Voice disorders are the most common communication disorder across the lifespan and vocal fold nodules are the most frequent pathology affecting voice in children. The goal of the present study is to determine the safety, feasibility, and efficacy of a short-course of inhaled corticosteroids in addition to standard voice therapy for treating vocal fold nodules.
Voice disorders are the most common communication disorder across the lifespan, affecting more than 5 million school-aged children annually in the United States. Vocal fold nodules are the most frequent pathology affecting voice in children, with 21% of children negatively influenced at any given point in time, resulting in negative quality of life consequences and inferior academic performance. The traditional first-line approach to treatment of vocal fold nodules is voice therapy by Speech-Language Pathology, although corticosteroids are often implemented in conjunction with voice therapy to reduce focal inflammation at the lesion site. Operating room procedures are the traditional method to administer corticosteroids to the lesion site, although recent advances in office-based laryngeal steroid injections have become a widely popular alternative to reduce lesion size. Unfortunately, although in-office injections are more favorable to operating room procedures, due to their less invasive nature, in-office procedures are still an invasive alternative in the pediatric population. Specifically, they involve equipment that may be intimidating to the child and require the child to remain very still for prolonged periods of time, which may not be feasible with some children. Furthermore, focal vocal fold injections still involve potential adverse effects such as vocal fold hematoma. To mediate these concerns, a short course of inhaled corticosteroids may be a safe and non-invasive alternative to reducing inflammation and lesion size within the larynx. The goal of the present study is to determine the safety and feasibility of a short-course of inhaled corticosteroids in addition to standard voice therapy for treating vocal fold nodules. The study also aims to examine the effects of inhaled corticosteroids on quality of life outcomes and acoustic and aerodynamic outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
2
fluticasone inhaler 44mcg/puff, 2 puffs twice a day for 4 weeks
Standard voice therapy sessions
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, United States
adverse events
number and type of adverse events
Time frame: 1 year after start of voice therapy
compliance with inhaler use (percent of prescribed doses marked as "taken" on diary)
percent of prescribed doses marked as "taken" on diary
Time frame: 4 weeks
fundamental frequency (Hertz)
change in fundamental frequency from baseline to end of therapy
Time frame: 9-12 weeks
quality of life questionnaire
change in score from QOL questionnaire from baseline to end of therapy
Time frame: 9-12 weeks
maximum phonation time (seconds)
change in time from baseline to end of therapy
Time frame: 9-12 weeks
s/z ratio
change in ratio of 2 measures from baseline to end of therapy
Time frame: 9-12 weeks
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