Vocal fold lesions in the pediatric age group: our experiences at a tertiary care teaching hospital of India (original) (raw)
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Journal of the Pakistan Medical Association, 2022
Vocal fold nodules are benign vocal cord lesions which develop in voice abusers, including children, though chronic cough, sinusitis, and reflux may also be the causative agents. Since low or no-evidence treatment strategies, like the boone technique, are in use in paediatrics, this study was conducted to determine the treatment strategies used by speech-language pathologists in paediatric vocal fold nodules using a cross-sectional survey at Riphah International University, Lahore, from October 2016 to May 2017. Sixty-five speech-language pathologists working with children in private clinics and multidisciplinary settings were recruited using purposive sampling. A self-structured questionnaire was used for data collection. Analysis using SPSS -18 revealed that a combination of voice therapy and vocal hygiene was the most favoured treatment used by 65 (100%) speech-language pathologists, followed by 58 (89.2%) who also favoured respiratory and relaxation exercises, and 56 (86.2%) who...
The prevalence of vocal fold nodules in school age children
Objective: To explore the actual prevalence of vocal nodules among school age children. Methods: A total of 617 children aged from 7 to 16 years were examined. Their voices were recorded and analyzed by using acoustic analysis techniques, and vocal folds were examined by using rigid telescopic laryngoscope. The findings were noted as normal, minimal lesion, immature and mature nodules. Results: Laryngoscopic examination revealed that 430 (69.7%) of the children were normal. Of the remaining 187 children, 82 (13.3%) had minimal lesion, 88 (14.3%) immature nodule, 16 (2.6%) mature nodule and 1 (0.2%) vocal polyp. Comparisons of acoustic parameters revealed that there were no statistically significant differences between normal and minimal lesion groups, and between immature and mature nodule groups. Actual vocal nodule ratios which include both immature and mature nodule groups among whole school children were found to be 21.6% in males and 11.7% in females.
Hoarseness of Voice in the Pediatric Age Group: Our Experiences at an Indian Teaching Hospital
Indian Journal of Child Health
ommunication or speech of children plays a greater role in everyday life. Dysphonia and hoarseness are the terminology used for altered voice quality. Dysphonia is commonly encountered as a clinical problem in pediatric otolaryngology practice. Hoarseness or dysphonia is around 6-9% of all childhood voice problems [1]. Pediatric dysphonia represents a broad-spectrum disorder ranging from hoarseness to inability to communicate. Hoarseness (often seen in all age groups) or dysphonia is a disorder characterized by the altered quality of voice, loudness, pitch or vocal effort which reduces the voice quality so impairs the communication [2]. The incidence of hoarse voice in the school-going children was reported as 2-23% [3]. Dysphonia has a negative effect on the health of the child, communication, social and educational development, selfimage, and self-esteem. The etiologies of pediatric dysphonia are classified into infectious, inflammatory, traumatic, iatrogenic, congenital, and functional [4]. The functional causes for voice changes in children are emotional or psychological problems such as personality disorders, adjustment problems, or anxiety. While the organic causes are the laryngeal papilloma, laryngeal web, stenosis, malignant lesions, polyp, cysts and nodules, allergic or infectious laryngitis and laryngitis due to gastroesophageal reflux are other common causes for hoarseness of voice in children [5]. Endolaryngeal microlaryngoscopic excision by minimal stripping or CO 2 laser is helpful for vocal fold lesions such as nodules and polyps. The variable causes and its effects on the social, educational, and emotional part of life prompted us to carry out such study. MATERIALS AND METHODS This was a prospective study where the vocal symptoms were analyzed along with laryngoscopic findings of the dysphonic children between the age group of 3 and 16 years, at a tertiary care teaching hospital, from October 2015 to September 2018. After the Ethical Committee Approval and getting the consent from the respective parents, we included a total of 132 children. All the pediatric patients presenting with hoarseness of voice were included in this study. Exclusion criteria were a history of previous laryngeal surgery, history of radiotherapy of head and neck region and child not cooperative for examination. Children
Evolution of Vocal Fold Nodules from Childhood to Adolescence
Journal of Voice, 2007
Bilateral (quasi) symmetrical lesions of the anterior third of the vocal folds, commonly called vocal fold nodules (VFNs) are the most frequent vocal fold lesions in childhood caused by vocal abuse and hyperfunction. This study evaluates their long-term genesis with or without surgery and voice therapy. A group of 91 postmutational adolescents (mean age, 16 years), in whom VFNs were diagnosed in childhood, were questioned to analyze the evolution of their complaints. Thirty four of them could be clinically reexamined by means of the European Laryngological Societyprotocol, including a complete laryngological investigation and voice assessment. A total of 21% of the questioned group (n 5 91) had voice complaints persisting into postpubescence with a statistically significant difference (P # 0.001) between boys (8%) and girls (37%). VFNs were still present in 47% of the girls and 7% of the boys of the clinically evaluated group (n 5 34). Analysis of the data before and after puberty shows that the variables gender, allergy, and degree of dysphonia (''G'') in childhood enable a fairly correct prediction of persisting voice complaints in adolescence (sensitivity of 89% and specificity of 67%). The results of this study show a clearly different evolution for both sexes, with significant higher long-term risks for dysphonic girls with allergy.
Correlation of Vocal Fold Nodule Size in Children and Perceptual Assessment of Voice Quality
Annals of Otology, Rhinology & Laryngology, 2010
Objectives We examined the relationship between the size of vocal fold nodules and perceptual rating of voice quality in children. Methods We carried out an Institutional Review Board-approved retrospective study in a voice clinic within a tertiary-care pediatric medical center. We studied children seen between 2000 and 2009 with a primary diagnosis of vocal fold nodules as the cause of their voice disturbance. Pediatric vocal fold nodule size was rated with a published validated scale, and voice quality was rated on the Consensus Auditory-Perceptual Evaluation of Voice scale. Results One hundred forty-five patients met the inclusion criteria. Small nodules were noted in 23% of patients, medium nodules in 39%, and large nodules in 37%. Univariate and multivariate analyses demonstrated a statistically significant relationship (p < 0.05) between vocal fold nodule size and rated perceptual qualities of overall severity of voice disturbance, roughness, strain, pitch, and loudness. Wi...
International Journal of Pediatric Otorhinolaryngology, 1995
The pediatric otolaryngologist has an especially important role in the differential diagnosis and treatment of two voice disorders; these are the voice quality problems (dysphony) and the resonance problems (rhinophony). The first step in the examination is to preclude the organic causes. The functional dysphonia is mostly related to voice abuse/misuse, but may be present on a psychosomatic basis; environmental factors can also playa role in the etiology and the personality structure has been found to be very relevant. The perceptual evaluation of voice is of obvious importance. Endoscopy with a transnasal flexible scope makes it possible, in practically all cases, to identify the morphodynamic changes. Stroboscopy and phonetography can be carried out only in older children, sometimes a 'trial treatment' is of valuable help. The therapy can be divided into five groups (counselling, voice re-education. drug treatment, psychotherapy, surgery), but should be always individual. An open question: how to choose the preferable treatment of vocal nodules: surgery, conservative or wait-andsee? According to a detailed survey in Kurume University Hospital the following can be stated: if the patient is in trouble due to hoarseness, and immediate improvement of his voice is necessary, surgery should be indicated; if they need the improvement but do not need it urgently, voice therapy is recommended; without motivation vocal hygiene is proposed. No matter what treatment patients receive, their voices improve in the majority after puberty, but 15% of the patients do not show any improvement. In cases of hoarseness due to long-term postintubational glottic lesions logopedic treatment is the only therapeutic possibility. The delay of speech development of tracheotomized children can and should be
The Journal of Medical Investigation
Objective : In the present study, an attempt was made to evaluate the acoustic characteristics of voice in pediatric patients with vocal nodules using acoustic analysis of voice. Methods : Thirty-five pediatric patients with vocal nodules and 32 control children without dysphonia were enrolled in this study. Their voice samples were analyzed using the Multi-Dimensional Voice Program. Acoustic parameters of voice, such as pitch period perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and noise-to-harmonic ratio (NHR), were measured. Results : In phonation at a loudness of over 80 dBA, the PPQ, APQ, and NHR values of the voice significantly increased in children with vocal nodules than in the control children without dysphonia. The sensitivities and specificities of PPQ, APQ, and NHR for prediction of vocal nodules in children were 62.86% and 84.38%, 74.29% and 75.00%, and 31.43% and 93.75%, respectively. Discussion : The present findings suggest that vocal nodules affect vocal fold vibration, resulting in impaired control of pitch and loudness leading to increased noise components. NHR could be used to evaluate the efficacy of treatment, such as voice rehabilitation, in pediatric patients with vocal nodules because of its high specificity for prediction of vocal nodules in children.
Behavioral Profile of Children With Vocal Fold Nodules-A Case-control Study
Journal of voice : official journal of the Voice Foundation, 2018
The aim of this case-control study was to evaluate the overall behavior of children with vocal fold nodules (VNs). The study group included children with VNs between 4 and 15 years old diagnosed using fiberoptic video laryngoscopy with stroboscopy in a tertiary university hospital. As a control group, children between 4 and 13 years old without VNs, routinely followed up in a primary care facility, were included in the study. Parents of the participants completed the parent-proxy strengths and difficulties questionnaire (SDQ), a brief behavioral screening questionnaire designed for children. The SDQ evaluates emotional, conduct, and peer problems, and also focuses on hyperactivity and prosocial behavior. Children are classified into "normal," "borderline," or "abnormal" according to the total SDQ score. Twenty-seven children (24 boys and 3 girls) with VNs and 41 controls (33 boys and 8 girls) were enrolled in the study. The two groups did not differ sig...
Outcome Analysis in Patients with Benign Vocal Fold Lesions
International Journal of Phonosurgery & Laryngology, 2016
Introduction Benign vocal cord lesions cause significant dysphonia by disrupting the normal vibratory function of the vocal fold mucosa. Multidimensional assessment of voice characteristics allows for an accurate analysis of voice impairment and can be used to assess the outcome of different treatment modalities. Aims To evaluate the outcome in patients treated for benign vocal fold lesions using multidimensional voice assessment Materials and methods Thirty adult patients with benign vocal fold lesions were treated according to standard protocols and followed up for 6 months. Voice was evaluated by visual analog scale (VAS), GRBAS (grade, roughness, breathiness, asthenia, strain) scale, maximum phonation time (MPT), S/Z ratio, and acoustic parameters using PRAAT. Pre- and posttreatment voice was compared. Results Benign lesions observed were vocal polyps (16), vocal nodules (7), vocal fold cysts (5), vocal cord papilloma (1), and sulcus vocalis (1). Mean VAS rating improved from 7....