VOICE DISORDERS IN CHILDREN

The pediatric otolaryngologist has an especially important role in the differential diagnosis and treatment of two voice disorders; these ar e the voice quality problems (dysphony) and the resonance problems (rh inophony). The first step in the examination is to preclude the organi c causes. The functional dysphonia is mostly related to voice abuse/mi suse, but may be present on a psychosomatic basis; environmental facto rs can also play a role in the etiology and the personality structure has been found to be very relevant. The perceptual evaluation of voice is of obvious importance. Endoscopy with a transnasal flexible scope makes it possible, in practically all cases, to identify the morphodyn amic changes. Stroboscopy and phonetography can be carried out only in older children, sometimes a 'trial treatment' is of valuable help, Th e therapy can be divided into five groups (counselling, voice re-educa tion, drug treatment, psychotherapy, surgery), but should be always in dividual. An open question: how to choose the preferable treatment of vocal nodules: surgery, conservative or wait-and-see? According to a d etailed survey in Kurume University Hospital the following can be stat ed: if the patient is in trouble due to hoarseness, and immediate impr ovement of his voice is necessary, surgery should be indicated; if the y need the improvement but do not need it urgently, voice therapy is r ecommended; without motivation vocal hygiene is proposed. No matter wh at treatment patients receive, their voices improve in the majority af ter puberty, but 15% of the patients do not show any improvement. In c ases of hoarseness due to long-term postintubational glottic lesions l ogopedic treatment is the only therapeutic possibility. The delay of s peech development of tracheotomized children can and should be avoided by applying proper cannula technique and by logopedic training, The p hysiological nasality which depends upon the undisturbed activity of t he velopharyngeal closure, can become pathologic in four forms: closed , open, mixed and alternating nasality (rhinophonolalia). In the diagn osis of hyperrhinophony due to VPI X-ray procedures, supplemented with nasendoscopy, proved to be the most informative methods, the etiology (neuromyogen processes) may be revealed by electrophysiological metho ds; the voice and speech can be assessed and visualized by nasometry, but the detailed speech evaluation is indispensable. The basic possibi lities of treatment are as follows: speech therapy, surgery, speech bu lb, electrotherapy and medicines. The basis of operative treatment is flap surgery. The anatomical result of 1000 (velo) pharyngoplasties ca rried out in Madarasz and Helm Pal Children's Hospital (Budapest) is g ood in 98%, the hyperrhinophony ceased or became minimal in 90% after surgery. The ideal age for operation is 4.5 years.