Clinical Challenges in Otolaryngology
January 2005

Nonsurgical Management of Pediatric Vocal Fold Nodules

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Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Otolaryngol Head Neck Surg. 2005;131(1):68-70. doi:10.1001/archotol.131.1.68

Financial Disclosure: None.

Hypothesis: Pediatric vocal fold nodules are best managed without surgery.

Pediatric vocal fold nodules are challenging to diagnose and treat. Making an accurate diagnosis in the office usually requires fiberoptic laryngoscopy in awake patients, which is not tolerated by all patients (or parents!). There is a lack of firm agreement about what constitutes a vocal fold abnormality in a child because a pediatric larynx normally looks different than an adult one.14 Even when accurately identified, there is not a common classification scale for the extent or severity of pediatric vocal fold nodules or their impact on communication. To compound the difficulties of studying this entity, many clinicians believe that vocal fold nodules are self-limiting, resolving at puberty,2 so that earlier investigation or intervention is considered “unnecessary.” In this article, I describe the basic pathologic features of vocal fold nodules, the options for diagnosis and management, and then discuss the pros and cons of the hypothesis that they are best managed without surgery.

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