title: The paediatric voice clinic.
abstract: BACKGROUND
  Prevalence of paediatric voice disorders has been reported as 6-9% in children of school age. The appropriate diagnosis and management of paediatric voice disorders is essential for progress in education and psychosocial development. This paper presents a review of a UK tertiary paediatric voice clinic experience of referral patterns, diagnosis, management and socioeconomic variations.
  
  
  METHODS
  An audit of 195 consecutive appointments (154 were new patients) between October 2009 and September 2013 at a monthly paediatric voice clinic based at the Royal Hospital for Sick Children in Glasgow.
  
  
  RESULTS
  Of the 154 new patients, 86 were male and 68 were female. The age at first clinic appointment shows a trimodal peak at ages 5, 8 and 11 years. General practitioners were the main referral source (46%). Vocal cord nodules accounted for 52% of diagnoses with a male predominance. Clinic attendance was most common from Scottish Index of Multiple Deprivation groups 1 (most deprived) and 5 (least deprived). Analysis of the muscle tension dysphonia group indicates that they are more likely to come from social groups 4 or 5 (69%) and an older age group (mean age 10.4 years).
  
  
  CONCLUSIONS
  A dedicated paediatric voice clinic is the optimal method for assessment, diagnosis and management of these patients. Diagnosis is possible on the majority of the patients in clinic, with the predominant pathology being vocal cord nodules that receive speech and language therapy. Socioeconomic group appears to have an influence on paediatric voice particularly vocal cord nodules and muscle tension dysphonia.
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Smillie
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK.
authors.forename: Kirsy
authors.initials: K
authors.lastname: McManus
authors.affiliation: School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Cohen
authors.affiliation: School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lawson
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK.
authors.forename: David MacGregor
authors.initials: DM
authors.lastname: Wynne
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D012017:Referral and Consultation; D006113:United Kingdom; D014832:Voice Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy
keywords: Ent; Voice disorders; socio-economic; vocal cord nodules