title: A retrospective review of the progression of pediatric vocal fold nodules.
abstract: OBJECTIVE
  To our knowledge, the rate of change in the size of pediatric vocal fold nodules (VFNs) has not been investigated. Improved understanding of the factors that affect change in VFN size may help to better guide treatment decisions and counselling of families.
  
  
  OBJECTIVE
  To characterize the rate of change in the size of pediatric VFNs over time and to identify which factors affect increased rates of improvement.
  
  
  METHODS
  Retrospective review of 67 children evaluated in a voice clinic between 2002 and 2011 with a primary diagnosis of VFNs.
  
  
  METHODS
  No treatment or behavioral modification only (n = 19) vs targeted voice therapy with or without the treatment of associated conditions (gastroesophageal reflux and allergic rhinitis) (n = 45) vs surgical intervention (n = 3).
  
  
  METHODS
  Change in VFN grade (graded according to a previously validated scale based on size) over time.
  
  
  RESULTS
  Sixty-seven patients with a median (range) age of 6.0 (3.8-20.6) years were analyzed. Median (range) follow-up was 25 (1-119) months. The rate of change in VFN grade over time was significantly associated with large baseline VFN size (P < .001) and targeted voice therapy with or without the management of associated conditions or surgery (P = .01); the association with postpubescent age was not significant (P = .09). The rate of change in VFN grade was not significantly different at 1 and 3 years postbaseline (P = .33).
  
  
  CONCLUSIONS
  Baseline VFN size, treatment, and patient age are important in predicting the rate of improvement in nodule size over time. Rate of change in VFN size is a gradual decrease that is steady over time. This information can be used to help guide treatment decisions and counsel families of children with VFNs regarding expectations for improvement. Additional study is needed to evaluate whether the same factors that influence nodule size similarly influence parental perception of voice and expert perceptual voice analysis.
authors.affiliation: Division of Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
authors.forename: Heather C
authors.initials: HC
authors.lastname: Nardone
authors.affiliation: Department of Otolaryngology and Communication Disorders, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Thomas
authors.initials: T
authors.lastname: Recko
authors.affiliation: Clinical Research Program, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Lin
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Otolaryngology and Communication Disorders, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Roger C
authors.initials: RC
authors.lastname: Nuss
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007818:Laryngeal Diseases / Q000175:diagnosis*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014741:Video Recording; D014827:Vocal Cords / Q000473:pathology*; D014832:Voice Disorders / Q000175:diagnosis; D014833:Voice Quality; D055815:Young Adult