All kids strain their voices every now and then: cheering for the home team at a ballgame; belting out a favorite song in the shower; calling out to friends on the playground.
Most of the time, this doesn't do any real harm to the vocal cords, the delicate bands of tissue in the larynx, or voice box. But chronic misuse of the vocal cords — such 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.
Sounding hoarse for a few hours or the day after a big game is probably nothing to worry about, and usually resolves on its own. But chronic hoarseness that lasts for days, weeks, or even months needs to be checked out by a doctor. Speech therapy may be needed to get the vocal cords back into perfect pitch.
When we inhale, oxygen travels through the nose or mouth and down the throat (pharynx), passing through the voice box and windpipe (trachea), to get to the airway passages in the lungs. This route is reversed when exhaling carbon dioxide from the lungs or talking.
To speak, air is pushed out of the lungs. In the larynx, the vocal cords — a "V"-shaped band of muscle — prepare for making sound by tightening up and moving closer together. As air passes through the vocal cords, they vibrate. This vibration, combined with the movement of the tongue, lips, and teeth, is what makes the sound of the voice.
Chronic misuse of the voice can cause excess wear and tear on the vocal cords. They may stretch too far or rub together, causing small irritations that, if not allowed to heal, turn into small calluses, or vocal cord nodules.
Vocal cord nodules are the primary cause of chronic hoarseness in children. They happen when kids do any of the following for a long period of time:
Other causes of hoarseness include growths, vocal cord paralysis (when vocal cord nerves lose their function), smoke inhalation, chronic sinusitis or allergies, hypothyroidism, gastroesophageal reflux disease (GERD), and radiation therapy (in those being treated for throat cancer).
A child with chronic hoarseness will be referred to an otolaryngologist (also called an "ears, nose, and throat" specialist, or ENT) for evaluation. The doctor will ask for a medical history, listen for strain or breathiness in the voice, and do a diagnostic test that provides an internal view of the voice box and vocal cord function.
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."
A typical vocal hygiene program will consist of:
For kids with established bad habits — like talking loudly when they're excited or clearing their throats when they're nervous — it might be hard to make changes in the beginning. The first step is to make kids aware of the behavior and see how often they do it.
Older kids might learn to keep track of how often they engage in the behavior (perhaps keeping notes in a diary), which many do without realizing. Then they can practice the skills they've learned in therapy when at home, at school, and spending time with friends.
It's up to parents and other family members to encourage good vocal habits by setting a good example themselves. For example, rather than calling to kids from another room, walk into the other room to talk to them. Promote quiet times (perhaps for half an hour each day) and using an "inside voice" when indoors.
Reward systems that encourage these new behaviors usually are successful in elementary schoolers. Parents can offer stickers, tokens, extra TV time, a later bedtime, or similar incentives to get kids on board with the new, healthier habits.