1, how to determine children may be suffering from voice disease? Parents should pay attention to the following conditions in their children and take them to the ENT department of the hospital in time: hoarseness or leakage of air in the voice; speaking voice that is too small or too loud; a tone of voice that does not match the child’s age and gender; loss of voice for any reason, i.e., the inability to make a sound. 2. What is the process of treating voice disorders in children in the hospital? Children’s voice disease involves more problems, therefore, it usually needs to go through the following steps: The ENT doctor conducts the inquiry of the condition, i.e. consultation; The auxiliary department instruments examine and objectively evaluate the voice lesion, i.e. examination and evaluation, such as voice analysis, hose or rigid tube laryngeal endoscopy; The doctor clarifies the diagnosis and gives the treatment plan according to the examination report; The voice treatment is carried out by the professional voice therapist Voice therapy, which is conducted by professional voice therapists to teach children to learn the correct way of vocalization and to avoid damage to the vocal organs caused by misuse or abuse of the vocal cords; Regular follow up visits to observe the efficacy of the treatment and to adjust the program according to the condition. 3. General knowledge of vocal organs: (1) What are the vocal cords? Vocal cords are two small muscles located in the laryngeal cavity that are responsible for vocalization, positioned at the level of the thyroid cartilage in the neck, i.e. the laryngeal node. The vocal cords are very short, about 11mm long in women and 18mm long in men. (2) How is sound produced? Most of the time the two vocal cords are open on both sides and are separated in a “V” shape. When sound is produced, the left and right vocal folds move together towards the center and vibrate together to produce sound. Then, through the coordinated movement of the pharyngeal muscles, tongue and lips, people can produce intelligible speech. 4. What is hoarseness? When the vocal cords are congested, red and swollen, with rough edges or fibrosis, the airflow through the vocal folds tends to form turbulence that is difficult to control, and the voice becomes hoarse, hoarse or even completely lost. Hoarseness is not the name of the disease, but a signal and sign that the vocal cords are not working properly. 5. What are the common causes of hoarseness in children? Any factor that directly or indirectly damages the vocal cords in the larynx and prevents them from closing completely will cause hoarseness. Direct causes include colds or inflammation of the vocal cords, and indirect causes non-infectious diseases such as environmental or traumatic diseases, congenital and hereditary diseases. In addition, the causes of hoarseness in newborns and children are significantly different. In newborns, hoarseness or abnormal crying is commonly due to congenital disorders or neurologic abnormalities (cranial or peripheral nerves). In children, hoarseness is most often caused by a disease that develops after birth. Common causes include: vocal cord nodules; infections; recurrent papillomas of the laryngotracheal tubes; and gastroesophageal reflux disease. 6. What are the common infectious causes of hoarseness? Viral and bacterial infections can cause hoarseness by directly invading the larynx and vocal cords in a condition called laryngitis, laryngotracheitis or laryngotracheobronchitis. Usually the condition does not last more than a week, but hoarseness may persist for about a month after the initial infection. There are also rare clinical cases of hoarseness caused by laryngeal tuberculosis. Infections such as sinusitis cause increased nasal secretions, and if the secretions flow into the laryngeal cavity (postnasal leakage), it can also cause infection of the vocal cords leading to hoarseness. 7.What are the common non-infectious causes of hoarseness? Allergies are one of the common non-infectious inflammatory diseases that cause hoarseness. Common allergens trigger secretions that can flow into the larynx (postnasal drip). Allergies can also cause swelling of the vocal cords, which can lead to hoarseness. Effective treatment for allergies can relieve hoarseness. Abuse or misuse of the vocal cords can cause vocal cord nodules, another common cause of hoarseness. Gastroesophageal reflux syndrome or acid reflux into the larynx can also cause hoarseness, and the cause may be much more common than we previously recognized. Since reflux is difficult to detect because it is not obvious in many children, examination of the vocal cords and testing for reflux are indispensable if the true cause of hoarseness is to be discovered. 8. What are the common traumatic causes of hoarseness? Traumatic causes of hoarseness include injuries to the neck or vocal cords caused by trauma. Examples include inhalation of corrosive substances (acids, toxic gases), endotracheal intubation (insertion of a ventilation tube), insertion of a nasogastric tube, birth trauma, or other injuries (car accidents). 9. What are the congenital or hereditary disorders that cause hoarseness? A laryngeal abnormality or neurologic condition that accompanies the birth of a baby can cause hoarseness. In most of these disorders, there is also a sharp laryngeal sound or a rough breathing sound. These causes of hoarseness include: vocal cord paralysis, laryngeal chondromalacia, congenital cysts of the larynx, laryngeal webbing (molding at the vocal folds) or laryngeal clefts. Certain hereditary syndromes also include malformations that cause hoarseness and certain airways. 10. What are the causes of vocal cord paralysis? Any cause of injury to the recurrent laryngeal nerve (which governs the movement of the vocal cords) can lead to hoarseness in a condition called vocal cord paralysis. Congenital injury to this nerve is very rare. Surgery to the neck, chest or around the heart or large blood vessels may injure the nerve and cause hoarseness. 11. Under what circumstances does hoarseness require a visit to an ENT doctor? If the hoarseness is caused by vocal cord abuse or inflammation, it usually returns to normal within 2 weeks. If the hoarseness is persistent or recurrent and not related to vocal cord abuse or inflammation, it may be a more serious condition. Therefore, if the hoarseness lasts for more than 1 month, it is recommended to visit the ENT department of the hospital. In addition, if the following conditions occur, you need to go to the hospital immediately: loss of voice lasts for more than 5-7 days; sudden onset of difficulty swallowing or a feeling of fullness in the throat; difficulty breathing. 12. What are the self-treatments and precautions for early hoarseness at home? Let the vocal cords rest. Avoid talking and whispering as much as possible. Especially need to emphasize is that many people think that do not allow speech to take the way of whispering to communicate with others, that whispering does not vibrate the vocal cords, in fact, whispering on the vocal cords of the damage and speech is the same big. If you need to communicate with others, it is recommended to use writing or gestures. Drink plenty of water. Water is the best way to keep the vocal cords moist; no smoking and no alcohol. Both can cause dryness and irritation of the vocal cords; Keep the air moist. If you live in a dry environment with low humidity, use a humidifier in your home; Avoid the cold. If it is very cold but you have to go out, it is recommended to wear a scarf or mask to cover your mouth; Avoid violent coughing. If you have a tickle in your throat and want to cough, it is recommended that you put cough syrup or tablets in your mouth; avoid clearing your throat constantly. 13. When should parents pay attention to their child’s hoarseness? A child with hoarseness should be evaluated immediately in the hospital for a thorough examination and evaluation for hoarseness if: the hoarseness has persisted for more than 4 months in an otherwise healthy child; a newborn with hoarseness, such as a history of chest surgery or other congenital disease; if the child has had hoarseness since the beginning of his or her speech and it has never gotten better; and 14. What is included in the evaluation of the voice for hoarseness? Every child is not the same, so the assessment needs to be tailored to the child’s individual situation. This includes the following: a thorough history and physical examination; an optional hearing test to rule out deafness as a cause of hoarseness; and ancillary examinations of the larynx, such as fiberoptic laryngoscopy, which can be inserted through the nose under surface anesthesia on an outpatient basis and is less painful; 15. Does an ENT doctor evaluate for hoarseness? ENTs specialize in head and neck disorders (not including the eyes, head or spinal cord). Because hoarseness can be caused by a number of things, the best way to evaluate it is to have an ophthalmologist, ENT, and neurologist examine and evaluate it together. The final diagnosis will then determine which specialist will provide treatment. 16. Does a muffled voice mean I have vocal cord nodules? No, it does not. Although vocal nodules are a common cause of persistent hoarseness, they are not the only cause. If the hoarseness persists for more than 4 months, it is important to see an ENT doctor for a thorough and detailed examination and evaluation. 17. What are Vocal Nodules? Vocal cord nodules are white, callus-like projections on the free edge of the vocal cords bilaterally, often occurring in the anterior middle third of the vocal cords, and can range in size from a pinprick to the size of a pea. Normal voice, the vocal folds will be tightly closed together, while the vocal folds can not be completely closed due to the nodule will produce air leakage, then there will be hoarse voice, the nodule is large and will even appear to be vocal weakness or breathing sound/gas sound. 18. What are the causes of vocal fold nodules? Vocal nodules are usually caused by damage to the vocal cords due to improper vocalization methods, misuse or abuse of the vocal cords. Vocal nodules can be caused by any one or more of the following: 1) Misuse of the vocal cords; excessive shouting, screaming, cheering, or crying over a long period of time; stressful vocalizations, such as imitating animal, noise, or motorcycle noises; prolonged, loud conversations; hard onset of speech, which is sudden and soft; coughing or clearing the throat with force; 2) Misuse of the vocal cords; use of incorrect tones, volumes, or qualities of voice; inadequate breath support; speaking with the neck muscles in the throat; and 3) Misuse of the vocal cords. Breath support; Excessive tension in the neck muscles when speaking; 3) Other factors Chronic upper respiratory tract infections or allergies; Active or passive smoking; Esophageal reflux, where stomach acid returns through the esophagus to the larynx and irritates the vocal cords; Endocrine or hormonal disorders; Fatigue; Personality or general condition of the child with allergies. 19. Is there any pain associated with having vocal cord nodules? Vocal nodules do not produce pain during their onset or development. The most common symptom is a change in voice, such as hoarseness or a gassy sound. If you experience pain, you should go to the hospital immediately for examination and consultation with an ENT doctor. 20. What is the treatment for vocal cord nodules? Voice therapy, is the primary and preferred treatment for vocal cord nodules and can prevent recurrence. The optimal frequency of training is about half an hour 1-2 times a week. Vocal abstinence can improve hoarseness and even shrink the nodes by reducing vocal fold edema and preventing further vocal damage. Medications, such as steroids, anti-inflammatory drugs, and proprietary Chinese medicines, can reduce swelling of the vocal cords. Laryngeal microsurgery. Most cases of vocal cord nodules do not require surgical treatment because surgery does not remove the cause of the vocal cord nodules and therefore they can easily recur after surgery. Only when hoarseness persists for a long time, seriously affecting the sound of the voice, and voice treatment is ineffective, then consider using laryngeal microsurgery to remove the fibrotic nodules. 21. What are the factors to be considered when operating on vocal fold nodules? Except for a few cases, most of the vocal fold nodules do not require surgical treatment. Therefore, it is necessary to consider a number of factors before the surgery and decide on the implementation of the surgery after weighing the pros and cons: the effectiveness of the voice treatment before the surgery; the severity of the voice damage at present; whether the diagnosis is clear or not, some of which are not clear until the surgery is a cyst, a polyp, or a small nodule; the risk of the surgical scars on the damage of the voice; and the benefits of the surgery for the patients. 22. Why is it not advisable to treat vocal fold nodules by simple surgical excision? If the cause of the vocal fold nodule is not eliminated, the nodule is likely to recur no matter how many removal surgeries are performed. Therefore, surgical excision is not recommended for children with vocal cord nodules (except in rare cases). 23. Is it inappropriate to perform vocal cord nodule excision before voice change? Will the hoarseness be relieved after the period of change of voice? Clinical observation and case statistics show that most of the children with vocal cord nodules will gradually improve their hoarseness in the process of vocalization, which may be related to endocrine and hormone levels. Therefore, we do not recommend surgical removal of vocal fold nodules in children before the voice change stage. 24. What is voice therapy? Voice therapy is one type of speech-language therapy, which is used to treat a variety of communication disorders, mainly by speech-language pathologists. 25. What is the purpose of voice therapy? On one hand, voice therapy removes the main causes of vocal nodules and certain voice disorders, i.e., reduces the abuse and misuse of the vocal cords. On the other hand, it teaches the child a scientific and effective method of vocalization. The ultimate goal of voice therapy is to restore the patient’s voice to a certain level of functionality, i.e., to be able to perform daily speaking and communication needs. 26. What does voice therapy involve? Voice therapy mainly includes the following four aspects: understanding how the voice is produced and how it is damaged; learning about voice hygiene, i.e. a set of methods for daily voice care; vocal and breathing exercises; and home exercises. 27. What are the steps in voice therapy? The first step is to make it clear to the child how he is using his voice. The child must be made aware of his own wrong habits of using his voice and then he can correct them. The second step is to establish a set of correct voice behaviors for the child to follow and to develop good voice habits. These include: limiting screaming, shouting, and prolonged singing; encouraging the child to approach the person he/she is talking to and then start talking rather than shouting from a distance; avoiding throat clearing and dry coughing by swallowing hard and drinking water, as increased water intake is usually good for the voice; avoiding prolonged talking in loud noisy environments; and allowing the vocal cords to rest from talking after talking out loud, e.g., by having the child do quiet activities that do not involve talking ( painting, etc.). The third step is to master the scientific method of voice production: use abdominal breath to produce voice instead of speaking laboriously with the voice. 28. What are the success factors of voice therapy? The success of voice therapy depends on the following four factors: correct medical diagnosis; clear assessment of voice function; knowledge and skills of the voice therapist; and patient compliance. 29. How long does voice therapy take? Usually a course of treatment is 6-8 weeks, with voice training at the hospital 1-2 times a week for half an hour to an hour each time. In addition to practicing in the hospital under the guidance of a voice therapist, parents should also create conditions to help their children’s rehabilitation training in the daily home environment. 30. What is the significance of family involvement in voice therapy? Although the child will be followed by the ENT doctor and the voice therapist throughout the treatment, the success of the treatment is often determined by the family’s participation and encouragement. 31. What can the family and people around the child do to help the child recover? Reinforcement of the child’s new vocal habits through continuous positive feedback. It is also important for the child to be surrounded by people who have good vocal habits and can set the right example for the child. 32. How should new scientific vocal habits and behaviors be reinforced? Positive feedback is usually the most effective method of reinforcement. Whenever you notice that your child is using the correct method of vocalization, give immediate encouragement and praise. When you notice a bad habit or incorrect practice in your child, never nag him repeatedly, but tell him what the right thing to do is. The child needs to be made to understand that correct behavior produces good results while bad behavior is sure to fail.