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.