Speech-Language Pathology

Increasing Pediatric Patient Access to Voice Evaluation and Treatment

Voice disorders are common among children, typically affecting between 2% to 25% of the pediatric population.¹ Children may experience difficulty voicing or abnormal voice changes at some point in their development, which can impact social, emotional, and educational growth. The most common pediatric voice disorders are benign mucosal lesions, such as vocal fold nodules, and primary or secondary muscle tension dysphonia (MTD). Behavioral voice therapy with a speech-language pathologist (SLP) has been shown to be effective in improving or resolving voice issues in children with benign mucosal lesions and MTD.¹⁻²

Until 2021, pediatric SLP voice evaluation and treatment within the Head & Neck Institute had been limited. In 2020, ˂ 10 pediatric voice evaluations were completed by the SLP team. Historically, following evaluation by an otolaryngologist and completion of laryngeal imaging, pediatric patients with diagnosed voice disorders were routed to Cleveland Clinic Children’s Hospital for Rehabilitation (CCCHR) for SLP services. These patients were then seen by SLPs that have some, but not extensive, training in the evaluation and treatment of voice disorders.

In 2021, a pediatric voice clinic was established within the Head & Neck Institute, which was a joint venture between the SLP, pediatric otolaryngology, and laryngology sections. This is the first of its kind in northeast Ohio. Joint voice evaluations with an otolaryngologist and SLP are provided, which has helped increase access to voice-specialized pediatric care. During each visit, patients receive a full evaluation with a pediatric otolaryngologist and a pediatric voice-specialized SLP, as well as laryngeal videostroboscopic imaging. The team then establishes and implements a plan of care at that same visit, which most often results in a referral to voice therapy. Creating this clinic has facilitated further outreach to the CCCHR teams, pediatric primary care physicians, and other pediatric specialty providers. It has also helped to increase the number of pediatric voice referrals to SLPs in the last year, which have become more streamlined and efficient, giving pediatric patients quicker access to voice treatment.

Since establishing a designated pediatric voice program within the Head & Neck Institute SLP team, pediatric voice evaluations have increased from < 10 patients in 2020 to 50, during a 1.5 year timespan, from the start of 2021 to present. Age of evaluation of these patients ranged from 15 months to 18 years. Continued voice therapy was recommended for about 80% of the patients evaluated by the SLP, which led to scheduling 4 to 6 sessions per patient during a 6 to 12 week timespan. The majority of the referrals to SLP for pediatric voice concerns have come from within the institute (pediatric otolaryngology, laryngology, and comprehensive otolaryngology), but referrals have also come from CCCHR providers, pediatric allergy, pediatric pulmonology, pediatric primary care, and more. The increase in pediatric voice evaluations is a direct result of the newly established multidisciplinary pediatric voice clinic, a dedicated pediatric voice-specialized SLP taking on this role, and improved outreach to other pediatric institutes within Cleveland Clinic and the greater Cleveland area.

Age Ranges (N = 50)
Age RangesPatients (N)
0 -3 years3
4 - 7 years20
8 - 10 years11
11 - 157
16 - 189
Number of Pediatric Voice Evaluations

2020 - Present

  1. Braden M, Thibeault SL. Outcomes of voice therapy in children with benign vocal fold lesions. Int J Pediatr Otorhinolaryngol. 2020 Sep;136:110121. doi: 10.1016/j.ijporl.2020.110121. Epub 2020 May 16.

  2. Braden MN, van Leer E, McConville K, Blakeslee SDM. Patient, Parent, and Speech-Language Pathologists' Perceptions of Pediatric Voice Therapy Through Interviews. Am J Speech Lang Pathol. 2018 Nov 21;27(4):1385-1404.