Relationship Between Lesion Size, Voice Quality, and Quality of Life in Children With Vocal Nodules

Abstract

Objective: To examine the relationship between lesion size, auditory-perceptual ratings, patient-related quality of life measure, and acoustic voice measures in children with vocal nodules. Methods: Thirteen children (5-10 years) with vocal nodules were recruited in this cross-sectional cohort study. Auditory-perceptual ratings of overall voice severity were performed using a Visual Analog Scale. Acoustic measures of cepstral peak prominence (CPP), low/high ratio, and the Cepstral Spectral Index of Dysphonia (CSID) were computed on vowels /a:/, /i:/, and an all-voiced sentence. The Nuss scale was used to rate lesion size from high-speed videoendoscopy (HSV). Patient Voice-Related Quality of Life (PVRQOL) was obtained from both the child and the parent. Correlations were computed for HSV ratings vs. auditory ratings, PVRQOL ratings, and acoustic measures as well as for interrelationships among all variables. Results: Lesion size on HSV correlated moderately with overall severity of auditory-perceptual voice rating and with acoustic measures CPP and CSID, but not with PVRQOL. Significant, strong correlations were observed between auditory ratings and CPP, L/H ratio, and CSID in vowels and sentences. Several moderate strength correlations were observed between PVRQOL subscales (parental and child physical function; child social emotional well-being) and acoustic measures. Conclusions: Since nodules influence both vocal fold structure and vocal function, multiple parameters (lesion size, auditory-perceptual ratings, measures of physical function and social-emotional impact, and acoustic measurements) are needed to fully characterize the potential effect(s) on the voice. These findings could be used to improve clinical assessment and outcome measurements in children with vocal fold nodules.