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Signs and symptoms
The signs
and symptoms of nodules or vocal strain in pre-adolescents include one or more of the
following:
- dysphonia,
which is a hoarse, breathy or rough voice; or a voice with excessive glottal fry
- intermittent
aphonia, which is a recurring temporary loss of voice, especially first thing in
the morning and at the end of the day, or after specific events such as sports day
- voice
breaks, which are fleeting interruptions to the voice, during speech or singing, as though
it "cuts out" for a second
- pitch
breaks, which are fleeting, abrupt changes in the pitch of the voice, during speech or
singing, usually from a lower note to a higher note
- excessively
loud voice
- inability
to sustain a note when singing
- effortful
or strained voice
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Causes
Voice
strain and nodules are caused by stress to the larynx, within which are the delicate vocal
cords. This stress is generally referred to as "vocal abuse". It is rare to find
just one "abusive" behaviour producing voice symptoms. Classically, young people
with nodules are in the habit of talking too long, too loudly and with too much effort.
Usually children develop vocal nodules or vocal strain due to the interaction of two or
more of the following, done to excess:
-
talking
and singing, for example: excessive and over-enthusiastic rehearsal of school plays
or concerts; excessive choir or solo-singing practice; overusing the voice on school camps
or excursions; shouting in the playground; talking and shouting against background noise,
such as in a swimming pool; overusing the voice during an infection such as a head cold;
cheer leading; and overusing the voice when tired or emotionally upset. Lengthy talking,
even at normal rate and volume, but without a quiet "recovery time" can also
contribute to vocal strain and nodule formation.
- glottal
attack: sharp glottal attack and forceful use of the voice can seriously damage the
vocal cords.
- coughing,
and loud, forceful sneezing: many people with nodules do not rest their voices when
they have upper respiratory tract infections, even when their throats are sore. Coughing
and sneezing can be particularly problematic for a child with asthma or a post nasal drip.
- crying,
laughing and loud or prolonged outbursts of emotion: for example, even very young
children who tantrum frequently can develop nodules. Inappropriate or unresolved coping
mechanisms for negative emotions (anger, fear, sadness, nervousness) can lead to bottled
up anger, explosive outbursts or irrational behaviour, accompanied by loud, forceful voice
use.
- shouting,
cheering and screaming: one loud episode at a sporting event or pop concert is
sufficient to produce an episode of aphonia.
- grunting
: grunting while load-bearing, for example in a football scrum or while weight training,
puts a sudden shock through the vocal cords as they "fix" into position to
create a vacuum in order to "take the weight".
- throat
clearing: the chronic throat clearing associated with post nasal drip puts a constant
strain on the vocal cords, which are g-r-o-u-n-d together each time the throat is cleared.
- making
sound-effects: Dalek, explosion and monster noises, etc., especially if they are
made
while breathing IN (!) put a tremendous strain on the cords, as can assuming character
accents, for example Power Rangers, Ninja Turtles, Street Sharks, and macho villain
and "tough guy" impersonations, and using excessive and deliberate glottal
fry when speaking.
- dryness:
the overuse of certain medications, such as cough lozenges, antihistamines and
patent "cold cures", especially in conjunction with voice overuse, infections or
allergy dries out the delicate lining of the larynx and vocal cords, making voice symptoms
worse. Caffeine (e.g., in cola and coffee) can act as a diuretic, adding to
drying effects. Mouth breathing is also potentially drying. Marijuana is more
drying than nicotine, and can actually burn the larynx.
- restricted
fluid intake: for a healthy respiratory and vocal system good hydration is
necessary (even in cold weather).
A simple way of checking for adequate fluid intake is to ensure that urine is pale in
colour.
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Risk factors
Some
young people are more vulnerable to developing vocal nodules and vocal strain than others.
Those who are more at risk may have one or more of the following:
- a
family with loud voice habits such as yelling around the house and calling from room to
room in constant background noise. Some young people with vocal problems have developed
habitually loud voices simply in order to "get the message across" in a
constantly loud household.
- chronic
asthma and/or allergies (including post nasal drip and allergic rhinitis); and incorrect
use of some puffers (i.e., no spacer and/or drink of water when they are recommended)
- recurrent
and frequent upper respiratory tract infections including infected tonsils, sinuses,
adenoids and throat
- gastric
reflux
- affective
disorders such as attention deficit disorder and hyperactivity, or a "temperamental
personality"
- behaviour
problems
- excessive
stress or tension in the person’s life, due to internal factors (within the
individual), external factors (within the environment) or interpersonal factors (e.g.,
conflict or competition)
- a
loud, outgoing, enthusiastic, competitive personality with a tendency to "act
out" emotionally
- a highly conscientious personality and a tendency for the young person to "push"
themselves to succeed.
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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. |