Randomized Controlled Trial of Voice on Children With Vocal Nodules
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Randomized Controlled Trial of Voice on Children With Vocal Nodules|
- Pediatric Voice-Related Quality of Life Instrument (PVRQOL) [ Time Frame: Administered at Screening, Baseline, Therapy Completion, and Follow-Up ] [ Designated as safety issue: No ]The PVRQOL consists of 10 questions completed by parent proxy administration that requires approximately 5 minutes to complete. It measures the parent's assessment of their child's overall quality of life as related to their vocal condition.
- "Consensus Auditory-Perceptual Evaluation of Voice" (CAPE-V) [ Time Frame: Completed at Baseline, Therapy Completion, and Follow-Up ] [ Designated as safety issue: No ]The CAPE-V specifies standardized procedures for the perceptual evaluation of voice, including standardized recording conditions, word stimuli and rating procedures.
- Phonation Threshold Pressure (PTP) [ Time Frame: Completed at Baseline, Therapy Completion, and Follow-Up ] [ Designated as safety issue: No ]The aerodynamic measures obtained will focus on estimated Phonation Threshold Pressure (PTP), defined as the minimum amount of subglottal pressure required to initiate and sustain vocal fold oscillation. These measures will be obtained in a non-invasive manner from oral pressures generated during repetitive production of five consonant-vowel-consonant (CVC) strings (/pae pae pae pae pae/.
- Harmonics-to-Noise Ration [HNR) [ Time Frame: Completed at Baseline, Therapy Completion, and Follow-Up ] [ Designated as safety issue: No ]Recordings will be analyzed using KayPENTAX's Computerized Speech Lab (CSL). To analyze the steady state vowel productions, the steadiest one second segment from the mid portion of each vowel production will be selected from the digitized waveform for analysis, and HNR results for that segment will be obtained using CSL software.
- Nodule grade [ Time Frame: Completed at Baseline and Follow-Up ] [ Designated as safety issue: No ]A grading system for vocal fold nodules has been validated with established inter-rater reliability for nodule presence and size. The 3-point grading scale for nodule size will be used with grade 1 being small, grade 2 a moderate nodule, and grade 3 a large nodule. The contour of the nodule will also be rated as either discrete or sessile. One secondary objective of the study is to compare nodule grade across baseline and 12 (or 16) weeks. Changes in grade are compared for subjects treated with voice therapy versus office instructions alone.
|Study Start Date:||January 2011|
|Estimated Study Completion Date:||October 2015|
|Primary Completion Date:||October 2015 (Final data collection date for primary outcome measure)|
Two groups of children who are hoarse and have vocal nodules will be examined to see whether voice therapy is effective as a treatment strategy
Voice disorders place over five million school-aged children at increased risk for inferior school performance, dysfunctional social development, and higher participation in criminal activities. The lesions most commonly associated with pediatric vocal dysfunction are reported to be vocal fold nodules, which are present in up to 21% of the general pediatric population and are associated with behavioral problems and inferior quality of life. Voice therapy with a speech-language pathologist is recommended by 95% of otolaryngologists for management of vocal fold nodules. When implemented, this voice therapy requires significant time investment and typically results in regular absence from the classroom over a period of 1-3 months or longer, depending on the protocol and the setting. Regular absence from school has been shown to place children at risk for poorer scholastic performance but the benefits of this voice therapy have yet to be demonstrated in any rigorous prospective, controlled trial. Thus, the most widely used treatment for the most common lesion associated with pediatric voice disorders has not been rigorously tested in a randomized controlled trial to determine whether it may have benefits.
A randomized clinical trial addressing whether voice therapy improves voice-related quality of life for children with apparent vocal fold nodules is a logical step toward developing an evidence-based treatment plan to optimize outcomes for this sizable population of at-risk children. There are currently no well-powered, prospective, controlled studies which compare voice therapy versus control in children who present with apparent nodules. Our goal is to remedy this deficiency through testing of the following primary null hypothesis: There is no difference in the change in PVRQOL scores after 3 months of treatment with voice therapy versus office instructions.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01255735
|United States, Massachusetts|
|Massachusetts Eye and Ear Infirmary|
|Boston, Massachusetts, United States, 02114|
|United States, Pennsylvania|
|Drexell University College of Medicine|
|Philadelphia, Pennsylvania, United States, 19103|
|United States, Wisconsin|
|Children's Hospital of Wisconsin|
|Milwaukee, Wisconsin, United States, 53226|
|The Hospital For Sick Children|
|Toronto, Ontario, Canada|
|Principal Investigator:||Christopher Hartnick, MD||Massachusetts Eye and Ear Infirmary|