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• Ear, Nose, and Throat Disorders in Children
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A communication disorder can involve hearing, voice, speech, language, or a combination.

More than 10% of children have a communication disorder. There are several types:

Hearing Impairment: See Ear, Nose, and Throat Disorders in Children: Hearing Impairment in Children.

Voice Disorders: More than 6% of school-age children have voice problems, such as hoarseness. Such problems may interfere with academic performance and socialization in school. These problems usually result from overusing or misusing the voice. As a result, small nodules can form on the vocal cords.

These nodules usually resolve with voice therapy and only rarely require surgery.

Speech Disorders: In these disorders, the production of a speech sound is difficult. As a result, children are less able to communicate meaningfully. About 5% of children entering the first grade have a speech disorder. Speech disorders include the following:

• Speaking through the nose, which may result from a cleft palate or other facial defect
• Stuttering
• Difficulty forming sounds because controlling and coordinating the muscles used to produce speech is difficult (articulation disorders)

Speech therapy is helpful in many of the disorders. A cleft palate is almost always repaired surgically. Speech therapy is often also needed.

Specific Language Impairment: The ability to use language—understanding or expressing it—is reduced in otherwise healthy children. Thus, the ability to communicate is greatly impaired, limiting educational, social, and vocational opportunities. This disorder occurs in about 5% of children and is more common among boys than girls. Abnormal genes appear to play a role in many cases.

Some children appear to recover on their own. Others need language therapy. Some respond poorly to therapy.

Diagnosis

To diagnose voice and speech disorders, doctors examine the mouth and look at the voice box with a mirror or a thin, flexible viewing tube (laryngoscope), which is inserted through the nose.

Language disorders are diagnosed by comparing the child's language with that expected for children of the same age.

Most important, parents or caretakers should be alert for communication problems in children and should contact a doctor if they suspect such a problem. Checklists of communication developmental landmarks are available and can help parents and caregivers detect a problem (see National Institute on Deafness and Other Communications Disorders). For example, if children cannot say at least two words by their first birthday, they may have a communication disorder.

Last full review/revision January 2009 by Robert J. Ruben, MD