"My 2 year-old has had a hoarse-sounding voice for what seems like forever. What could be some of the reasons for this?"
Thank you for reaching out and let me first share that hoarseness (AKA dysphonia) in children in comparison to adults is more often the result of a benign cause. However, there still exist certain conditions and/or situations where hoarseness in a child becomes an immediate concern, so appropriate follow up for an accurate diagnosis is clearly a must.
The differential diagnosis of hoarseness in young children is quite extensive so it is often best to break it down into categories based on the time frame of the symptoms. But ultimately, an evaluation by a pediatric otolaryngologist (Ear, Nose and Throat physician) for ongoing hoarseness may be in order.
Acute Hoarseness (less than 2 weeks): usually related to a viral illness whether it be a viral pharyngitis (sore throat) or a simple cold with postnasal drip. If your child’s physician makes one of the above diagnoses, simple observation may all be that is needed and a trip to the ENT’s office will probably not be necessary.
Chronic Hoarseness: vocal nodules (little bumps of tissue sitting on the vocal cords) lead the way. A chronic cough from something like asthma or postnasal drip from allergies can cause this and further aggravate nodules. Another trigger may be related to gastroesophageal reflux disease (GERD). With chronic hoarseness, be prepared to be seen by an ENT physician, but as far as treatment measures, that will depend upon the diagnosis that is made.
Progressive Hoarseness (worsening over a two week period): Probably the most concerning of the different categories described, secondary to the acute nature. A trip to the ENT’s office will be needed as visualizing the area around the vocal cords is a must. Possible diagnoses include tumors, neuromuscular disorders and probably the most common diagnosis, respiratory papillomatosis (RRP). RRP is causes by HPV (yes, the same virus that causes genital warts) and transmission usually occurs during birth. But please note this is a benign growth and with surgery and voice therapy, a good recovery is often made.