Research Article| Volume 37, ISSUE 3, P470.e1-470.e6, May 2023

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The Evaluation of Beck Anxiety Scale, Voice Handicap Index, and Brief Symptom Inventory on Treatment of Patients With Vocal Fold Nodules

Published:February 25, 2021DOI:



      Vocal fold nodules are benign lesions that cause hoarseness in all age groups including children, adolescents, and adults. These nodules may be caused either by singing or other causes of tension in vocal activity.


      The aim of this study was to evaluate the psychological symptoms of adult patients with hoarseness and to investigate the relationship in psychological symptoms before and after voice therapy.


      23 Patients who were admitted with a voice complaint and diagnosed with vocal fold nodules and a matched control group were evaluated. Two inventories recommended by our psychiatrist (The Beck Anxiety Inventory, Brief Symptom Inventory) and Voice Handicap Index-10 (VHI-10), were completed to evaluate the treatment outcomes and psychosocial properties of the patients before and after voice therapy.


      A significant difference was observed in the BAI and BSI scores between the nodule (+) group and the control group at the beginning of the study, before voice therapy. A significant difference was found between the mean scores on the BAI and the BSI before and after therapy in the vocal fold nodules group.


      Patients with vocal fold nodules should be evaluated more extensively using psychological assessment scales, such as the BSI, and a psychiatric consultation should be added in cases of abnormal findings.


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        • Cervera FJ
        • Vega F
        • Garcıa Tapia R
        Benign lesions of vocal folds. Diagnosis and Treatment of Voice Disorders.
        Garsi, Madrid, Spain1996: 223-240
        • Koc C
        Kulak Burun Boğaz Hastalıkları ve Baş Boyun Cerrahisi, Bölüm 7,3 Larenksin Benign Lezyonları.
        Guneş Tıp Kitabevi, Ankara2004: 1159-1165
        • Bastian RW
        • Keidar A
        Simple vocal tasks for detecting vocal fold swelling.
        J Voice. 1990; 4: 172-183
        • Colton RH
        • Casper JK
        • Leonard RJ in
        Understanding voice problem: a physiological perspective for diagnosis and treatment.
        Fourth edition. Wolters Kluwer, 2011: 231-240 (Health Adis (ESP))
        • Ban JH
        • Lee KC
        • Jin SM.
        Investigation into psychological correlates of patients with vocal nodules using the Symptom Checklist-90-Revision.
        J Otolaryngol. 2007; 36: 227-232
        • E.Aronson Arnold
        • M.Bless Diane
        Clinical Voice disorders.
        4th ed. Thieme Medical Publishers, New York, NY2009: 166-193
        • Roy N
        • Bless DM
        Personality traits and psychological factors in voice pathology: a foundation for future research.
        J Speech Lang Hear Res. 2000; 43: 737-748
        • Roy N
        • McGrory JJ
        • Tasko SM
        • et al.
        logical correlates of functional dysphonia: an investigation using the Minnesota Multiphasic Personality Inventory.
        J Voice. 1997; 11 (Psycho): 443-451
        • Dietrich M
        • Verdolini Abbott K
        Vocal function in introverts and extraverts during a psychological stress reactivity protocol.
        J Speech Lang Hear Res. 2012; 55: 973-987
        • Arnold GE
        Disorders of laryngeal function.
        Otolaryngology. 1973; : 634
        • Banse R
        • Schere KR
        Acoustic profiles in vocal emotion expression.
        J Personality and social psychol. 1996; 70: 614-636
        • Juslin PN
        • Laukka P
        Communication of emotions in vocal expression and music performance: different channels, same code?.
        Psychol Bulletin. 2003; 129: 770-814
        • Preti E
        • Suttora C
        • Richetin J
        Can you hear what I feel? A validated prosodic set of angry, happy, and neutral Italian pseudowords.
        Behav Res Methods. 2016; 48: 259-271
        • Bachorowski JA
        • Owren MJ
        Sounds of emotion: production and perception of affect-related vocal acoustics.
        Ann N Y Acad Sci. 2003; 1000: 244-265
        • Preti E
        • Suttora C
        • Richetin J
        Can you hear what I feel? A validated prosodic set of angry, happy, and neutral Italian pseudowords.
        Behav Res Methods. 2016; 48: 259-271
        • Derogatis LR
        • Melisaratos N
        The Brief Symptom Inventory: an introductory report.
        Psychol Med. 1983; 13: 595-605
        • Şahin H.N
        • Batıgün D.A
        • Uğurtaş S
        Kısa Semptom Envanteri (KSE): Ergenler İçin Kullanımının Geçerlik, Güvenilirlik ve Faktör Yapısı.
        Türk Psikiyatri Dergisi. 2002; 13: 125-135
        • Beck AT
        • Epstein N
        • Brown G
        • et al.
        An inventory for measuring clinical anxiety: psychometric properties.
        J Consul Clin Psychol. 1988; 56: 893-897
        • Ulusoy M
        • Sahin NH
        • Erkmen H
        Turkish version of the Beck Anxiety Inventory: psychometric properties.
        J Cogn Psychother. 1998; 12: 163-172
        • Jacobson B.H.
        • Johnson A.
        • Grywalski C.
        • et al.
        The voice handicap index: development and validation.
        Am J Speech Lang Pathol. 1997; 6: 66-70
        • Kiliç MA
        • Okur E
        • Yildirim I
        • et al.
        Ses Handikap Endeksi (Voice Handicap Index) Türkçe versiyonunun güvenilirliği ve geçerliliği [Reliability and validity of the Turkish version of the Voice Handicap Index].
        Kulak Burun Bogaz Ihtis Derg. 2008; 18: 139-147
        • Murry T
        • Woodson GE
        A comparison of three methods for the management of vocal fold nodules.
        J Voice. 1992; 6: 271-276
        • Siupsinskiene N
        • Razbadauskas A
        • Dubosas L
        Psychological distress in patients with benign voice disorders.
        Folia Phoniatr Logop. 2011; 63: 281-288
        • Seifert E
        • Kollbrunner J
        Stress and distress in non-organic voice disorders.
        Swiss Med Wkly. 2005; 135: 387-397
        • Alves Silverio KC
        • Brasolotto AG
        • Thaís Donalonso Siqueira L
        • et al.
        Effect of application of transcutaneous electrical nerve stimulation and laryngeal manual therapy in dysphonic women: clinical trial.
        J Voice. 2015; 29: 200-208
        • Birchall MA
        • Carding P
        Vocal nodules management.
        Clin Otolaryngol. 2019; 44: 497-501
        • Hogikyan ND
        • Appel S
        • Guinn LW
        • et al.
        Vocal fold nodules in adult singers: regional opinions about etiologic factors, career impact, and treatment. A survey of otolaryngologists, speech pathologists, and teachers of singing.
        J Voice. 1999; 13: 128-142
        • Misono S
        • Haut C
        • Meredith L
        • et al.
        Dysphonia, perceived control, and psychosocial distress: a qualitative study.
        J Voice. 2019 Sep; 33: 682-690
      1. Stein Dan J. Hollander Eric Rothbaum Barbara O. Textbook of Anxiety Disorders. American Psychiatric Pub, 2009
        • Arnold GE
        Disorders of laryngeal function.
        in: Paparella MM Shumrick DA Otolaryngology. W.B. Saunders, Philadelphia, PA1973: 634
        • Green G
        Psycho-behavioral characteristics of children with vocal nodules: WPBIC ratings.
        J Speech Hear Disord. 1989; 54: 306-312