Clinical and Videostroboscopic Characteristics of Vocal Fold Nodules in Conservatory Students in Georgia: A Case Series.

Abstract

Background: Voice disorders are common among professional voice users, particularly singers and vocal students exposed to high vocal demands. Vocal fold nodules are among the most frequent benign vocal fold lesions associated with phonotrauma. However, data on the clinical and functional characteristics of vocal fold nodules among conservatory students, particularly in Georgia, remain limited.

Methods: This descriptive case series included 10 conservatory vocal students and recent graduates presenting with dysphonia at a specialized otolaryngology clinic in Tbilisi, Georgia. Clinical data were collected retrospectively and included demographic characteristics, vocal background, presenting symptoms, clinical findings, and management. All patients underwent videostroboscopic examination to assess vocal fold structure and function, together with acoustic voice assessment.

Results: Participants ranged in age from 17 to 28 years, and 60% were female. Dysphonia was present in all cases (100%), with high-register dysphonia reported in four patients (40%). Videostroboscopic examination demonstrated bilateral, symmetrical nodular lesions located at the junction of the anterior and middle thirds of the vocal folds, with incomplete glottic closure and reduced mucosal wave observed in several cases. Abnormal acoustic parameters were identified in eight patients (80%). Symptoms suggestive of reflux-related laryngeal irritation were reported in four patients (40%), and reflux laryngitis was diagnosed in two patients (20%). All patients underwent phonomicrosurgery because of persistent symptoms despite conservative management and their professional vocal requirements, followed by structured postoperative voice rehabilitation and voice therapy. Four patients (40%) additionally received inhaled corticosteroid therapy. Clinical improvement in dysphonia was observed following surgery.

Conclusion: Vocal fold nodules contribute to dysphonia among conservatory vocal students and recent graduates presenting with voice-related complaints. The combined use of videostroboscopy and acoustic voice assessment provides complementary information on vocal fold structure and vocal function. In this case series, phonomicrosurgery followed by structured postoperative voice rehabilitation was associated with clinical improvement in dysphonia among patients with persistent symptoms and substantial professional vocal demands. Larger prospective studies using standardized pre- and post-treatment voice outcome measures are needed to further evaluate treatment outcomes in this population.