Voice is the sound produced by vibration of the vocal folds (or vocal cords) in the larynx (voice box). A voice disorder occurs when the vocal folds do not vibrate well enough to produce a clear sound.

Causes of a Voice Disorder

The most common voice disorder in children is the result of “phono trauma” or voice misuse such as yelling or making loud “play” sounds, throat clearing, and excessive coughing. These voice behaviors cause the vocal folds to close tightly against each other, causing blister-like bruises. These bruised areas can harden into callus-like bumps called vocal nodules.

Other types and causes of voice disorders can include:

• Vocal fold paralysis (one or both vocal folds do not move)
• Vocal fold cysts (fluid-filled sac)
• Papilloma (wart-like growths)
• Laryngeal web (band of tissue between vocal folds)
• Muscle tension dysphonia (excessive muscle tightness), resulting in a strained voice
• Subglottic stenosis (narrowing of the airway)

Signs and Symptoms of a Voice Disorder

• Hoarseness
• Breathiness
• Raspiness
• Strain
• Volume that is too loud or too soft
• Pitch that is too high or low for age
• Recent loss of voice (such as after an upper respiratory infection) that did not resolve

Treatment for Voice Disorders

Some voice disorders can be treated with voice therapy. Other voice disorders are treated with medication or surgery. Usually, voice therapy is prescribed after surgery and sometimes before and after surgery. Voice therapy consists of learning new habits and patterns of voice production and eliminating old ones.

Voice therapy can include:

• Identifying and eliminating harmful voice patterns (such as yelling, screaming and making loud play sounds)
• Improving vocal health by increasing water intake and avoiding caffeine
• Using specific voice exercises designed to balance, strengthen or promote best vibration of the vocal folds. These help the voice to sound better.
• Learning to use the new voice production in everyday talking

Helping Your Child

The purpose of voice therapy is to teach your child a new improved way to produce voice. For this to become easier the child should practice the voice exercises daily. Family members should also look at their own voice use. Modelling your own good voice behaviors and rewarding good voice habits will help your child improve their voice.

• Avoid yelling and screaming. Model the use of a gentle, softer voice. Walk to your listener, then talk.
• Take turns talking with your child and other family members. Talking at the same time can result in increased volume.
• Drink plenty of water and avoid soft drinks or coffee. Vocal cords produce sound more effectively with less effort if well hydrated.
• Encourage “voice naps.” For example, play a game without any words. This helps your child give his or her voice a rest.
• Reward your child when they use the “better” voice, or practice good vocal health. Focus on the positive by telling your child about his good voice habits.