Family‐Involved Hybrid Voice Therapy for Pediatric Vocal Fold Nodules in School‐Aged Children: Clinical Outcomes and Socioeconomic Associations

Objectives: To evaluate the effectiveness of a family-involved hybrid voice therapy program in children with vocal fold nodules using multidimensional voice outcomes (objective acoustic, auditory-perceptual, and parent-reported measures) and to examine whether family socioeconomic opportunity is associated with baseline burden or posttreatment outcomes. Methods: This prospective single-arm pre-post observational study included children with vocal fold nodules confirmed by fiberoptic or videolaryngoscopic examination. Participants completed a 12-week hybrid voice therapy program consisting of 12 weekly sessions alternating face-to-face and synchronous online delivery (six in-person, six online). Caregivers received structured vocal hygiene education and were trained to support standardized Vocal Function Exercises with daily home practice (5-10 min/day) monitored using an exercise diary. Pre- and posttreatment assessments included acoustic measures (jitter, shimmer, cepstral peak prominence smoothed CPPs, maximum phonation time MPT, noise-to-harmonics ratio NHR), auditory-perceptual evaluation (CAPE-V), and parent-reported impact (pVHI-10). Family socioeconomic opportunity was assessed using the 20-item Family Socioeconomic Opportunity Questionnaire (FSOQ; score range 0-60). Results: < 0.001), indicating that higher FSOQ scores were associated with higher parent-reported voice handicap. Posttreatment, FSOQ was not significantly correlated with CAPE-V or pVHI-10. Conclusion: A 12-week family-involved hybrid voice therapy program was associated with substantial improvements in acoustic, perceptual, and parent-reported outcomes in children with vocal fold nodules. Family socioeconomic opportunity was associated with baseline subjective burden but not with posttreatment outcomes. Controlled studies with longer follow-up are warranted. Level of Evidence: Level 3.