Voice disorders in children.

The pediatric otolaryngologist has an especially important role in the differential diagnosis and treatment of two voice disorders; these are the voice quality problems (dysphony) and the resonance problems (rhinophony). The first step in the examination is to preclude the organic causes. The functional dysphonia is mostly related to voice abuse/misuse, but may be present on a psychosomatic basis; environmental factors can also play a role in the etiology and the personality structure has been found to be very relevant. The perceptual evaluation of voice is of obvious importance. Endoscopy with a transnasal flexible scope makes it possible, in practically all cases, to identify the morphodynamic changes. Stroboscopy and phonetography can be carried out only in older children, sometimes a 'trial treatment' is of valuable help. The therapy can be divided into five groups (counselling, voice re-education, drug treatment, psychotherapy, surgery), but should be always individual. An open question: how to choose the preferable treatment of vocal nodules: surgery, conservative or wait-and-see? According to a detailed survey in Kurume University Hospital the following can be stated: if the patient is in trouble due to hoarseness, and immediate improvement of his voice is necessary, surgery should be indicated; if they need the improvement but do not need it urgently, voice therapy is recommended; without motivation vocal hygiene is proposed. No matter what treatment patients receive, their voices improve in the majority after puberty, but 15% of the patients do not show any improvement. In cases of hoarseness due to long-term postintubational glottic lesions logopedic treatment is the only therapeutic possibility. The delay of speech development of tracheotomized children can and should be avoided by applying proper cannula technique and by logopedic training. The physiological nasality which depends upon the undisturbed activity of the velopharyngeal closure, can become pathologic in four forms: closed, open, mixed and alternating nasality (rhinophonolalia). In the diagnosis of hyperrhinophony due to VPI X-ray procedures, supplemented with nasendoscopy, proved to be the most informative methods, the etiology (neuromyogen processes) may be revealed by electrophysiological methods; the voice and speech can be assessed and visualized by nasometry, but the detailed speech evaluation is indispensable. The basic possibilities of treatment are as follows: speech therapy, surgery, speech bulb, electrotherapy and medicines. The basis of operative treatment is flap surgery. The anatomical result of 1000 (velo) pharyngoplasties carried out in Madarász and Heim Pál Children's Hospital (Budapest) is good in 98%, the hyperrhinophony ceased or became minimal in 90% after surgery. The ideal age for operation is 4.5 years.