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Apart from the conditions previously mentioned under airway obstruction, there are a number of conditions such as reflux which can cause laryngeal irritation and hoarseness, congenital conditions such as laryngomalacia which is a common laryngeal abnormality causing intermittent crowing inspiratory stridor, respiratory distress, difficulty with feeding and failure to thrive. Usually laryngomalacia settles spontaneously but occasionally will require laser surgery to the affected area in the larynx in the more severe cases.

Vocal cord paralysis as mentioned previously can be bilateral or unilateral and the causes of this in the bilateral case may be due to birth trauma, intracranial disease or a condition such as an Arnold Chiari Malformation. The unilateral vocal cord paralysis causes that may be related to cardiac surgery, neurologic conditions, vascular conditions, obstetrical trauma or unknown causes, is more common on the left and the child has a weak cry and sometimes has stridor on exertion. This can be diagnosed by flexible fibreoptic endoscopy of the larynx and can be managed conservatively or occasionally surgically.

Subglottic stenosis is narrowing of the area of the upper trachea just below the vocal cords and this can be either present at birth or may develop subsequently. It causes stridor, respiratory distress and may be seen in very premature children particularly those who had intubation for a long period of time in a neonatal intensive care unit. It can be investigated using an examination of the larynx and trachea under anaesthesia and there are a number of surgical procedures which can be performed to remedy the condition.

Subglottic haemangiomas is a rare condition where the child in 50% of cases has a similar strawberry like lesion on their skin and they have a soft compressible mass under their vocal cords which may cause increasing stridor. This condition can occasionally be managed medically but sometimes requires surgical management and even tracheostomy on the odd occasion.
Recurrent respiratory papillomatosis or warts on the vocal cord and larynx is on the increase but is not particularly common. This causes increasing hoarseness and stridor and treatment may involve interferon or laser surgery to remove the warts which are obstructing the breathing passage. This is a serious condition which often requires surgical management. HPV vaccination may reduce the incidence of this condition.

Vocal cord nodes are a common cause of hoarseness due to vocal abuse or chronic cough and often improve with speech therapy (or this condition often resolves spontaneously in teenage years when the child acquires the maturity not to abuse their voice) but occasionally we need to remove the vocal nodules if there is failed speech therapy or the child is handicapped socially with the condition.

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