A ‘normal' voice is perceived by others when the following characters are present:-
- pleasant vocal quality
- proper balance of oral and nasal resonance(nasality)
- appropriate loudness
- a pitch level and range suitable to the age, size and sex of the child
- appropriate voice inflections involving pitch and loudness
A child with a voice problem may present with:
Disturbed vocal quality which is characterised by hoarseness, harshness or breathiness.
Resonance or tone problems, caused by improper balance of oral and nasal resonance resulting in Hypernasality (‘too' much nasal sound) or hyponasality (denasal or too little nasal sound which mirrors the nasality associated with nasal congestion).
Loudness problems ie the voice is too soft or too loud.
An abnormal pitch level that is too high or too low for age, size and sex of child/adult
The most common voice disorders in children tend to be hoarseness, hypernasality and loudness problems.
The causes of voice problems in children can be divided into four main categories:
1. Organic causes
There are five primary sires of organic causes of voice disorders including the :
(eg laryngomalacia, growths, trauma)
- velopharyngeal area
(eg cleft palate, adenoidectomy)
- oral cavity
(eg oral nasal fistula)
(eg nasal obstruction)
(eg hearing impairment which may influence loudness, pitch, resonance and vocal quality).
Neurological disorders (eg cerebral palsy) and developmental delay may also place the child at risk of developing a voice disorder, which may influence loudness, pitch, resonance and vocal quality
2. Organic changes resulting from vocal abuse and misuse
Many children present with vocal hoarseness, breathiness, loss of voice as a result of:
- vocal abuse (shouting, excessive talking, coughing/throat clearing, abrupt phonation)
- misuse (characterised by excessive loudness or inappropriate pitch levels) this can also result I vocal hoarseness and breathiness.
- irritants such as smoking, alcohol or toxic sprays and particular substances inhaled can also cause damage to the vocal cords. The organic changes that can result from abuse, misuse and irritants include :-
- vocal nodules ( most common pathological change)
- phonation by the false vocal folds (dysphonia plicae ventricularis)
- hyperkeratosis (small red thickening of edge of a vocal cord)
- nonspecific laryngitis ( thickening and reddening of the vocal cords)
3. Functional causes
A functional voice disorder is characterised by normal laryngoscopic examination of the larynx, with abnormal vocal cord vibratory patterns. Functional causes of voice problems in children are generally related to disturbed mutation during normal pubescent changes (eg retention of a high pitch voice in an adolescent male), psychological (eg hysterical aphonia, spastic dysphonia), imitation of abnormal voices in the child's environment and faulty learning (eg a child who speaks abnormally loudly due to his developed speech habits with say hearing impaired parents).
Encouraging good vocal behaviour.