Are of different etiology. They may occur in connection with organic diseases of the larynx, inflammation, injuries and after operations. Severe general acute or chronic diseases and exzessive weight loss should be mentioned, too. Minimal deformities of the vocal cord, poor development of the vocal apparatus with asymmetric larynx or weakness of the larynx muscles often lead to persistent dysphonia because of infectious diseases, even after only slight functional or emotional stress. Functional voice disorders also occur because of excessive and inexpedient use of the voice.

Dysphonia because of depression or psycho-social problems should be taken into account, too. Bad housing conditions, school problems, exzessive demands on the child, social strains such as alcoholism or delinquency within the family are some of the possible aspects. Besides of this, there are various neurotic voice disorders, one of them to be mentioned as psychogenic aphonia.

To achieve the correct diagnosis, the history of the child is marginal. As differential diagnoses voice disorders because of endocrinological diseases and residuals of brain function disorders must be taken into account.

Can impair the individual development during the entire childhood. Especially moderate hearing losses are difficult to diagnose because they rather present as speech or learning disorders. Therefore all children with speech or language delay should undergo audiologic testing, regardless of how well the child seems to hear in an office setting, and regardless of whether other disabilities are present which might explain the disorder.

There is a significant relationship between the conductive hearing loss resulting from recurrent otitis media during the first 3 to 5 years and subsequent problems in speech and language development. The serous otitis media is a frequent disorder, as 80 % - 90 % of children up to the age of 8 years have at least one episode of middle ear effusion. However, there is a spontaneous recovery rate of about 95 %, so that initially conservative treatment should be preferred (Valsalva maneuver). In cases of persistent middle ear effusion, adenoidectomy and myringotomy should be discussed, and, in cases of recurrence, a ventilation tube should be inserted to reduce pathological changes in the middle ear and subsequent delayed speech development. In conclusion, all infants and young children, especially those at higher risk, should be examined for otitis media during regular medical checkups, and speech and language treatment should be undertaken as early as possible.

Patients with mucopolysaccharidoses are frequently hard of hearing. This disorder is often the result of chronis serous otitis media. Such patients frequently undergo myringotomy. A progressive neurosensory hearing loss is less often observed. Examination of temporalbones suggest arrested development including incomplete pneumatization. Hair cell dysfunction is implicated.

Providing a hearing aid to a child with proven hearing disorder is decisive for the social, psychological and speech development of the child. Depending upon the age of the child, the fitting of a hearing aid requires a variety of strategies most different from those applied to adults. The early fitting of a hearing aid is more difficult, needs more time and very much patience and experience. In addition, the child requires intensive early and long-term aftercare to ensure normal speech development. Close communication among pediatrician, otolaryngologist, and speech and hearing personnel is essential to maximize the communicative skills of those children.

Occur as rhinolalia clausa or aperta. The etiology of rhinolalia clausa are adenoids, foreign bodies, and strictures of the nasal cavity. Operative procedures in the oro-, naso- and hypopharynx may lead to more or less severe speech disturbances (Moller 2001). Open nasal speech may occur after tonsillectomy. Especially in children with cleft palate, deterioration of pronounciation after tonsillectomy always must be taken into account. In dependency to the cranio-facial morphology in the vertical dimension, the configuration of the bony nasopharynx and the sagittal jaw relationship are of significant importance. Both the position and function of the soft palate are essential for the development of an open nasal speech. All children with cleft palate must undergo oto-audiological testing within the first 18 months for the early diagnosis of catarrhal otitis, serotympanon, malformation of the ear and conduction deafness, which have adverse influence on the child's speech development.

Malformations of the palate should be detected prior to adenotomia and tonsillectomy. There also may be a submucosal cleft palate, or, more often, a short palate, in which the distance between uvula and posterior pharynx is too wide. Congenital velopharyngeal insufficiency or paresis is not rare, in most cases they occur as residual after infantile supra-bulbar palsy. In their history these children had difficulties when drinking, with nasal and tracheal swallowing up.

Children with diagnosed allergies may also develop vocal disturbances, articulation errors, and hearing disorders. Vocal quality disorders may occur in relationship to bronchial asthma in association with other allergic reactions. There is a strong relation between allergic rhinitis, misarticulations and hearing loss, too. The presence of speech sound omissions in allergic rhinitis children above age 8 may predict the presence or history of fluctuating hearing loss.

In a study on 31 children Hill/Singer (1990) described the speech and language development after intubation. In all cases intubation occurred before the age of 13 months and remained in situ for more than 3 months. Non of the children had primary neurological, developmental or mental disorder. The results based on the children's age showed a clear pattern of language disability in the expressive language of the oldest group of children, although they were previously thought to develop normal speech and language skills. A report on children with tracheotomy for more than 12 months (Arvedson et al. 1992) showed similar results, so that these children should undergo early diagnosis of speech-language pathology.