Dysphonia.
• Retropharyngeal abscess.
• Intoxication of the body.
• Allergic reactions.
• Acute epiglottitis (inflammation of the epiglottis and surrounding tissues of the larynx and pharynx).
• Overstrain of the vocal cords.
• Foreign objects entering the larynx.
• Burns and sores of the larynx.
• Metabolic disorders.
• Paresis and paralysis.
• Stress, severe fear and anxiety.

When making a final diagnosis, the results of differential, instrumental and laboratory diagnostics are taken into account.

Treatment hoarseness of voice

An essential component of treatment is silence, i.e. rest for the vocal cords. When a person is silent, the glottis is open, and the cords are as far apart as possible. When talking, the cords come closer and rub against each other, which leads to their microdamage. Therefore, if the cords are inflamed, talking will only worsen their condition and cause additional painful symptoms.

For more information on treating hoarseness in children, read these publications:

• Methods of treating hoarseness in a child
• Inhalations for hoarseness in children
• Syrups for hoarseness in children

Prevention

There are several recommendations that help maintain the health of the respiratory system and serve as an excellent preventative measure against hoarseness:

• Avoid shouting as this is the main cause of a hoarse, scratchy voice.
• Control the humidity level in the room.
• Annual flu vaccination.
• Avoid contact with people who have colds or other airborne illnesses.
• Wash your hands more often.
• Timely treatment of inflammatory lesions of the respiratory system.
• Use of respirators when in contact with allergens or when working with toxic substances.
• Limit your child's time in places where people smoke.
• Limit your intake of spicy and straight foods, as they cause increased secretion of hydrochloric acid in the stomach and its entry into the esophagus and throat.

In addition to the above tips, it is not recommended to sleep without a pillow, as this leads to the backflow of acidic contents from the stomach into the throat, which, in addition to disrupting the sound, can cause heartburn.

Forecast

Hoarseness in a child has a favorable prognosis in most cases. The earlier the diagnosis is made, the causes of the disease are established and treatment is prescribed, the lower the risk of developing various consequences and complications. It should be taken into account that voice disorders in pediatric patients negatively affect their general and speech development. The disorder affects the formation of personality and the process of social adaptation.