Vocal fold nodules (VFNs) are the most frequent cause of voice problems in children and are caused mainly by vocal abuse and misuse. In adults, voice therapy is used as a first-line therapy. In contrast, many Japanese hospitals and clinics do not promote the use of voice therapy in children, because natural remission is expected in most pediatric VFN cases and it is thought children are not unduly bothered by dysphonia. However, children with severe hoarseness and girls with allergic diseases are likely to have voice complaints that remain after they reach puberty. Moreover, it has been reported that children, like adults, are aware of their dysphonia, and that people with this problem are disadvantaged socially. In light of these issues, voice therapy should be provided for pediatric VFNs, at least in those children who are at high risk of a poor prognosis.
In our clinic, we provide voice therapy for VFNs in children accompanied by their parent(s) or guardian(s). In our vocal hygiene instruction, we do not prohibit vocalizations other than shouting, but we instruct the children to be aware of vocal misuse themselves and to correct their bad phonation habits. Voice training is performed by using semi-occluded vocal tract exercises. In the past 10 years, reports on the effectiveness of voice therapy in children with VFNs have been increasing, but many of these studies have not been well designed. Further consideration needs to be given to this point.

We examined the effectiveness of an online Lidcombe Program (LP) in children who stutter. The results in 17 "online group" children who were treated by using the online LP were examined retrospectively and compared with those of 22 "face-to-face group" children treated by using a face-to-face LP. Severity ratings (SRs) scored by parents and speech-language pathologists were compared between the two groups before and after 16 sessions of LP. Both groups showed statistically significant improvement after 16 LP sessions compared with their SRs before the LP. No significant differences were found between the face-to-face and online groups. These results suggest that the effectiveness of at least 16 sessions of online LP is comparable to that of the same number of face-to-face LP sessions. Future studies should examine the effectiveness of online LP by comparing the time required for stuttering remission and the rate of stuttering recurrence after remission between the two groups.

The reproducibility of the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) perceptual evaluation scale for dysphonia depends on the skill level of the examiner. Reproducibility is considered low among different examiners and within a single examiner. In this study, three speech-language pathologists (SLPs) with at least 10 years of practical experience in vocal disorders were recruited to use the GRBAS scale to evaluate the recorded voices of 74 patients with speech disorders. After 2 months, the voices were randomized again and reevaluated. For the intra-rater reliability evaluation, the coincidence between the first and second scores was examined. Reliability among the three examiners' scores was evaluated by the degree of coincidence of the three SLPs' scores. All intra-rater parameters were generally consistent, but the R and S parameters were inconsistent among the different examiners. As the intra-rater degree of coincidence was high, evaluation by the same examiner may be useful. In contrast, the degree of coincidence among the different examiners' scores was not reliable, as the evaluations of multiple parameters differed between experienced SLPs. In future, it will be necessary to develop a more objective evaluation scale than the GRBAS scale.