Vocal Nodules in Children:Flexible Fibre Optic Laryngoscopy.
Dr.K.O.Paulose FRCS, DLO.Consultant ENT Surgeon. Jubilee Hospital, Trivandrum, Kerala, South India
A 6 year old child with husky voice being examined by using fibreoptic flexible laryngoscope in the OPD.The nose is sprayed with 4% lignocaine.Examination revealed vocal nodules on both vocal cord (singers nodule).
Vocal Nodules in Children:
Chronic misuse of the vocal cords caused by such things as repetitive screaming, yelling, or using the voice in an unnatural way can lead to hoarseness. When this happens, the voice crackles and sounds rough, raspy, or breathy. Chronic misuse of the voice can cause excess wear and tear on the vocal cords in children.
Rarely nodules, polyps on the vocal cords can also be caused by chronic sinusitis or allergies, hypothyroidism, and gastro esophageal reflux disease.
Symptoms of vocal nodules include vocal fatigue and hoarseness or breathiness. Hoarseness or breathiness that lasts for more than two weeks may signal a voice disorder and should be followed up with an appointment with an ENT doctor.
The ENT doctor will ask for a medical history, listen for strain or breathiness in the voice, and perform a diagnostic test that provides an internal view of the voice box and vocal cord function.
Flexible laryngoscopy. During this examination, a tiny, flexible fiber-optic endoscope passed through a nostril and into the throat to allow doctors to get a magnified view of the larynx. Kids are asked to speak, sing, sniff, cough, and make other sounds that cause the vocal cords to vibrate. Movements are recorded so that specialists can analyze them later.
Rigid laryngoscopy. This can be performed in the office for older kids, but very young children and others who cannot tolerate a flexible laryngoscopy will undergo this test in an operating room under general anesthesia. The rigid scope is passed through the mouth to provide the best view of the vocal cords. Images of the vocal cords are recorded.
Treatment for hoarseness caused by vocal cord nodules involves making behavioral changes so that the vocal cords can heal. Speech therapists work one-on-one with kids and their families to promote good vocal habits, or what’s called “vocal hygiene.” Treatment, or voice rehabilitation, usually involves vocal training, speech therapy, and, occasionally, vocal rest. In rare cases, surgery may be required. Removal of vocal cord nodules is a relatively safe and minor surgery. This procedure is called Microlaryngoscopy.