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| Voice
therapy for children 1 VOICE STRAIN & VOCAL NODULES Copyright © 1998 Caroline Bowen |
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| Cite
this article as: Bowen, C. (1998). Voice therapy for children 1. Voice strain and vocal nodules. Downloaded on (date) from www.speech-language-therapy.com/kidsnodules.html |
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Ear Nose and Throat Specialist Speech-language pathologists (SLP's) do not treat vocal nodules or hoarse voices in children or adults until the person's larynx (voice box) has been examined by an Ear Nose & Throat (ENT) specialist. It is the ENT specialist's task to determine the medical reason, if any, that a person has voice symptoms such as hoarseness or frequent loss of voice. This examination is called laryngoscopy. Laryngoscopy usually occurs in the ENT specialist's consulting room. Sometimes it is done under general anaesthetic. The ENT specialist may find a problem that requires a surgical or medical solution (i.e., not speech pathology treatment). On the other hand, they may find a problem that is best treated by a speech-language pathologist. Alternatively, surgery and voice therapy may be required. If necessary, having performed the laryngoscopy, the ENT specialist informs the speech-language pathologist about what he or she observed, and diagnosed, in the patient's larynx (e.g., normal structure and function, reddened vocal cords, laryngitis, vocal nodules, a paralysed vocal cord, bowing of the cords, vocal polyps, granuloma, etc). From this information the SLP can determine the appropriate course of speech pathology intervention (treatment). |
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| SLP Management of children with voice issues The following notes notes relate to the SLP management of children with nodules or voice strain. |
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| Detailed case history Once the child has had an ENT examination, speech-language pathology assessment can commence. As part of the initial process, the speech-language pathologist needs to take a very detailed case history, which can involve asking parent/s some very searching and personal questions. These questions cover areas such as the child's early development, the way they get on with other people, relationships within the family including the way family disputes are resolved, behaviour management, peer relationships, health history including allergies, and the child's personality. |
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| Treatment The overall aim of voice therapy is to teach a healthy, non-abusive voice production pattern. The speech-language pathology treatment of nodules and vocal strain in children begins by educating the child and his or her family about the nature of the problem, including its signs and symptoms, causes and risk factors. |
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| It is helpful for the child and
family to understand the normal anatomy and physiology of the larynx (“voice
box”), in relation to the child’s specific laryngeal pathology (e.g., nodules,
thickened vocal cords, etc). The potentially damaging effects of tension and strain upon the larynx due to forcing the voice need to be explained to the child and his or her family. The child is taught about voice production: phonation (how the sound is produced by the vocal cords); respiration (breathing); and, resonance. The idea of adequate breathing patterns are explained, and the child is helped to “feel” the sensations of appropriate breath support sitting, standing and lying down. They are shown how to check that the level of the thyroid notch does not rise excessively during gentle humming (e.g., “hmmm, ummm, hummm...”). They also learn to palpate (feel) their own necks, or to look in a mirror, for excessive neck muscle tension around the larynx. Finally, the child learns, by imitating the therapist, how to produce resonance in different parts of the vocal tract: e.g., “chest” voice, “head” voice, and “nasal” voice, and front and back oral resonance. This voice training provides a foundation for learning to produce the best voice with the least effort. Resonance training is especially important, since it helps if children with abusive voice production habits can be taught to “project” their voices to achieve increased loudness, rather than using a loud strained voice. Throughout therapy children are encouraged to remember that: “If your voice sounds good, you are using it a healthy way”. The term 'hyperfunctional' means 'overused'. Hyperfunctional voice disorders, and laryngeal pathology such as vocal nodules almost always result from some form of vocal abuse or misuse. It is therefore essential to identify abusive behaviours (hence the need for detailed case history taking at the outset of therapy) and reduce or eliminate them, so that the cords can heal and recover, allowing a return to normal voice. Simple voice exercises, performed morning and evening, are helpful in many cases in “warming up” and “cooling down” the voice. These exercises are outlined and supervised, according to the particular patient's needs, by the speech-language pathologist. |
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| Reference Glaze, L.E. (1996). Treatment of voice hyperfunction in the pre-adolescent. Language, Speech & Hearing Services in Schools, 27, 3, 244-250. |
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| More articles on this site about
the voice and voice care Tummy
Trouble! Conditions that may affect the voice |
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| Page updated 04 Feb 2010
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http://www.speech-language-therapy.com/kidsnodules.html |
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| COPYRIGHT © Caroline Bowen ALL RIGHTS RESERVED | |||||