Abstract
BACKGROUND: Hoarseness in school-aged children may affect their
educational achievement and interfere with their communication and
social skills development. The global prevalence of hoarseness in
school-aged children ranges between 6% and 23%. OBJECTIVE: Measure the
prevalence of hoarseness among school-aged children and identify its
associated factors. DESIGN: Cross-sectional questionnaire-based survey.
SETTING: Randomly selected primary and early childhood schools in Saudi
Arabia. PATIENTS AND METHODS: Data were collected using a questionnaire
completed by the children’s parents, which included sociodemographic
aspects, health and related comorbidities, history of frequent crying
during, history of letter pronunciation problems and stuttering, history
of vocal fold surgery, the Reflux Symptom Index (RSI), and Children’s
Voice Handicap Index-10 for parents (CVHI-10-P). MAIN OUTCOME MEASURES:
Determinants of hoarseness were investigated using the chi-square test,
Fisher exact test, and adjusted and unadjusted logistic regression
models SAMPLE SIZE: 428 children RESULTS: The mean age of the study
children was 9.05 ± 2.15 years, of whom 69.40% were male. The rate of
hoarseness in the participants was 7.5%, 9.90% were female and 6.40%
were male. Hoarseness was found to be significantly associated with a
history of excessive crying in infancy (12.24%, x2=7.54, p=0.006),
letter pronunciation issues, especially ‘R’ and ‘S’ (13.56%, x2=8.71,
p=0.003), stuttering (16.39%, x2=8.08, p=0.004), and those with a
previous history of hoarseness (p=0.023). In addition, having symptoms
of gastrointestinal reflux increased the risk of hoarseness by four
times (OR=4.77, 95% CI= 2.171, 10.51) after adjustment for age and
gender. CONCLUSIONS: Hoarseness in children may be underestimated as it
may reflect the presence of speech problems (i.e., letter articulation
and stuttering) in addition to the presence of laryngopharyngeal reflux.
Hoarseness was assumed on the basis of parental complaints. Therefore,
further research with diagnosis based on clinical assessment is needed
to understand the magnitude of the hoarseness and its consequences