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
from private and governmental sectors in the Eastern Province, 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 infancy, 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 problem and its
consequences in children.