Voice disorders: hoarseness

By Cristiano Antonino On Dec 19, 2022

Hoarseness is an alteration of the voice that affects intensity and timbre, with the vocal quality changing to weak, hoarse and harsh

In children, the prevalence varies from 3.9% to 23.4%, while the most affected age group is between 8 and 14 years.

Hoarseness is often misdiagnosed due to the presence of upper airway disorders that mask the onset of the vocal disorder and lead to a late diagnosis.

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The causes of hoarseness in children are many:

Greater vulnerability of the child’s larynx (tissue laxity, high frequency of upper airway inflammation, hearing deficit often related to catarrhal otitis);
Vocal strain;
Environmental pollution;
Familiar vocal and behavioural habits and patterns.

Hoarseness, general causes of laryngeal abnormalities

Voice abnormalities can be congenital (when they are already present at birth) or acquired (when they occur after birth) and can be due to organic or dysfunctional pathologies.

The first cause of congenital laryngeal abnormality is laryngomalacia (50% of cases), due to a defect in the maturation of the laryngeal cartilages that manifests itself with difficulty breathing, stridor, and jugular retraction.

Laryngeal palsies represent the second most common cause of congenital laryngeal abnormality (15-20% of cases) and are characterised by unilateral or bilateral vocal cord motility deficits and may manifest as isolated forms or associated with various genetic syndromes. Laryngeal paralysis can also be acquired: iatrogenic (following surgery), traumatic, neurological, infectious or idiopathic in origin.

The most common acquired organic pathologies of school age are vocal cord nodules, with incidence ranging from 38% to 78%, more frequent in males than females.

These are benign irritative changes of the free edge of the vocal cords due to vocal strain.

Other benign lesions that can cause hoarseness are polyps, cysts and papillomas that occur less frequently.

Dysfunctional voice changes, on the other hand, are characterised by excess or defect of muscular tension and are accompanied by abrupt emission of the voice, alterations in verbal flow, such as speaking quickly and a tendency to articulate words poorly.

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