The Role of Nutritional and Dietary Habits in Etiology in Pediatric Vocal Fold Nodule

Published:October 01, 2020DOI:



      In pediatric pediatric vocal fold nodule (VFN) patients, different causes have been suggested in the development of the vocal cord nodule, including laryngopharyngeal reflux (LPR). It is known that the content of consumed foods, obesity, and other dietary behaviors are among the risk factors for the development of reflux. The aim of this study was to evaluate dietary and food consumption habits in pediatric VFN patients.


      This prospective-controlled study included 50 children with VFNs (age range 5–14 years) and 50 age-matched children without any voice disorders as a control group. BMI values of each participant were evaluated according to age-percentile range. The voice usage habits and personality structure of all the children were questioned. All patients underwent laryngeal examination and voice analysis. The Turkish Pediatric Voice Handicap Index (t-PVHI) and Child Voice Handicap Index-10 (t-CVHI) were completed by patients or their parents. The examination findings of all patients were evaluated with the reflux finding score (RFS), and their complaints were questioned with the reflux symptom index (RSI). In addition, eating and drinking at night, fast eating and excessive food consumption habits and the frequency of consumption of packaged foods defined as junk food, carbonated beverage were questioned. The data obtained were compared statistically between the two groups.


      There was no significant difference between the study and control groups in terms of age, gender distribution, median BMI value, voice usage habits, and personality structure. In the study group, t-PVHI, t-CVHI, jitter, schimmer values, the mean RFS, and RSI scores were significantly higher than those of the control group. The number of children with high consumption of junk food and carbonated drinks was higher in the study group. There was no significant difference between the two groups in terms of dietary habits.


      Food consumption habits may play a role in childhood voice problems in this population.

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        • De Bodt MS
        • Ketelslagers K
        • Peeters T
        • et al.
        Evolution of vocal fold nodules from childhood to adolescence.
        J Voice. 2007; 21: 151-156
        • Kiliç M
        • Okur E
        • Yildirim I
        • et al.
        The prevalence of vocal fold nodules in school age children.
        Int J Pediatr Otorhinolaryngol. 2004; 68: 409-412
        • Martins RG
        • Hidalgo Ribeiro CB
        • Fernandes de Mello BM
        • et al.
        Dysphonia in children.
        J Voice. 2012; 26: 17-20
        • Tuzuner A
        • Demirci S
        • Oguz H
        • et al.
        Pediatric vocal fold nodule etiology: what are its usual causes in children?.
        J Voice. 2017; 31: 506-511
        • D'Alatri L
        • Petrelli L
        • Calò L
        • et al.
        Vocal fold nodules in school age children: attention deficit hyperactivity disorder as a potential risk factor.
        J Voice. 2015; 29: 287-291
        • Martins RH
        • do Amaral HA
        • Tavares EL
        • et al.
        Voice disorders: etiology and diagnosis.
        J Voice. 2016; 30: 761-770
        • Włodarczyk E
        • Tomasz J
        • Raj-Koziak D
        • et al.
        Diagnosis of laryngopharyngeal reflux in children with voice disorders using 24-hour pharyngeal pH monitoring.
        Int J Pediatr Otorhinolaryngol. 2019; 121: 188-196
        • Wiles NJ
        • Northstone K
        • Emmett P
        • et al.
        ‘Junk food’ diet and childhood behavioural problems: results from the ALSPAC cohort.
        Eur J Clin Nutr. 2009; 63: 491-498
        • Costa CS
        • Del-Ponte B
        • Assuncao MCF
        • et al.
        Consumption of ultra-processed foods and body fat during childhood and adolescence: a systematic review.
        Public Health Nutr. 2018; 21: 148-159
        • Leung AK
        • Hon KL
        Gastroesophageal reflux in children: an updated review.
        Drugs Context. 2019; 17 (eCollection 2019): 212591
        • Takeshita E
        • Furukawa S
        • Sakai T
        • et al.
        Eating behaviours and prevalence of gastroesophageal reflux disease in japanese adult patients with type 2 diabetes mellitus: the dogo study.
        Can J Diabetes. 2018; 42: 308-312
        • WHO Multicentre Growth Reference Study Group
        WHO Child Growth Standards based on length/height, weight and age.
        Acta Paediatr. 2006; 450: 76-85
        • Belafsky PC
        • Postma GN
        • Koufman JA
        The validity and reliability of the reflux finding score (RFS).
        Laryngoscope. 2001; 111: 1313-1317
        • Belafsky PC
        • Postma GN
        • Koufman JA
        Validity and reliability of the reflux symptom index (RSI).
        J Voice. 2002; 16: 274-277
        • Özkan ET
        • Tüzüner A
        • Demirhan E
        • et al.
        Reliability and validity of the Turkish pediatric Voice Handicap index.
        Int J Pediatr Otorhinolaryngol. 2015; 7: 680-684
        • Tadihan Özkan E
        • Tüzüner A
        • Çiyiltepe M
        • et al.
        Reliability and validity of the Turkish children's voice handicap index-10 (TR-CVHI-10).
        Int J Pediatr Otorhinolaryngol. 2017; 96: 131-134
        • Trani M
        • Ghidini A
        • Bergamini G
        • et al.
        Voice therapy in pediatric functional dysphonia: a prospective study.
        Int J Pediatr Otorhinolaryngol. 2007; 71: 379-384
        • Azemati B
        • Kelishadi R
        • Ahadi B
        • et al.
        Association between junk food consumption and cardiometabolic risk factors in a national sample of Iranian children and adolescents population: the CASPIAN-V study.
        Eat Weight Disord. 2018; 11: 1-7
        • Choi YJ
        • Ha EK
        • Jeong SJ
        Dietary habits and gastroesophageal reflux disease in preschool children.
        Korean J Pediatr. 2016; 59: 303-307
        • Venkatesan NN
        • Pine HS
        • Underbrink M
        Laryngopharyngeal reflux disease in children.
        Pediatr Clin North Am. 2013; 60: 865-878
        • Galluzzi F
        • Schindler A
        • Gaini RM
        • et al.
        The assessment of children with suspected laryngopharyngeal reflux: an Otorhinolaringological perspective.
        Int J Pediatr Otorhinolaryngol. 2015; 79: 1613-1619
        • Block BB
        • Brodsky L
        Hoarseness in children: the role of laryngopharyngeal reflux.
        Int J Pediatr Otorhinolaryngol. 2007; 7: 1361-1369
        • Ercan S
        • Dallar YB
        • Önen S
        • et al.
        Prevalence of obesity and associated risk factors among adolescents in Ankara.
        Turkey J Clin Res Pediatr Endocrinol. 2012; 4: 204-207
        • Lightdale JR
        • Gremse DA
        Section on gastroenterology, hepatology, and nutrition. Gastroesophageal reflux: management guidance for the pediatrician.
        Pediatrics. 2013; 131: 1684-1695
        • Simons JP
        • Rosen CA
        • Casselbrant ML
        • et al.
        Comparison of pediatric voice outcome survey, reflux symptom index, reflux finding score, and esophageal biopsy results.
        Arch Otolaryngol Head Neck Surg. 2008; 134: 837-841
        • Karkos PD
        • Leong SC
        • Apostolidou MT
        • et al.
        Laryngeal manifestations and pediatric laryngopharyngeal reflux.
        Am J Otol. 2006; 27: 200-203
        • Lechien JR
        • Saussez S
        • Harmegnies B
        • et al.
        Laryngopharyngeal reflux and voice disorders: a multifactorial model of etiology and pathophysiology.
        J Voice. 2017; 31: 733-752
        • Carr MM
        • Abu-Shamma U
        • Brodsky LS
        Predictive value of laryngeal pseudosulcus for gastroesophageal reflux in pediatric patients.
        Int J Pediatr Otorhinolaryngol. 2005; 69: 1109-1112
      1. Kelishadi R, Heshmat R, Mansourian M, et al. Association of dietary patterns with continuous metabolic syndrome in children and adolescents; a nationwide propensity score-matched analysis: the CASPIAN-V study. Diabetol Metab Syndrome.2018 52-63.

        • Lee JM
        • Roy N
        • Dietrich M
        Personality, psychological factors, and behavioral tendencies in children with vocal nodules: a systematic review.
        J Voice. 2019; 6: 945-963
        • Barona-Lleo L
        • Fernandez S
        Hyperfunctional voice disorder in children with Attention Deficit Hyperactivity Disorder (ADHD). A phenotypic characteristic?.
        J Voice. 2016; 30: 114-119