The Effect of Inhaled Corticosteroids on Vocal Fold Nodules in Children

Overview

Voice disorders are the most common communication disorder across the lifespan and vocal fold nodules are the most frequent pathology affecting voice in children. The goal of the present study is to determine the safety, feasibility, and efficacy of a short-course of inhaled corticosteroids in addition to standard voice therapy for treating vocal fold nodules.

Full Title of Study: “The Effect of Inhaled Corticosteroids on Vocal Fold Nodules in Children: A Pilot Study”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: July 2025

Detailed Description

Voice disorders are the most common communication disorder across the lifespan, affecting more than 5 million school-aged children annually in the United States. Vocal fold nodules are the most frequent pathology affecting voice in children, with 21% of children negatively influenced at any given point in time, resulting in negative quality of life consequences and inferior academic performance. The traditional first-line approach to treatment of vocal fold nodules is voice therapy by Speech-Language Pathology, although corticosteroids are often implemented in conjunction with voice therapy to reduce focal inflammation at the lesion site. Operating room procedures are the traditional method to administer corticosteroids to the lesion site, although recent advances in office-based laryngeal steroid injections have become a widely popular alternative to reduce lesion size. Unfortunately, although in-office injections are more favorable to operating room procedures, due to their less invasive nature, in-office procedures are still an invasive alternative in the pediatric population. Specifically, they involve equipment that may be intimidating to the child and require the child to remain very still for prolonged periods of time, which may not be feasible with some children. Furthermore, focal vocal fold injections still involve potential adverse effects such as vocal fold hematoma. To mediate these concerns, a short course of inhaled corticosteroids may be a safe and non-invasive alternative to reducing inflammation and lesion size within the larynx. The goal of the present study is to determine the safety and feasibility of a short-course of inhaled corticosteroids in addition to standard voice therapy for treating vocal fold nodules. The study also aims to examine the effects of inhaled corticosteroids on quality of life outcomes and acoustic and aerodynamic outcomes.

Interventions

  • Drug: Fluticasone propionate
    • fluticasone inhaler 44mcg/puff, 2 puffs twice a day for 4 weeks
  • Behavioral: Standard voice therapy
    • Standard voice therapy sessions

Arms, Groups and Cohorts

  • Experimental: inhaled steroid + voice therapy
    • fluticasone inhaler, 88mcg (2 puffs), twice a day for 4 weeks + standard voice therapy
  • Other: voice therapy only
    • standard voice therapy

Clinical Trial Outcome Measures

Primary Measures

  • adverse events
    • Time Frame: 1 year after start of voice therapy
    • number and type of adverse events
  • compliance with inhaler use (percent of prescribed doses marked as “taken” on diary)
    • Time Frame: 4 weeks
    • percent of prescribed doses marked as “taken” on diary

Secondary Measures

  • fundamental frequency (Hertz)
    • Time Frame: 9-12 weeks
    • change in fundamental frequency from baseline to end of therapy
  • quality of life questionnaire
    • Time Frame: 9-12 weeks
    • change in score from QOL questionnaire from baseline to end of therapy
  • maximum phonation time (seconds)
    • Time Frame: 9-12 weeks
    • change in time from baseline to end of therapy
  • s/z ratio
    • Time Frame: 9-12 weeks
    • change in ratio of 2 measures from baseline to end of therapy

Participating in This Clinical Trial

Inclusion Criteria

  • Newly diagnosed with vocal fold nodules; – Considered behaviorally and cognitively appropriate by PI for voice therapy; – English comprehension and production sufficient to participate in the protocol and in voice therapy; – Not currently on inhaled corticosteroids; – No previous voice therapy; – Willing to participate in voice therapy at Children's Hospital of Pittsburgh Exclusion Criteria:

  • Other medical conditions or medications that would mask or amplify voice outcomes, including developmental or other neuromuscular conditions, major illness or disorders, chronic or acute with the exception of laryngopharyngeal reflux disease or allergies and their treatments.

Gender Eligibility: All

Minimum Age: 4 Years

Maximum Age: 11 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Joseph Dohar, MD
  • Provider of Information About this Clinical Study
    • Sponsor-Investigator: Joseph Dohar, MD, Professor of Otolaryngology – University of Pittsburgh
  • Overall Official(s)
    • Joseph Dohar, MD, Principal Investigator, ENT Department, Children’s Hospital of Pittsburgh
  • Overall Contact(s)
    • Amber D Shaffer, PhD, 412-692-6874, shafferad@upmc.edu

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