The Ohio State University College of Medicine, Columbus, OH, USA; Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Arizona College of Osteopathic Medicine of Midwestern University, Glendale, AZ, USA.
Am J Otolaryngol. 2024 Mar-Apr;45(2):104174. doi: 10.1016/j.amjoto.2023.104174. Epub 2023 Dec 9.
Vocal cord nodules (VCNs) are the most common cause of dysphonia in school-aged children, with potential negative impacts on quality of life including diminished self-esteem and academic performance. The standard of care for VCNs is conservative management which ranges from voice hygiene to speech therapy with a focus on voice otherwise known as voice therapy, with surgical excision reserved for refractory cases. Thus, few studies have analyzed outcomes of surgical management of VCNs. The purpose of this study is to assess the prevalence and efficacy of surgical excision of VCNs when compared to speech therapy.
Children with VCNs seen at a single tertiary care institution between 2015 and 2020 were identified by ICD-9 code 478.5 and ICD-10 code J38.2. Demographics, objective voice assessment, intervention, and follow-up assessment data were reviewed. Frequencies, medians, and interquartile ranges were calculated. Time to resolution and improvement were assessed by Cox proportional hazards model. Univariate logistic regression was performed. A P value of <0.05 was considered statistically significant.
Three hundred sixty-eight patients diagnosed with VCNs were identified. 169 patients received intervention for VCNs, with 159 (43.2 %) receiving speech therapy alone and 5 (1.4 %) receiving surgery alone. On bivariate analysis, there was no significant difference in demographic features between treatment groups, however speech therapy patients did have a longer follow-up time. 154 patients underwent objective voice assessment at the time of VCN diagnosis. Among these patients, 95 (61.7 %) received speech therapy and 59 (40.3 %) received no intervention. Speech therapy patients had significantly higher pVHI scores, however there was no significant difference in CAPE-V Overall Severity scores or computerized voice assessment analysis. On Cox proportional hazards analysis, surgical intervention was associated with faster resolution and faster improvement of dysphonic symptoms. On binary logistic regression, surgery was associated with a significantly greater proportion of patients reporting resolution of dysphonic symptoms, however there was no significant difference in proportion of patients reporting improvement of dysphonia.
For most patients with VCNs, conservative measures such as voice hygiene and speech therapy remain first line, however certain patients may benefit from the rapid improvement and resolution of symptoms that surgical intervention may provide.
声带小结（VCN）是学龄儿童中最常见的发音障碍原因，可能对生活质量产生负面影响，包括自尊心下降和学业成绩下降。VCN 的标准治疗方法是保守治疗，包括从嗓音卫生到以嗓音为重点的言语治疗（即嗓音治疗），手术切除仅保留用于难治性病例。因此，很少有研究分析 VCN 手术治疗的结果。本研究的目的是评估与言语治疗相比，手术切除 VCN 的患病率和疗效。
通过 ICD-9 代码 478.5 和 ICD-10 代码 J38.2，在一家三级医疗机构中确定 2015 年至 2020 年间患有 VCN 的儿童。审查了人口统计学、客观嗓音评估、干预和随访评估数据。计算了频率、中位数和四分位距。通过 Cox 比例风险模型评估解决和改善的时间。进行了单变量逻辑回归。P 值<0.05 被认为具有统计学意义。
共确定 368 例 VCN 患者。169 例患者接受 VCN 干预，其中 159 例（43.2%）仅接受言语治疗，5 例（1.4%）仅接受手术治疗。在单变量分析中，治疗组之间的人口统计学特征无显著差异，但言语治疗患者的随访时间更长。154 例患者在 VCN 诊断时进行了客观嗓音评估。在这些患者中，95 例（61.7%）接受了言语治疗，59 例（40.3%）未接受干预。言语治疗患者的 pVHI 评分明显更高，但 CAPE-V 总体严重程度评分或计算机化嗓音评估分析无显著差异。在 Cox 比例风险分析中，手术干预与更快地解决和改善发音障碍症状相关。在二项逻辑回归中，手术与报告发音障碍症状得到解决的患者比例显著增加相关，但报告发音改善的患者比例无显著差异。
对于大多数 VCN 患者，嗓音卫生和言语治疗等保守措施仍是首选，但某些患者可能受益于手术干预可提供的症状快速改善和缓解。
