Voice parameters and videonasolaryngoscopy in children with vocal nodules: A longitudinal study, before and after voice therapy

Background: Vocal Nodules (VN) are a functional voice disorder associated with voice misuse and abuse in children. There are few reports addressing vocal parameters in children with VN, especially after a period of vocal rehabilitation. Objective: The purpose of this study is to describe measurements of vocal parameters including Fundamental Frequency (FF), Shimmer (S), and Jitter (J), videonasolaryngoscopy examination and clinical perceptual assessment, before and after voice therapy in children with VN. Voice therapy was provided using visual support through Speech-Viewer software. Materials and methods: Twenty patients with VN were studied. An acoustical analysis of voice was performed and compared with data from subjects from a control group matched by age and gender. Also, clinical perceptual assessment of voice and videonasolaryngoscopy were performed to all patients with VN. After a period of voice therapy, provided with visual support using Speech Viewer-III (SV-III-IBM) software, new acoustical analyses, perceptual assessments and videonasolaryngoscopies were performed. Results: Before the onset of voice therapy, there was a significant difference (p<0.05) in mean FF, S and J, between the patients with VN and subjects from the control group. After the voice therapy period, a significant improvement (p<0.05) was found in all acoustic voice parameters. Moreover, perceptual voice analysis demonstrated improvement in all cases. Finally, videonasolaryngoscopy demonstrated that vocal nodules were no longer discernible on the vocal folds in any of the cases. Conclusions: SV-III software seems to be a safe and reliable method for providing voice therapy in children with VN. Acoustic voice parameters, perceptual data and videonasolaryngoscopy were significantly improved after the speech therapy period was completed.