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Hoarse voices or vocal nodules in children always need to be examined by and Ear Nose & Throat specialist first, before being examined by a speech-language pathologist. The ENT specialist is a person qualified for determining the medical reasons for symptoms such as frequent loss of voice or hoarseness. The exam itself is medically referred to as laryngoscopy and in certain cases it needs to be done under general anesthetic. The exam may determine that certain medical or surgical solution may be used for the treatment of the problem. Some cases may require voice therapy or surgery, while certain cases may require treatment from a speech-language pathologist. Information gathered by the ENT specialist is passed on to the SLP so that the appropriate intervention of speech pathology can be determined.
SLP Management
The first step of the treatment process is getting to know a very detailed case history which sometimes involves plenty of searching and plenty of personal question which cover the child’s personality, complete health history, peer relationships, behavior management, the family relationships, the way the child gets on with other people and his or her early development.
The main goal of the whole voice therapy is to teach the child a non abusive voice production pattern. Both the child and his or her family need to be well informed about the problem nature, all of the different symptoms, signs, risks and various sorts of risk factors. The child needs to understand the physiology and anatomy of the larynx and all the problematic areas such as the thickened vocal cords or nodules. The strain and tension which may be damaging the larynx also need to be understood properly. The process of voice production needs to be fully understood as it involves phonation (in which the sound gets produced by the vocal cords), respiration (the process of breathing) and lastly, resonance. It is of utmost importance for the child to understand the proper breathing patterns. Visual and tactile techniques of understanding the problem are also introduced. The final steps of the treatment process involve learning how to produce resonance in different parts of the vocal tract. The child is taught how to project the voice properly without straining the vocal tract excessively. All different sorts of hyperfunctional voice disorders involve excessive straining of the vocal tract and commonly result in voice misuse or voice abuse. Simple vocal exercises can be of great help.

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