Voice difficulties might include chronic hoarseness, aphonia (absence of voice), low/high pitch, or strained/strangled quality. Speech-language pathologists are not permitted to begin therapy with a child or adult with a suspected voice problem without first having them evaluated by an otolaryngologist (ENT). The ENT will perform a laryngoscopic examination where they are able to view the vocal folds (voice box) in real time. This examination is necessary to rule out the presence of the following:
Vocal fold nodules are benign growths on both vocal folds that are caused by vocal abuse (yelling, excessive throat clearing etc.). Over time, repeated misuse of the vocal folds results in soft, swollen spots on each vocal fold that develop into harder, callus-like growths. The nodules will become larger and more stiff the longer the vocal abuse continues. Can also be the result of acid reflux
Take a number of forms and are sometimes caused by vocal abuse. Polyps appear on either one or both of the vocal folds and appear as a swelling or bump (like a nodule), a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke's edema.
While rare in children, cancer must be ruled out before therapy can begin with them as well as adults.