Laryngeal ultrasound and pediatric vocal fold nodules

TLDR

Vocal fold nodules are bilateral thickening of the membranous folds linked to repetitive mechanical stress, usually diagnosed by laryngeal stroboscopy, but obtaining a clear view in children can be difficult, prompting interest in high‑frequency ultrasonography for transcervical laryngeal imaging. The study aimed to evaluate whether laryngeal ultrasound (LUS) can reliably detect vocal fold nodules in dysphonic children. A prospective case‑control design enrolled 46 children (mean age 4.8 yr), with 23 having stroboscopically confirmed nodules and 23 without lesions, and LUS examinations were interpreted by two blinded pediatric radiologists. LUS showed substantial inter‑rater agreement (κ = 0.70) and strong concordance with stroboscopy (κ = 0.87), achieving 100 % sensitivity and 87 % specificity, indicating it can identify nodules in children with substantial agreement to the gold standard.

Abstract

The term vocal fold nodules refers to bilateral thickening of the membranous folds with minimal impairment of the vibratory properties of the mucosa. Nodules are thought to be related to repetitive mechanical stress, associated with voice use patterns. Diagnosis is typically made in the office via either rigid or flexible laryngeal stroboscopy. Depending on the individual child, obtaining an optimal view of the larynx can be difficult if not impossible. Recent advances in high-frequency ultrasonography allows for transcervical examination of laryngeal structures. The goal of this project was to determine if laryngeal ultrasound (LUS) can be used to identify vocal fold nodules in dysphonic children.Prospective case-control study in which the patient acted as his or her own control.Forty-six pediatric patients were recruited for participation in this study; the mean age was 4.8 years. Twenty-three did not have any vocal fold lesions and 23 had a diagnosis of vocal fold nodules on laryngeal stroboscopy. Recorded LUSs were reviewed by two pediatric radiologists who were blinded to the nodule status.There was substantial inter-rater agreement (κ = 0.70, 95% confidence interval [CI]: 0.50-0.89) between the two radiologists regarding the presence of nodules. There was also substantial agreement (κ = 0.87, 95% CI: 0.72-1) between LUS and laryngeal stroboscopy. Sensitivity of LUS was 100% (95% CI: 85%-100%) and specificity was 87% (95% CI: 66%-97%).LUS can be used to identify vocal fold nodules in children with substantial agreement with laryngeal stroboscopy.3b Laryngoscope, 127:676-678, 2017.