Efficacy of Voice Therapy on Vocal Cord Nodules and Applicability Analysis of Assessment Methods

<bold>Objective</bold>To investigate the clinical efficacy of voice therapy in children with vocal nodules and to analyze the applicability of different assessment methods for evaluating the therapeutic outcomes.<bold>Methods</bold>A total of 37 patients with vocal cord nodules who visited the Voice Department of Zhongshan Hospital, Xiamen University between January 2023 and January 2025 were selected as the study participants. The patients received a two-month voice therapy program provided by a therapist in a one-on-one individual training format. The therapy included vocal hygiene education, relaxation training, and resonant voice therapy (RVT), conducted once weekly for 45 minutes per session. Patients were instructed to perform daily home exercises once a day, 30 minutes per session. Assessments were conducted before training, after one month of training, and after two months of training using the following tools: the Pediatric Voice Handicap Index (pVHI) to evaluate the impact of the voice disorder on the children's quality of life; the GRBAS scale for subjective auditory perceptual evaluation of voice quality; stroboscopic laryngoscopy to examine the morphology of the vocal cord nodules, glottal closure, symmetry of vocal fold movement, mucosal wave, and regularity of vocal cord vibration; and objective acoustic parameters (fundamental frequency, jitter, shimmer) to assess voice quality.<bold>Results</bold>Compared with pre-training, the total pVHI score, as well as the physical and emotional domain scores all decreased after 1 month of training (<italic>P</italic>&lt;0.05); after 2 months of training, the total pVHI and functional, physical, and emotional domain scores all decreased (<italic>P</italic>&lt;0.05); When comparing the results at 2 months after training with those at 1 month after training, the total pVHI score, as well as the functional and emotional domain scores all decreased (<italic>P</italic>&lt;0.05). Compared with pre-training, the G, R, and B scores in the GRBAS Scale all decreased after 1 month and 2 months of training (<italic>P</italic>&lt;0.05); compared with those after 1 month of training, the G, R, and B scores all decreased (<italic>P</italic>&lt;0.05) after 2 months of training. There was no statistically significant difference in the distribution of different grades of vocal nodules among the number of patients before and after one month of training (<italic>Z</italic>=-1.908, <italic>P</italic>=0.056); after 2 months of training the distribution proportion of the number of patients with different grades of vocal cord nodules showed statistically significant difference (<italic>Z</italic>=-5.024, <italic>P</italic>&lt;0.001). Compared with pre-training, the scores for glottal closure, vocal fold mucosal wave, and regularity of vocal fold vibration under stroboscopic laryngoscopy after 1 month of training all decreased (<italic>P</italic>&lt;0.05); after 2 months of training the scores for glottal closure, symmetry of vocal fold movement, vocal fold mucosal wave, and regularity of vocal fold vibration all decreased (<italic>P</italic>&lt;0.05); compared with that after 1 month of training, the score for symmetry of vocal fold movement decreased after 2 months of training (<italic>P</italic>&lt;0.05). Compared with pre-training, the values of jitter and shimmer after 1 month and after 2 months of training all decreased (<italic>P</italic>&lt;0.05); compared with that after 1 month of training, the value of shimmer after 2 months of training decreased (<italic>P</italic>&lt;0.05).<bold>Conclusion</bold>Voice therapy effectively improves vocal quality in pediatric vocal cord nodules, although morphological changes lag behind the subjective and objective acoustic assessment results. Auditory-perceptual assessments and acoustic analysis exhibit superior clinical applicability compared to laryngoscopic evaluation. As a noninvasive tool, acoustic analysis is particularly valuable for monitoring therapeutic efficacy during voice rehabilitation.