Hoarseness

Almost all cases of chronic hoarseness in a child are due to the presence of vocal cord nodules.   Vocal cord nodules can be thought of as small bumps on the anterior portion of the vocal cords that keep the entire surface of the vocal cords from having contact and the correct vibrational pattern.  The nodules are areas of thickening of the of the vocal cord that normally result from overuse injury.  They are usually seen in children that tend to be more loud and vocal.  When the nodules start, the child becomes hoarse, and thus has to strain or alter his speaking pattern and therefore begins a cycle of constant stress and injury to the vocal cord surface.  Even though nodules are the most common cause of hoarseness, it is important to rule out other problems.  Sometimes a unilateral nodule or cyst will be found that would need surgical correction.  Occasionally an abnormal growth of tissue called a vocal cord papilloma will be found and this will also require surgical diagnosis and intervention.  A complete history and physical will be performed but it will also be important to perform a flexible endoscopy (link) to make the diagnosis, as this is the only way to actually visualize the vocal cords.