Voice Disorders

Your voice is the sound produced by vibration of your vocal folds, or vocal cords, in the larynx, also known as your voice box. A voice disorder occurs when the vocal cords do not produce a clear sound.  Sometimes these conditions are referred to as disorders of the larynx or voice box disorders.

C.S. Mott Children’s Hospital provides comprehensive care for children with voice disorders.  We offer a multidisciplinary approach to care, led by specialists in pediatric otolaryngology (ENT) and speech-language pathology.  Our program is designed to provide truly specialized care exclusively for children - from providing an accurate diagnosis to creating individualized treatment plans for each child and supporting families each step of the way.

What are voice disorders?

Many voice disorders are associated with symptoms of hoarseness, raspiness, what may seem like a “weak and breathy” voice, and various asthma-like symptoms. 

A child's voice disorder may significantly impair a child's ability to be heard and understood, due to the voice disorder itself or in combination with a speech and articulation difficulty.

Our voice specialists treat a variety of common and complex voice disorders, including:

  • Subglottic stenosis - narrowing of the trachea , often caused by prolonged intubation which limits the amount of airflow available to help generate the voice
  • Congenital or acquired laryngeal webs / vocal cord webs / glottic webs and subglottic webs – a band of tissue between the vocal cords or in the larynx that prevents normal movement.
  • Papillomatosis - persistent or recurring wart-like lesions that develop in the airway. Papillomas typically cause hoarseness in the early stages, and may progress to cause significant airway difficulties.
  • Vocal cord cysts or polyps – benign (non-cancerous or life-threatening) growths  on the vocal cords.
  • Vocal cord nodules – thickened areas on the vocal folds that usually are caused by voice overuse.
  • Vocal cord paralysis/paresis – usually caused by an injury or lesion in the nerve to the vocal cord (the recurrent laryngeal nerve), or affecting central nervous system controls for voice production.
  • Paradoxical vocal fold function/vocal cord dysfunction – a condition caused when the vocal cords close when they are supposed to open.
  • Vocal fold inflammation due to gastroesophageal reflux (GERD) or laryngopharyngeal reflux (LPR).  This occurs when acid washing over the vocal cords leads to inflammation and often hoarseness and frequent throat clearing.
  • Vocal hyperfunction – vocal habits involving excessive muscle usage that develop as a compensatory behavior in response to dysfunction of the vocal cords, and often caused by trauma to the structure of the vocal folds, such as vocal cord nodules.

Diagnosing voice disorders

Early detection and diagnosis of voice disorders in children is important to support speech and language development and optimal communication.  Our team specializes in the diagnosis and management of speech and language disorders in children.

During your evaluation we will talk with you and your child to understand the duration and severity of your symptoms and perform a comprehensive ear, nose and throat exam.  We will also want to discuss any previous voice therapy, treatments or procedures that your child has undergone.

Our speech-language pathologist will work with your child to evaluate voice characteristics such as roughness, breathiness, strain, pitch and loudness, and assess how well your child is using related systems such as breathing, or respiratory effort, to produce voice.  This will help in determining the severity of the voice disorder, and in developing an appropriate plan for treatment if needed.  

Specific diagnostic procedures that may also be used to make an appropriate diagnosis may include:

  • Perceptual assessments:  standardized procedures for perceptual evaluation of voice quality. These tests are performed by an expert therapist who carefully listens to your child’s voice in different situations.
  • Acoustic assessments: digital recording of your child's voice to allow objective measurement of different aspects of voice such as variation in pitch and loudness over time.
  • Aerodynamic assessment: an assessment of the amount of air flow and air pressure used to produce voice .
  • Laryngeal endoscopy or videostroboscopy:  a procedure using an endoscope with a small lit camera to view the larynx and vocal folds during vibration.

Treatments for voice disorders

Whether your child’s voice disorder is the result of a congenital malformation, injury or the side effect of an illness, our comprehensive approach allows us to develop a treatment plan that addresses your child’s unique needs.

Vocal hygiene: Our speech-language pathologists will work with you and your child to identify possible habits that may be contributing to vocal cord irritation, and to learn about healthy ways to use your voice that will help your vocal cords heal and stay healthy. .  This can include learning to avoid yelling, establishing good voice habits, and learning to rest your voice. It may also include things like drinking enough water to keep your vocal cords well hydrated, and avoiding foods that may cause reflux, as this can also irritate the vocal cords.

Voice therapy: Once your child has been evaluated by one of our otolaryngologists and referred for voice assessment and therapy, our speech pathologists will develop a treatment program specifically targeted to your child’s specific needs. For younger children (under 5), this may include helping families design home programs to develop and reinforce healthy voice habits. Most effective for children ages 5 and up, direct voice therapy focuses on weekly sessions designed to teach vocal techniques that promote efficient use of breath support for voicing, and reducing strain and effort with speaking.

Surgical treatments:  Surgery for benign vocal fold lesions or for vocal fold paralysis is recommended in rare instances, for example when the child cannot achieve the desired voice use or when there is a medical need to prevent aspiration of food and liquids. For children requiring surgery, our pediatric otolaryngologists offer a full range of surgical techniques to repair or rebuild vocal structures. Often times, these procedures are performed by surgeons who also participate in our airway disorders and aerodigestive disorders clinics.

Some of the surgical procedures we offer include:

  • Vocal cord injection, a procedure done under anesthesia that involves injecting a substance into the vocal cord to help it approximate to the opposite side. Injected materials may be temporary, intermediate term, or long-term substances.
  • Vocal cord medialization, a procedure in which the paralyzed vocal cord is pushed to the middle so that the functioning vocal cords can close as necessary for normal voice and swallowing.
  • Vocal cord reinnervation, an innovative procedure for vocal cord paralysis in which the surgeon takes a branch of the ansa cervicalis, a motor nerve in the neck, and sews it to the recurrent laryngeal nerve, the nerve that gives the vocal fold mobility and tone.

Surgery to remove vocal cord nodules is NOT RECOMMENDED for children, due to the likelihood of recurrence, as well as increased risk for developing scar tissue that will interfere with vocal fold vibration for healthy voice production.  Vocal cord nodules are best treated by voice therapy.

Take the next step:

Schedule an appointment by calling us at 734-936-8051


The Mott Team of Speech Language Pathologists: 

Lynn Driver

Erica Osborne