Voice Disorders in Children Require a Team Approach

According to Dr. Verdolini Abbott, a permutation of the “Adventures in Voice” program is currently being investigated in a clinical trial led by chief investigator Christopher Hartnick, MD, sponsored by the National Institutes of Health and conducted through Harvard Medical School. She said that, to date, no clinical trial has been reported on voice therapy in children.

For children who require additional therapy, medical treatment or surgical intervention are potential options. Dr. Woodson emphasized, however, that surgery is not recommended as first-line treatment for vocal nodules in children because this may lead to scarring that can permanently alter the voice. In cases such as papilloma, for which laryngeal surgery is required, she emphasizes following phonosurgical principles to minimize the impact of the surgery on the voice.

Dr. Statham said there are some situations in which surgery may be warranted. “Surgery to remove vocal fold lesions is an elective surgery done to improve quality of life and, therefore, you want to be very thoughtful about it,” she said. Given that advice, she said she would consider surgery in a child with a deep vocal fold scar that may be congenital. She also recommended limiting this type of surgery to children who are mature enough to be compliant to post-surgical care such as voice rest and therapy.

The use of innovative surgical approaches for treating voice disorders in children is still an emerging area, Dr. Statham said, adding that she would like to see the more sophisticated techniques currently offered to adults adapted to children.

“As a field, otolaryngology has not pushed the envelope with some of these procedures in children.” she said.