Emotional Adjustment in Children with Vocal Fold Nodules

  • Jeong Min Lee
    Address correspondence and reprint requests to: Jeong Min Lee, Ph.D., Department of Communication Sciences and Disorders, 390 South 1530 East, Suite 1201, BEH SCI-, Salt Lake City, UT, 84112
    Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah
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  • Nelson Roy
    Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah
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  • Albert Park
    Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, Utah

    Division of Otolaryngology – Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, Utah
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  • Harlan Muntz
    Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, Utah

    Division of Otolaryngology – Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, Utah
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  • Marshall Smith
    Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, Utah

    Division of Otolaryngology – Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, Utah
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Published:December 09, 2022DOI:



      Vocal fold nodules (VNs) in children are benign, bilateral, callous-like lesions at the junction of the anterior third and posterior two-thirds of the true vocal folds. Chronic, repetitive, and intense vocal behavior is often cited as the primary etiology; however, difficulties with emotional adjustment may predispose some children towards extreme and possibly phonotraumatic vocal activity, thereby contributing secondarily to the development of VNs.


      This case-control study examined the association between features of emotional adjustment and VNs in children.


      Parents of children with VNs (N = 40, Mage = 7.5, SDage = 2.03) and two medical control groups [ie, voice disordered, but not VNs (VDCs; N = 40, Mage= 7.09, SDage = 2.01) and vocally normal controls (VNCs; N = 40, Mage = 7.6, SDage = 1.54)] participated in the study. Features of emotional adjustment were assessed using two inventories: the Parent Rating scale for Reactive and Proactive Aggression and the Revised Child Anxiety and Depression Scale – Parent version.


      As compared with the VNCs, children with VNs were significantly more aggressive (P = 0.042, Cohen's d = 0.47) whereas the VDCs were more depressed (P = 0.013, Cohen's d = 0.60). Furthermore, VDCs experienced more separation anxiety than VNs (P = 0.038, Cohen's d = 0.45) and VNCs (P = 0.021, Cohen's d = 0.55). No other significant between-group differences were identified between the VNs and VDCs.


      When present, elevated aggression may represent a risk factor for VNs formation in children, and possibly influence treatment outcomes. Therefore, the current results highlight the importance of understanding the role of emotional adjustment in the evaluation and treatment of dysphonia in children.


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