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Voice Disorders Program

Refer a Patient

Parents want their kids to live a successful and fulfilling life. Often, our voices play an essential role in finding that success and expressing ourselves to the world. The Voice Disorders Program at CHOC nurtures the gift of voice by treating various voice-related pediatric conditions with a multi-disciplinary team approach. We believe every child deserves to be able to communicate, connect and share their thoughts and feelings with the world.

Why Choose CHOC for Voice Disorder Diagnosis and Treatment?

Our one-of-a-kind program, focused on supporting kids and teens, combines pediatric voice experts and voice surgeons into a single care team at CHOC. Together, we create treatment plans individualized to each child’s unique needs. It’s our mission to enhance the quality of life for every child, paving the way for a brighter, more expressive future. Our team of pediatric voice and speech specialists have dedicated themselves to opening a clinic to support children with voice-related issues. Rather than manage these often-complex conditions with multiple appointments between otolaryngologists (ENTs), pediatricians, speech pathologists and other related providers, families can rely on CHOC’s Voice Disorder Program as their core team to help build, coordinate and lead their child’s voice care plan. Furthermore, voice issues are often deeply intertwined with swallowing function and breathing, and the Voice Clinic team is experienced and specially trained in addressing these issues as well.

Voice Disorder Conditions We Treat

The Voice Disorder Program at CHOC provides evaluations, treatments, surgical procedures and therapy services for many voice-related conditions. Conditions we treat include congenital larynx problems, stress- and injury-related voice changes, velopharyngeal dysfunction (palatal speech problems), sudden voice changes and more. Common conditions that we treat include:  

Structural Abnormalities and Lesions

Neurological and Functional

  • Spasmodic Dysphonia
  • Vocal Cord Paralysis.
  • Soft Voice Syndrome

Inflammatory and Infectious

  • Laryngitis

Talking and Articulation 

Voice-Related Diagnostic Procedures

Your child will receive exams from an ENT (otolaryngology) specialist and a Speech-Language Pathologist during their diagnostic appointment. They will work together to evaluate your child’s vocal health using structural imaging, phonatory function assessments and observation during your visit. Our holistic approach considers every aspect of a child’s vocal health to support accurate diagnosis and targeted treatment plans.

Below are some tests that might occur during your first visit:

  • Voice Handicap Index (VHI): Questionnaire gathering patient information about the vocal issue.
  • Laryngoscopy: Examination of the larynx using a thin, flexible tube with a light and camera on the tip.
  • Stroboscopy: A particular form of laryngoscopy that uses a strobe light to observe the vocal fold vibrations.
  • Other Imaging: CT scans, MRIs or ultrasounds can provide detailed images of the larynx.
  • Acoustic Analysis: A software analysis of recorded voice samples.
  • Aerodynamic Assessment: The measurement of airflow and air pressure during speech.

Learn more about voice-related disorders causes, symptoms, and treatments.

Anatomy of Voice

The larynx, often called the voice box, is a complex tube-shaped organ located in the neck, right above the trachea (windpipe). It plays a crucial role in breathing, swallowing and talking.

Structure of the Larynx:

  • Vocal Cords (Vocal Folds): Two muscle-controlled structures in the larynx. When you talk or sing, they come together and vibrate as air passes through them to create sound.
  • Epiglottis: A little flap that covers the larynx when you swallow. It helps stop food and drink from entering your lungs.
  • Cartilage: The larynx is made up of several pieces of cartilage that give it structure. This includes the thyroid cartilage (Adam’s apple), typically more prominent in males.

Functions of the Larynx:

  • Voice: Vibrations from the vocal cords are crucial to sound production that creates our voice.
  • Breathing: The tube-shaped structure allows air to pass from the mouth and nose to the lungs.
  • Protection: The epiglottis and vocal cords work together to prevent food, liquids and other objects from entering our trachea or lungs.

Voice-Related Treatments at CHOC

Treating pediatric voice disorders requires an involved approach that incorporates behavioral, medical and sometimes surgical interventions. The underlying cause of the voice disorder, its severity and the child’s unique needs determine the treatment. Often combined, these treatments optimize your child’s voice function, facilitate effective communication and improve their overall quality of life. Here are several treatments used at CHOC to help resolve voice disorders:

Behavioral Interventions

  • Voice Therapy: Guided by a speech-language pathologist, voice therapy teaches exercises and techniques to help improve voice use and quality. Activities commonly include humming, pitch glides, sighing, resonant voice exercises and lip trills.
  • Speech Therapy: Speech therapy provides interventions focused on improving articulation, fluency, and resonance, which are essential for children.
  • Vocal Coaching: Coaching optimizes voice use and health by teaching enhancement techniques. It incorporates exercises for proper breath support and voice relaxation to help reduce tension, prevent strain, increase strength and improve endurance.

    • Medical Treatments

  • Medications: Managing underlying conditions affecting the voice, such as allergies, reflux or infections.
  • Hydration: Encouraging proper fluid intake and humidity to keep vocal cords well-lubricated and support healing.
  • Voice Rest: Limiting voice use to facilitate the healing of the vocal cords.

    • Surgical Interventions

  • Injection Laryngoplasty: May be used to help with vocal cord paralysis or glottal insufficiency, where the vocal cords do not close completely. Common types of injections for children include fat, collagen, hyaluronic acid and carboxymethylcellulose.
  • Structural Surgery: May be used to correct anatomical abnormalities or modify the structure of the vocal cords to improve voice function. Common surgeries to correct structure issues include thyroplasty, laryngeal reinnervation and layngoplasty.
  • Removal Surgery: May also be needed to remove abnormal growths and restore normal voice function. Common surgeries to remove growths include microflap, laser, endoscopic resection and shaving.

    • Gender Affirming Care

    We offer therapies to help patients with symptoms of gender dysphoria (feeling like they belong to a different gender than assigned at birth) develop a voice that feels authentic and comfortable. For older patients, options are also available to reduce the appearance of the Adam’s apple.
    • Voice Therapy
    • Tracheal Shave: Shaving reduces the size of the Adam’s apple for a smoother, more feminine throat shape.
    • Feminization Laryngoplasty: Surgery alters the larynx and vocal cords to help raise the pitch of the voice.

    Lifestyle Modifications

  • Environmental Changes: Reducing the exposure to common irritants, like smoke and dust, that affect the voice.
  • Dietary Modifications: Reducing the exposure to food that irritates existing conditions like acid reflux.
  • Voice Hygiene Education: Educating families to support healthy vocal habits like proper hydration, voice rest, avoiding shouting or whispering and using a proper pitch and volume. Kids are encouraged to adopt a routine of vocal care.

    • Coordination of Care

    Our program provides coordination of care to support efforts across your child’s ENT specialist, pediatrician, speech therapist and any other healthcare providers. They’ll receive ongoing assessments to adapt treatment strategies as needed.

    What to Expect: First Visit

    Children are usually recommended to our program by their pediatricians, who may observe irregularities in their voices. However, we also welcome children without referrals. At your first appointment at the CHOC Voice Disorder Program, anticipate a comprehensive voice evaluation from our specialized pediatric otolaryngologist (ENT) from CHOC and a pediatric speech pathologist from the Providence Speech & Hearing Center. The insights gained from these initial tests aid our specialists in establishing an accurate diagnosis for your child. The insights gained from these initial tests aid our specialists in establishing an accurate diagnosis for your child.

    Based on your child’s diagnosis, we assemble a team of multidisciplinary pediatric experts to tailor treatments to your child’s needs. This team may include pediatric otolaryngologists, speech pathologists, voice therapists, other specialized CHOC professionals and your child’s primary pediatrician.

    It’s crucial to note that integrating our specialized plans with your child’s existing care and therapeutic routine is seamless. There is no need to replace current therapy plans, providers or pediatricians when joining our program. We’re committed to collaborating with all professionals, ensuring your child benefits from the most comprehensive, specialized and effective treatment available, located conveniently under one roof at CHOC.

    Frequently Asked Questions

    When should I take my child to a specialist for their voice?

    If your child's voice issues continue beyond three weeks, especially without a clear cause, like a cold, it's wise to see a specialist. Timely checks can help address potential voice disorders in children.

    If your pediatrician recommends you see a specialist, you can learn more about rehabilitation assessments here.

    When is surgery required for a voice disorder?

    Surgery might be an option when non-surgical treatments aren't effective. It’s best to consult a pediatric ENT surgeon for diagnosis and guidance on the best approach for your child’s voice disorder.

    Why is my toddler’s voice changing?

    It’s natural for a toddler’s voice to change as they grow. However, a sudden or extended change might need a consultation to determine if there is a deeper cause.

    Why does my child have a raspy voice?

    A cold or overuse can cause a temporary raspy voice. If the rasp persists, especially in a toddler, it's crucial to seek guidance to ensure no underlying voice disorder.

    Why is my newborn’s voice hoarse?

    Hoarseness in a newborn can stem from many factors, from congenital to birth-related. Long-lasting hoarseness might indicate a need for examination to rule out structural problems in the voice box that can also cause breathing and swallowing issues.

    What does it mean when a child has a hoarse voice with no other symptoms?

    Hoarseness, by itself, in a child could be due to vocal strain or overuse. However, if it persists for more than three weeks without other symptoms, it's recommended to consult a specialist to rule out potential underlying voice disorders.

    Meet our Team

    Pham, Nguyen S. MD

    Specialty: Otolaryngology (ENT)
    Appointments: 714-633-4020

    Dr. Nguyen Pham is a board certified pediatric otolaryngologist (ENT) who treats ear, nose and throat problems in kids and performs head-and-neck surgery.