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Hoarseness is a symptom usually related to the vocal cord or larynx. It may present as an intermittent or persistent gravelly voice and may be present from birth or develop much later. The hoarseness may be caused by simple mouth breathing because of nasal obstruction where the child wakes up dry, thirsty, croaky and with bad breath. Once they have a drink it will improve. It may be due to laryngitis on a temporary basis but if it is persistent an investigation of the larynx, vocal cords and the region under the vocal cords should be carried out.

In most cases in pre school and school aged children the cause may be related to vocal abuse patterns where the child screams or shouts and develops vocal nodes which are otherwise known as “screamer’s nodes”, “auctioneer’s nodes” or “singer’s nodes”. With speech therapy these will often resolve but sometimes this vocal voice modification therapy does not work and on occasion the vocal nodes need to be removed. Other conditions such as vocal cord paralysis or haemangiomas or warts (papillomas) on the vocal cord may cause hoarseness as well. The important thing is to regard hoarseness as a symptom and not a sign in itself and that we should investigate the cause. The flexible fibreoptic examination of the larynx is the best procedure to do this in younger children but in some older children we are able to look indirectly using a mirror in the throat to examine the larynx. The management of the condition causing the hoarseness depends on its nature and a number of conditions do not require treatment other than speech therapy whilst others may require medications and a few conditions may require surgical management.

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