Voice Disorder Prevalence and Vocal Health Characteristics in Children

Questions  What is the prevalence of voice problems in school-aged children across the US, and what factors constitute risk for voice disorders?

Findings  In this survey study of 1154 caregivers of children aged 4 to 12 years, the prevalence of voice problems was 6.7%, and lifetime prevalence was 12%. Risk factors for voice problems included voice use patterns (ie, frequent talking, coughing, throat clearing, crying/yelling, and vocal strain), being male, poor speech intelligibility, larger household composition, online gaming, and secondhand smoke exposure.

Meaning  The results of this survey study suggest that pediatric voice complaints are common and can limit quality of life.

Importance  Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children.

Objective  To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns.

Design, Setting, and Participants  This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023.

Main Outcomes and Measures  Caregivers were surveyed regarding their children’s voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ² tests, and logistic regression were used to compare children with and without voice problems.

Results  Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use–related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults.

Conclusions  The results of this survey study suggest that pediatric voice problems are relatively common and detract from quality of life. Specific environmental and behaviorial factors are associated with increased risk for voice disorders.