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  • Title: Vocal fold nodules: A disorder of phonation organs or auditory feedback?
    Author: Lee SH, Yu JF, Fang TJ, Lee GS.
    Journal: Clin Otolaryngol; 2019 Nov; 44(6):975-982. PubMed ID: 31436035.
    Abstract:
    OBJECTIVE: Increasing evidence supports that auditory feedback of one's own voice closely relates to real-time adjustments of vocal control. Previous studies highlighted that the low-frequency modulations of below 3 Hz (LFM) embedded in vocal fundamental frequency (F0) showed a reflex-like response to altered auditory inputs. However, the auditory feedback control of different vocal disorders remains unclear. DESIGN: A cross-sectional, case-controlled study. SETTING: A tertiary medical centre. PARTICIPANTS: Sustained vocalisations of vowel/a/ from adult healthy controls and patients with vocal fold nodules, vocal fold polyps and vocal fold cysts, respectively. The vocalisations were made at a comfortable pitch and at the intensity of 70 ~ 80 dBC under the following four auditory conditions: natural hearing, 90-dBC speech noise, 10-dBC enhanced feedback of self-produced voice and both the noise and voice feedback. MAIN OUTCOME MEASURES: Power spectral analysis of F0 contour of sustained vowel. RESULTS: Patients with vocal fold nodules presented with different audio-vocal feedback behaviour and audio-vocal response to speech noise from the other two vocal pathologies of vocal fold polyp and vocal fold cyst as well as the healthy controls (P < .001, one-way ANOVA). CONCLUSION: The vocal fold nodules may be not only a vocal fold disease but also a disease caused by abnormal audio-vocal feedback. Moreover, the distinct audio-vocal feedback of vocal fold nodules could be revealed by power spectral analysis of vocal fundamental frequencies. Although further investigations are necessary, adjustments of audio-vocal feedback behaviour may provide a new insight and benefit to the treatment of vocal fold nodules in the future.
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