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Consultation with the Specialist

Hoarseness

Hoarseness in children is very common and usually self-limiting, but there are several very serious and potentially life-threatening causes of hoarseness that always should be considered. A careful history and physical examination usually can suggest underlying etiologies, with the definitive diagnosis usually made at the time of airway endoscopy. The following case and subsequent discussion attempt to clarify some of these issues.

Case Report

An 8-year-old boy presented to the emergency room with a 2-week history of increasing hoarseness, accompanied in the past 5 days by some respiratory distress. On physical examination he was alert and cooperative, with a hoarse but understandable voice and moderate inspiratory and expiratory stridor. Further history revealed that 6 weeks earlier he had been admitted to the pediatric intensive care unit with severe asthma that required 8 days of intubation and mechanical ventilation. He had done well after discharge for about 4 weeks, when his symptoms of hoarseness and then stridor developed.

Differential Diagnosis

The entities causing hoarseness can be divided primarily into congenital, neurogenic, neoplastic, inflammatory, physiologic, and traumatic (Table).

The most common overall etiology is laryngitis associated with an upper respiratory infection (URI), which generally is benign and self-limiting. Vocal nodules are the acquired lesions encountered most frequently and usually are not associated with airway compromise.

This article has been cited by other articles:

				E. V. Hastriter and J. M. Olsson In Brief: Hoarseness Pediatr. Rev., June 1, 2006; 27(6): e47 - e48. [Full Text] [PDF]