INTRODUCTION:
Hoarseness or dysphonia is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL).1 It can affect all age groups and all genders with a prevalence of approximately 29.9% and is more common among professional voice users such as singers or teachers.2,3 Children are also susceptible to develop hoarseness, with a prevalence ranging from 6% to 23% among school-aged children.4 It has been estimated that 2-4% of children with voice problems have never consulted a speech language pathologist for management.5 Voice disorders in children might negatively affect their personality and educational progress, which can eventually affect their normal developmental milestones.6 Thus, it is important to address and manage this problem as early as possible. In adults, the prevalence of hoarseness is higher in females than in males.3However, the opposite has been observed in children, with a higher prevalence among males than in females.7 There are many different factors that lead to hoarseness, such as personal, environmental, psychosocial, and genetics factors.8,9Depending on the etiology, voice disorders in children can be treated medically, surgically, or through voice therapy.6
The Voice Handicap index (VHI) is one of the most common validated tools used among clinicians to subjectively measure multiple aspects of voice disorders including the physical, functional, and emotional aspects.10 The VHI was developed by Jacobson et al in 1997, with a set of 30 items; in 2004, a simplified, less time-consuming, and easier-to-use version of a 10-item questionnaire was developed by Rosen et al, and it has been adopted and translated into many languages.11,12 The VHI is mainly used in adult patients and cannot be used in children as it is difficult for them to understand it. Therefore, many different tools, such as the Pediatric Voice Handicap Index (pVHI), Children’s Voice Handicap Index-10 (CVHI-10), and Children’s Voice Handicap Index-10 for parents (CVHI-10-P), were developed from the VHI and were validated for use in children.13 14 15The CVHI-10-P is a set of 10 validated items used to assess the parents’ perspective toward their children’s voice to help clinicians to better assess voice disorders in children.
The Reflux Symptom Index (RSI) is one of the tools available to subjectively assess the Laryngopharyngeal reflux (LPR) severity that was developed and validated by Belafsky in 2002.16 It has been found that up to 50% of adult patients with voice disorders also have LPR symptoms.17 Block et al found that 47% of children who presented with a main complaint of hoarseness were diagnosed with LPR.18 This study aimed to measure the prevalence of hoarseness among school-aged children and to establish possible associated risk factors.