title: Relationship between voice quality and vocal nodule size.
abstract: OBJECTIVE
  To determine the effect of vocal nodule size on voice in pediatric patients.
  
  
  METHODS
  Vocal nodules were graded according to a validated grading scale by three pediatric otolaryngologists.
  
  
  METHODS
  Patients evaluated from 2003 to 2007 with a diagnosis of vocal nodules were included.
  
  
  RESULTS
  Forty patients (21 female) with a mean age of 7.5 years were identified. Vocal nodules were rated as grade 1 (17 patients), grade 2 (15 patients), and grade 3 (8 patients). Pitch range was reduced in patients with larger nodules (P = 0.001). There was no statistical association between nodule grade and fundamental frequency abnormality, perturbation, shimmer, decreased respiratory support, air loss, or significant muscle tension.
  
  
  CONCLUSIONS
  Voice characteristics in patients with vocal nodules were evaluated. Other than pitch reduction, objective and subjective voice measurements are not statistically different in varying vocal nodule sizes; however, many of the measures did show a trend towards significance. Vocal rehabilitation is complex in children with nodules and may not directly correlate with vocal nodule size.
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA. rshah@cnmc.org
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Shah
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Engel
authors.forename: Sukgi S
authors.initials: SS
authors.lastname: Choi
mesh_terms: D002648:Child; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D049489:Stroboscopy; D014741:Video Recording; D014827:Vocal Cords / Q000473:pathology* / Q000503:physiopathology; D014832:Voice Disorders / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D014833:Voice Quality / Q000502:physiology*