Is voice therapy effective in the management of vocal fold nodules in children?

BACKGROUND The term ‘‘vocal fold nodules’’ refers to bilateral thickening of the membranous folds, with minimal impairment of the vibratory properties of the mucosa. They are considered to be related to repetitive mechanical stress, typically related to voice use patterns. Diagnosis is made in the office via either rigid or flexible laryngeal stroboscopy. The reported incidence of vocal fold nodules in school age children is 17% to 30%, with reported resolution in most cases by puberty. Traditionally, conservative management has been recommended for these lesions, although voice hygiene approaches, voice therapy techniques, and surgery also have been advocated. Voice hygiene typically includes education about healthy voice care, increased hydration, and elimination of abusive habits. Voice therapy encompasses a variety of behavioral techniques including, but not limited to, progressive relaxation, yawn-sigh, laryngeal massage, vocal intensity reduction, pitch elevation, vocal function exercises, and confidential and resonant voice therapy. Children with voice disorders often are seen as more aggressive and are viewed more negatively than their peers. Given the negative social and academic effects that can result from pediatric voice disorders, should voice therapy be used to treat children with vocal fold nodules?