Women with Vocal Fold Nodules: Analysis of Voice Quality and Vocal Self-Perception

To evaluate the voices of women with vocal fold nodules and those of a control group through acoustic assessment (multiparametric and cepstral measures), auditory- and self-perceptual assessments.

This observational analytical case-control study included 21 women with no laryngeal pathologies (CG) and 19 women with vocal fold nodules (NG), aged between 21 and 58 years. All participants underwent videolaryngoscopy. The selection criteria excluded participants from both groups who had allergic crises and/or colds, self-reported pregnancy, or menstruation on the day of data collection. Acoustic assessment was performed using sustained vowel [a], continuous speech, and specific phonation tasks. Cepstral measures (cepstral peak prominence (CPP) and smoothed CPP (CPPs)) and multiparametric acoustic indices (Acoustic Voice Quality Index, Acoustic Breathiness Index (ABI), and Dysphonia Severity Index (DSI)) were extracted using the Praat software. For auditory-perceptual assessment, the parameters of overall grade of dysphonia (G), roughness (R), and breathiness (B) were used, while vocal self-assessment was conducted using the Voice Symptom Scale (VoiSS) questionnaire. The statistical tests applied included the Anderson-Darling test, Student's t-test, Mann-Whitney U test, and chi-square test, with a significance level of 5%.

Significant differences were found between the groups in ABI (P = 0.013), DSI (P = 0.022) e CPPs of the vowel (P = 0.016), with more altered values observed in the NG. In the perceptual-auditory evaluation of the voices, the NG showed a higher occurrence of moderate breathy voice quality than the CG, with a statistically significant difference (P = 0.052). Regarding vocal self-perception, the NG obtained higher scores in the Limitation, Emotional, and Total Score subscales of the VoiSS, with statistically significant results (P < 0.000).

The presence of vocal fold nodules in women is associated with breathiness in voice quality along with alterations in the acoustic indices ABI, DSI, and CPPs of the sustained vowel, and a negative effect on vocal functionality.