title: Pediatric Vocal Fold Nodule Etiology: What Are Its Usual Causes in Children?
abstract: OBJECTIVE
  In this study, the relation between phonotrauma and presence of siblings and social activities was investigated, and the incidence of voice disorders in the mothers of children with vocal fold nodules was studied with objective (clinical voice analysis) and subjective (laryngostroboscopy, Voice Handicap Index) methods.
  
  
  METHODS
  Twenty-nine children with vocal fold nodules (age range 5-14 years), 45 age-matched children without any voice disorders as a control group, and their mothers were included in the study. All patients had laryngostroboscopy and clinical voice analysis, and their mothers filled out the Pediatric Voice Handicap Index. We noted the most common place or situation where children used their voice in excessively high volume according to their mothers, including home, school, sportive activities, and singing or reciting poem activities, to recognize the major cause of phonotrauma. In addition, presence of siblings was recorded.
  
  
  RESULTS
  It was found that 15 patients (51.7%) had younger siblings, seven patients (24.1%) had older siblings, five patients (17.2%) had both younger and older siblings, and two patients (6.8%) did not have any siblings. It was seen that excessive usage of high-volume voice at home had a correlation with presence of only younger siblings, and both younger and older siblings tended to cause phonotrauma at home (86.7%). Additionally, eight boys (44.4%) reported presence of sportive activities, whereas none of the girls had such an activity (P = 0.012).
  
  
  CONCLUSIONS
  Presence of siblings seems to be an important factor for vocal nodule formation. Maternal relationship does not seem to be a major factor for vocal misuse.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey. Electronic address: arzualanya@yahoo.com.
authors.forename: Arzu
authors.initials: A
authors.lastname: Tuzuner
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Sule
authors.initials: S
authors.lastname: Demirci
authors.affiliation: Private Practice, Ankara, Turkey.
authors.forename: Haldun
authors.initials: H
authors.lastname: Oguz
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Giresun University Hospital, Giresun, Turkey.
authors.forename: Kursat Murat
authors.initials: KM
authors.lastname: Ozcan
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D049489:Stroboscopy; D014421:Turkey / Q000453:epidemiology; D064706:Vocal Cord Dysfunction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*
keywords: Children; Dysphonia; Stroboscopy; Vocal abuse; Voice analysis