Diagnostic Value of Acoustic Analysis and Inflammation Markers in Pediatric Vocal Fold Nodules

BACKGROUND Vocal nodules (VFNs) are benign lesions that typically develop as a result of chronic trauma to the vocal fold mucosa. While multiple factors contribute to their development, inflammation plays a central role in their formation and progression. Therefore, the aim of this study was to evaluate the diagnostic value of voice analysis in pediatric patients with VFNs and to explore the potential role of inflammation as a contributing etiological factor. MATERIAL AND METHODS The study population consisted of 60 children: 30 patients with VFN and 30 healthy controls. Voice sample analysis was conducted for determining the fundamental frequency (F0), F0min, F0max, jitter, shimmer, and noise-to-harmonics ratio (NHR). The maximum phonation time (MPT) was also measured. Parents of all participants completed the Pediatric Voice Handicap Index (pVHI) questionnaire. Additionally, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and mean platelet volume (MPV) were calculated from patient hemograms. RESULTS In children with VFN, F0 max, jitter, shimmer, NHR, and pVHI values were significantly higher than in children without dysphonia. In contrast, the MPT value was considerably lower in the VFN group. According to the ROC analysis findings, F0 max and MPT provide moderate discrimination, while jitter, shimmer, NHR, and pVHI provide high discrimination. Moreover, NLR and PLR results were significantly higher in the VFN group than in the controls (p=0.010 and p=0.019, respectively). The sensitivity value of the NLR variable at the cut-off point was 0.667 and the specificity value was 0.667. NLR was found to be statistically significant and had moderate discrimination (p=0.012, AUC=0.689). CONCLUSIONS Numerous acoustic parameters, including F0 max, jitter, shimmer, NHR, pVHI, and MPT, demonstrated high specificity in predicting vocal dysfunction in children with VFN. Furthermore, the findings suggest that NLR may be a more significant marker than other inflammatory parameters in monitoring the disease course. Therefore, NLR is proposed as an effective predictive factor in pediatric VFN.