• The Journal of the Korea Contents Association
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• v.11 no.9
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• pp.429-436
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• 2011

There have been several studies reporting that vocal misuse and abuse causes voice problems, as well as laryngeal disease such as laryngitis, vocal nodules, vocal polyp. But few researches have investigated amounts or rates of vocal misuse or vocal abuse of patients. Therefore, the author of this study developed measuring device for vocal misuse and abuse behaviors and compared frequency of vocal misuse and abuse behaviors of normal children and children with vocal nodules. The subjects of this study were five normal children and five children with vocal nodules who were male, lower graders of elementary schools(first to third graders). Based on the results of this study, the frequency of the children with vocal nodules in vocal misuse and abuse using was 5,411(${\pm}145$) and that of the normal children was 3,133(${\pm}257$). The frequency of vocal misuse and abuse behaviors of the children with vocal nodules was around 1.5 time significantly higher than that of normal children(p<.001).

• Phonetics and Speech Sciences
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• v.9 no.4
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• pp.99-106
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• 2017

Clinical data about vocal nodules have seldom been reported, even though vocal nodules are commonly diagnosed in outpatient speech and voice clinic. This study aims to investigate clinical characteristics of the patients who are diagnosed with vocal nodules. This study analyzed the data for 10 years from the 319 patients diagnosed with vocal nodules (45 males and 274 females with the mean age of 39.4 ranging from 2 to 83) in terms of gender, age, occupation, voice change initiation pattern, change with time, throat clearing, smoking history, type of voice abuse, acoustic analysis, maximum phonation time, GRBAS, and VHI. Thirteen patients (4.08%) had unilateral vocal nodule and 306 patients (95.9%) had bilateral vocal nodule, the majority of which had a pattern of asymmetry (73.9%). The glottal closure pattern was hourglass in 72.1% of patients, posterior chink in 17.9% of patients, and irregular in 7.9% of patients. The most common occupational category was professional voice users (43.4%). The voice abuse pattern included excessive talking in 96 patients (76.8%), loud voice in 78 (62.4%) patients, and excessive singing in 17 patients (21.6%). The patients showed worse scores in G, B, and S than in R and A for the GRBAS evaluation. The most recommended treatment for vocal nodules was voice therapy. The current clinical data will be helpful for treatment planning for the patients of vocal nodule.

• Phonetics and Speech Sciences
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• v.4 no.4
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• pp.147-154
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• 2012

The purpose of this study is to examine the effect of voice improvement when vocal training, which relaxes the vocal contact, is applied to children with vocal nodules. Subjects included 20 5- to 12-year-old boys with vocal nodules in Otolaryngology and for whom voice therapy had been advised. The vocal therapy was conducted for 40 minutes per a week for a total of eight times. Results were evaluated by videostroboscopy, auditory-perceptual evaluation of GRBAS Scale, aerodynamic test, and acoustic analysis before and after therapy. As a result, first, the size of vocal nodules was reduced and the unstable pattern of vocal contact was improved. Glottic closure was increased and Phase symmetry was decreased during vocal vibration. Mucosal wave was increased and muscle tension of the larynx was reduced. Second, auditory-perceptual evaluation showed that subjects' overall quality of voice improved. GRBAS Scale Evaluation showed that the characteristics of the subjects' voice which were rough, breathy, and strained and breathy were reduced after therapy. Third, the measurements of acoustic parameters showed a statistically significant improvement. The fundamental frequency of the subejects' voice was increased and values of Jitter and Shimmer, NHR, [H1-H2] decreased. Fourth, the maximum phonation time of children was increased. These results imply that vocal relaxation training conducted in this study has a very positive effect to improve the voice of children with vocal nodules.

• Phonetics and Speech Sciences
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• v.1 no.2
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• pp.43-49
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• 2009

Vocal polyps are benign phonotraumatic lesions which are traditionally treated using phonomicrosurgical techniques. In the case of hyperfunctional voice use, voice therapy is effective and results in voice improvement. However, the utility of voice therapy about vocal polyp is in great demand. The purpose of this study was to evaluate the effects of voice therapy in patients with vocal polyps. The authors reviewed the medical records of 193 patients with vocal nodules or vocal polyps, and 64 patients (31 nodules and 33 polyps) were enrolled. All of the subjects had received explanation of problems, vocal hygiene education, and been treated by the $SKMVTT^{(R)}$ (Seong-Tae Kim's multiple voice therapy technique) ranging from 4 to 16 sessions (mean: 8.6 sessions). All subjects were examined by perceptual assessment, acoustic and aerodynamic measures, and VRP (voice range profile). In perceptual assessment, patients with vocal nodules had more breathy and strained voices than the vocal polyp group. Both groups significantly reduced rough, breathy voice after voice therapy. Patients with vocal polyps had worse voice quality than patients with nodules in acoustic measures. Both groups showed reduced jitter and shimmer after voice therapy. In aerodynamic measures, MPT and Psub were increased, and MFR was reduced (p<.05). Participants' frequency range and intensity range were increased after voice therapy, but only frequency range resulted in a significant difference (p<.05). In conclusion, the therapeutic effect of voice therapy in patients with vocal nodules and polyps was demonstrated perceptually and acoustically. We can suggest that voice therapy, including advice, vocal hygiene, and $SKMVTT^{(R)}$ is a useful as an initial choice of treatment for patients with vocal polyps before considering a surgical approach.

• Phonetics and Speech Sciences
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• v.1 no.2
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• pp.37-42
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• 2009

The purpose of the present study was to determine the effect of the management program known as vocal function exercise (VFE) on voice quality. Typical VFE was modified and applied to patients with vocal nodules by controlling intensity of voice and relieving the vocal fold to solve hyperfunctional problems in VFE. Eight female subjects aged between 28 and 54 who had been diagnosed with vocal nodules took part in the study. The patients performed VFEs once a week for eight weeks. Vocal function exercises consist of voice hygiene, respiratory training, phonation training, and glide training. The subjects' voices were analyzed pre and post therapy on the aspects of acoustics, maximum phonation time (MPT), GRBAS, and voice handicap index (VHI). As a result, it was found that fundamental frequency ($F_o$) was significant increased, shimmer decreased remarkably and that noise to harmonic ratio (NHR) lowered obviously in the acoustic parameter. In addition, MPT was increased significantly. The scale of GRBAS indicated significant improvement in grade, roughness, and strained voice. VHI indicated significant improvement in an emotional part. In conclusion, VFE was effective in improving voice quality for patients with vocal nodules.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.31 no.1
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• pp.13-18
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• 2020

Background and Objective The purpose of this study is to report the effect of voice therapy using the voice reinforcement method (VRM) in patients with vocal nodules. It is one of the holistic voice therapy methods for improving vocal mechanisms. VRM includes not only direct and indirect voice therapy, but also trial therapy and self-practice. Composed of four stages: vocal hygiene education, relaxation, reinforcement, and generalization. Materials and Methods The subjects were 13 patients who were diagnosed with vocal nodules. Acoustic analysis, auditory perceptual assessment, K-VHI-10 and nodules size were compared before and after voice therapy. Voice therapy was conducted by speech-language pathologist and the mean number was 4.2. Results In acoustic analysis, Jitter, vF₀, vAm, Shimmer, NHR, and VTI were significantly decreased. F₀ was increased after voice therapy for women. 'Grade', 'Rough,' and 'Breathy' were significantly decreased in the GRBAS scale after voice therapy. In addition, K-VHI-10 and nodules size were significantly decreased. Conclusion VRM seems to be an effective voice therapy method in vocal nodules treatment. In VRM, especially, trial therapy is given motivation for vocal nodules treatments and self-practice has a continuous therapeutic effect in everyday life. VRM can be also applied to the voice therapy for other hyper-functional dysphonia.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.9 no.1
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• pp.17-21
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• 1998

Benign vocal fold lesions such as polyps, nodules and edema are known to be caused by vocal trauma such as voice misuse and/or abuse. Even though these lesions are known to be caused by the same etiology, phonotrauma, they show widely different clinical features and different responses to voice therapy. Previous studies suggested that benign vocal fold lesions represent disturbance in the balance of the extracellular matrix(ECM) constituents of the vocal folds. Collagen is one of the major constituents of ECM. Among collagens, fibrillar collagens are most important ones for maintaining the structural integrity. On the basis of gross morphology, vocal polyps wert divided into angiomatous one and edematous one, and nodules were divided into conical one and sessile one. In these four groups, the pattern of distribution of various fibrillar collagens(type 1, 2, 3, 5) was studied by immunohistochemical staining using paraffin embedded tissues. Within each group, differences among collagen subtypes were insignificant. In edematous polyp, collagens were sparsely dispersed in lamina propria by diffuse edema. In angiomatous polyp, collagens were displaced into submucosal layer by hemorrhagic space. In nodules, collagens were stained compactly in lamina propria. Quite different distributions of fibrillar collagens between polyps and nodules are thought to suggest that vocal polyps and nodules are totally different disorders in their pathophysiology.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.7 no.1
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• pp.56-60
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• 1996

The vocal efficiency(VE) can be calculated as the ratio of acoustic power to aerodynamic power. It relates to the vocal intensity, air Sow rate and subglottic pressure. In this study, we treated 20 cases of vocal polyps and 10 cases of vocal nodules by way of laryngo-microsurgery or laser laryngo-microsurgery. The VE was measured preoperatively and postoperatively in all cases. The results showed that there was a significant improvement of VE postoperatively than that of preoperative measurement(p＜0.01) in vocal Polyp group. However, there was no significant difference(p＞0.05) in vocal nodule group. Through comparing the results, we obtained the conclusion : The laryngo-microsurgery is the reliable method of management for the vocal polyps, but f3r the vocal nodules, the laryngo-microsurgery should be selected after other more conservative approaches fail to produce the desired results.

• Journal of Clinical Otolaryngology Head and Neck Surgery
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• v.29 no.2
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• pp.229-234
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• 2018

Background and Objectives : Vocal nodules occur with a 12-22% prevalence in pediatric populations. Most otolaryngologists recommend voice therapy as the primary treatment. The aim of this study is to evaluate patient compliance with voice therapy and its effect on vocal nodules in children. Materials and Methods : We retrospectively reviewed 44 pediatric patients between 3 and 11 years old diagnosed with vocal nodules between March 2015 and December 2017. We evaluated the treatment adoption rate, dropout rate during voice therapy, and reasons for dropout. For patients who completed voice therapy, we measured the changes in nodule size, perceptual parameters, and acoustic parameters. We evaluated patient satisfaction using the pediatric voice handicap index (P-VHI). Results : Of the 44 pediatric patients diagnosed with vocal nodules, 22 (50%) agreed to voice therapy. Of the 22 patients who started voice therapy, 5 (22.7%) dropped out during therapy because they were unsatisfied with their treatment. Another 4 patients discontinued therapy for reasons unrelated to treatment effectiveness. Vocal nodule disappeared or decreased in all 13 patients who completed voice therapy. All voice parameters were improved and statistically significant changes were observed in perceptual, acoustic, and P-VHI parameters. Conclusions : Although compliance to voice therapy among the pediatric patients with vocal nodules was low, there were significant improvements in voice parameters for those who completed voice therapy. A change toward a positive perception of voice therapy is necessary and a multidisciplinary approach is needed to improve the effect of voice therapy on pediatric patients with vocal nodules.

• Speech Sciences
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• v.9 no.3
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• pp.77-86
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• 2002

The purpose of this study was to investigate the effects of Sea Dong-Il's technique on voice quality in patients with vocal nodules and phonasthenia (vocal fatigue). Ten patients (4 nodules and 6 vocal fatigue) participated in the study. Each subject was assessed acoustically (Fo, Jitter, Shimmer, NNE) in the first and last session. Dr. Speech (version 3.4, Tiger-DRS) was used to compare acoustic parameters of pre-and post-treatment. Sea Dong-Il's technique consisted of breathing exercise, relaxation exercise, and phonation exercise. The results were as follows: First, Sea Dong- Il's technique tended to be effective on improving voice quality in patients with phonasthenia and vocal nodules. Second, the nature of improvements were as follows: there was a significant difference between pre-and post-treatment in shimmer (p < .01) and NNE (p < .001), while there was no significant difference between pre-and post-treatment in Fo and Jitter. Finally, given the fact that the number of subjects was only 10, the jitter might have shown a significant difference if more subjects participated in the experiment.