Voice Therapy

The most common voice problem in children is vocal nodules. Vocal nodules are hard calluses that develop on the vocal folds. The voice is hoarse and sometimes weak and breathy if the nodules are large. The Causes of Nodules are generally from vocal abuse behaviors such as screaming, talking at the wrong pitch, frequent coughing or throat clearing or even constant loud talking and making sound effects for cars and motorcycles.

A child with a voice problem must be seen by an ear, nose, and throat doctor (ENT) prior to coming for a speech evaluation. Then under the direction of an ENT our Speech & Language Pathologists provide treatment for a variety of voice disorders. The purpose of voice therapy is to reduce the vocal abuse or eliminate vocal misuse. It helps eliminate the causes of the nodules and teaches the child more efficient use of their voice.

The first step is to identify how your child uses their voice. Your child must then be aware of these habits in order that they may be eliminated. It may be necessary to establish a new set of rules regarding the way in which your child may use their voice, and can include the following:

• Limit screaming, yelling, shouting, and long periods of singing
• Encourage your child to walk to where you can hear him rather than shout
• Replace abusive motor or animal sounds with less abusive sounds (sounds made with the lips for example, and not the voice)
• Replace throat clearing and dry coughing with hard swallowing and drinks of water (increase in fluid intake in general is helpful)
• Limit trying to talk over loud noises
• Rest the voice after loud periods occur, involving the child in a quiet, non-talking activity (for example, coloring)

Children and families are also provided with education on how to improve vocal hygiene habits contributing to voice disorders as well as strategies for improved vocal function. Family and friends can help to enforce the child's new vocal behaviors with consistency. It is also important that the people in the child's environment work to set a good example for the child. Positive reinforcement is usually the most effective way to emphasize a child’s behavior. Try not to nag about the bad habits; instead, point out the correct way to do it if you notice a slip. The child learns that appropriate behavior gets good results and inappropriate behavior "never wins".

Although continued follow-up by the Otolaryngologist and Speech Pathologist are essential components of your child's overall therapy program, the family's participation and encouragement can mean the difference between success and failure

Locations

Causes of Nodules

(Any one or more of the following can contribute to the development of vocal cord nodules):

Abuse

• Excessive shouting, screaming cheering or crying
• Strained vocalizations (for example, sounds used to imitate animal noises or motors)
• Excessive loud talking
• Hard vocal attacks (starting words abruptly)
• Excessive coughing or throat clearing

Misuse

• The use of an incorrect pitch, volume, or quality
• Inadequate breath support
• Excessive tension in the neck muscles when speaking

Other Factors

• Chronic (long standing) upper respiratory infections or allergies
• Exposure to smoking
• Reflux (stomach acid coming up the swallowing tube)
• Endocrine or Hormonal imbalance
• Fatigue
• Allergies
• Personality or general adjustment of the child