Abell BD, Kulich M, Olson KE
… +4 more, Hedman ME, Adkisson KH, Kelley PE, Gitomer SA
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41349227
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OBJECTIVES: Children with microtia/atresia (M-A) have a spectrum of complex and longitudinal needs which we aim to address at our center's innovative Multidisciplinary Clinic (MDC). Children attending the MDC see multipl...OBJECTIVES: Children with microtia/atresia (M-A) have a spectrum of complex and longitudinal needs which we aim to address at our center's innovative Multidisciplinary Clinic (MDC). Children attending the MDC see multiple specialists on the same day and participate in an inter-disciplinary discussion. The aim of this study was to compare patient characteristics, treatment choices, and outcomes between MDC and non-MDC patients. METHODS: This was a retrospective cohort study of patients with M-A treated at a tertiary children's hospital between 2001 and 2022. Demographic, socioeconomic, and clinical factors were compared between MDC and non-MDC patients. RESULTS: 507 children with microtia and/or atresia were included, 319 (63 %) of which attended the MDC. The two cohorts did not significantly differ in sex, race, ethnicity, insurance status, language, distance from the MDC, or the Distressed Communities Index. MDC patients had higher rates of both non-surgical (82.1 % vs. 53.7 %; p < 0.001) and transcutaneous surgical bone-amplification (40.6 % vs. 18.3 %; p < 0.001). Additionally, median age at first non-surgical bone amplification fitting was significantly lower in MDC patients (0.8 years vs. 2.5 years, p = 0.011). Device compliance and functional or reconstructive surgery rates were similar between groups. CONCLUSION: To date, this is the largest study of interdisciplinary M-A care. In this model, children have improved outcomes: they are more likely to receive a bone amplification hearing device and were fitted with non-surgical bone amplification devices at younger ages. It is worthwhile to promote early referral to the MDC, as well as implement similar multidisciplinary programs at other institutions.
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41344146
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OBJECTIVE: To compare teacher-reported socio-emotional and behavioral functioning in early-school-age children with cochlear implants (CI) versus normal-hearing (NH) peers using the Child Behavior Assessment Scale (CBAS)...OBJECTIVE: To compare teacher-reported socio-emotional and behavioral functioning in early-school-age children with cochlear implants (CI) versus normal-hearing (NH) peers using the Child Behavior Assessment Scale (CBAS), and to test whether group differences persist after adjustment for socioeconomic factors. METHODS: In this cross-sectional study, 80 children aged 5-6 years were enrolled (CI = 40; NH = 40). Teachers completed CBAS subscales (Adjustment, Social Anxiety, Rule-breaking Behaviors) and total score. Between-group comparisons used Mann-Whitney U tests. ANCOVA on CBAS total adjusted for maternal education, paternal education, and household income. Exploratory correlations within the CI group examined age and clinical durations. RESULTS: Compared with NH peers, the CI group showed lower Adjustment (mean ± SD: 61.45 ± 15.46 vs 80.95 ± 6.56; p < .001) and higher Social Anxiety (64.20 ± 13.27 vs 34.28 ± 7.02; p < .001) and Rule-breaking Behaviors (113.33 ± 26.77 vs 61.08 ± 15.98; p < .001). CBAS total was higher in the CI group (238.98 ± 48.22) than NH (176.30 ± 17.10; p < .001). In ANCOVA, the CI versus NH effect on CBAS total remained significant (F(1,75) = 33.846, p < .001; partial η = 0.311), while socioeconomic covariates were not significant. Within the CI group, child age correlated positively with Rule-breaking Behaviors (r = 0.331, p = .037). CONCLUSIONS: At school entry children with CI showed higher levels of socio-emotional and behavioral difficulties compared to NH peers; however, these findings should be interpreted with caution given the sample size and cross-sectional design. The results support routine psychosocial surveillance and targeted supports within CI follow-up and school settings.
Surapaneni S, Rangarajan N, Davis K
… +19 more, Pletcher K, Flowers J, Strub G, Nolder A, King D, Marston AP, Vecchiotti M, Alfonso K, Evans S, Deshpande A, Prickett K, Landry A, Goudy S, Govil N, Messner A, Richter G, Scott AR, Mehta D, Hill CA
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41338131
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INTRODUCTION: Early and accurate diagnosis of middle ear effusion in primary care settings enables timely intervention, improving long-term patient outcomes while preventing overtreatment with antibiotics. Diagnosis requ...INTRODUCTION: Early and accurate diagnosis of middle ear effusion in primary care settings enables timely intervention, improving long-term patient outcomes while preventing overtreatment with antibiotics. Diagnosis requires assessment of tympanic membrane mobility, but this is hampered by access to and inexperience with pneumatic otoscopy or tympanometry. This research aims to train an artificial intelligence algorithm, using tympanic membrane images captured with consumer-grade otoscopes, to accurately predict the presence or absence of pediatric middle ear effusions. METHODS: Using an over-the-counter digital otoscope, tympanic membrane images were obtained from patients aged 6 months to 6 years old undergoing tympanostomy tube placement at 4 different institutions. The images were labeled according to the middle ear findings identified by pediatric otolaryngologists during myringotomy. A deep learning neural network was trained to classify tympanic membrane images as "Effusion" or "No Effusion". RESULTS: From 219 patients, 537 tympanic membrane images were obtained. Serous, mucoid or purulent effusion were represented in 263 images and 273 images demonstrated no effusion. The trained model achieved a classification accuracy of 92.1 %, a sensitivity of 90.3 %, and specificity of 93.8 %. DISCUSSION: This model has a balanced sensitivity and specificity comparable to or surpassing pneumatic otoscopy (94 % sensitivity, 80 % specificity) and tympanometry (90-94 % sensitivity, 50-75 % specificity). With current barriers to using the diagnostic tools recommended in clinical guidelines, it is evident that an inexpensive, objective diagnostic aid is needed for the primary care setting. This model's performance demonstrates the first step toward an accessible tool for primary care providers.
Hunsicker JW, Ballard M, Khanwalkar A
… +5 more, Wine TM, Lovell MA, Suttman AG, Schneider KW, Chan KH
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41338130
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INTRODUCTION: Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the nasal cavity and paranasal sinuses. Its clinical relevance has increased following the discovery of its association with DICER1 syndro...INTRODUCTION: Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the nasal cavity and paranasal sinuses. Its clinical relevance has increased following the discovery of its association with DICER1 syndrome-a genetic condition predisposing individuals to multiple neoplasms. These two cases highlight important clinical extremes of this disease entity and offer practical evaluation and management recommendations for practicing otolaryngologists. METHODS: A retrospective review was conducted from 1999 to 2025 at a single institution. The report includes two female teenagers presented at ages 13 and 17 years, respectively, diagnosed with NCMH-one with and one without DICER1 syndrome. Key outcomes included recurrence rates, anatomical spread, genetic testing results (including evaluation for DICER1 variants), and disease-status at follow-up. A thorough literature review on NCMH and DICER1 syndrome was conducted to provide the reader with management recommendations. RESULTS:CONCLUSIONS: Genetic testing for DICER1 variants should be standard in all newly diagnosed NCMH cases. Annual nasal endoscopic and imaging follow up is recommended in all individuals with a constitutional or mosaic pathogenic DICER1 variant. There is no published guidance for recurrent NCMH at the olfactory groove/cribriform plate region. Conservative local excisions should be pursued for tumor recurrences.
Te BC, Hashim ND, Abdullah A
… +2 more, Goh BS, Wan Hashim WF
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41330837
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OBJECTIVES: Cochlear implant (CI) is an essential rehabilitative intervention for individuals with severe to profound hearing loss. This study aimed to assess the quality of life (QOL) and to identify potential factors i...OBJECTIVES: Cochlear implant (CI) is an essential rehabilitative intervention for individuals with severe to profound hearing loss. This study aimed to assess the quality of life (QOL) and to identify potential factors influencing the QOL among post-lingually deafened CI recipients. SUBJECTS AND METHODS: A cross-sectional study was conducted involving 58 post-lingual CI recipients with at least one year of implant experience. Demographic and CI-related data were collected. Auditory performance and speech intelligibility were evaluated using CAP II and SIR, while QOL was assessed using the WHOQOL-BREF questionnaire. Simple linear regression analyses were performed to investigate the associations between patients' characteristics and the four WHOQOL-BREF domains (physical health, psychological, social relationships and environment). RESULTS: The mean participant age was 32.95 (sd ± 18.27) years. Longer CI usage was significantly associated with better physical domain experience (b: 0.076; 95 %CI 0.01 to 0.14), whilst longer duration of deafness prior to implant negatively predicted environmental domain scores (b: -0.08; 95 %CI -0.12 to -0.34). Achieving verbal communication was associated with an 8.321-point increase in the environmental domain score (95 % CI 0.68 to 15.96). No significant determinants were identified for the psychological domain. Daily CI usage, CAP II and SIR score, monthly income level, CI laterality, and surgical complications had no significant association with any domain. CONCLUSION: CI enhances QOL in individuals with severe to profound hearing loss. Key positive determinants of QOL include shorter duration of deafness, longer CI experience and use of verbal communication. These findings underscore the importance of early implantation and effective post implant auditory rehabilitation in improving patient outcomes.
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41325690
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OBJECTIVE: This study aimed to investigate the relationships between cortical auditory evoked potentials (CAEPs), behavioral aided hearing thresholds, and functional auditory performance to validate CAEPs as an objective...OBJECTIVE: This study aimed to investigate the relationships between cortical auditory evoked potentials (CAEPs), behavioral aided hearing thresholds, and functional auditory performance to validate CAEPs as an objective tool for assessing hearing aids fitting and to develop an integrated test battery for children with hearing loss. METHODS: Thirty children (aged 24-60 months) with bilateral sensorineural hearing loss were participated in this study. CAEPs were recorded in sound field using the HEARLab™ system in response to three speech stimuli (/m/,/g/,/t/) presented at 55, 65, and 75 dB SPL. Participants were categorized into Group A (CAEPs present for all stimuli at 55 dB SPL, n = 12) and Group B (absent waveforms at 55 dB SPL, n = 18). Aided sound-field thresholds were behaviorally assessed, and functional auditory performance was evaluated using the validated Mandarin version of the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) scale. RESULTS: Group A demonstrated aided thresholds within the speech banana across all tested frequencies, whereas Group B exhibited significantly higher thresholds. CAEPs detectability was strongly dependent on sensation level (SL), with waveforms consistently detected above 10 dB SL. P1 latency decreased significantly with increasing SL (β = -0.513 ms/dB, p < 0.001), while P1 amplitude increased (β = 2.827 μV/dB, p < 0.001). A strong positive correlation was observed between CAEP scores and PEACH questionnaire results (r = 0.884, p < 0.001). CONCLUSION: CAEPs provide an objective and frequency-specific neurophysiological method for verifying HAs fitting outcomes in children who are unable to cooperate with conventional subjective testing.
Heck VJ, Eysel P, Prasse T
… +2 more, Scheyerer MJ, Eysel-Gosepath K
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41319456
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PURPOSE: Grisel Syndrome (GS) describes a rare, non-traumatic atlantoaxial rotatory subluxation in children typically associated with upper respiratory tract infection, or otorhinolaryngological surgery. The aim of this...PURPOSE: Grisel Syndrome (GS) describes a rare, non-traumatic atlantoaxial rotatory subluxation in children typically associated with upper respiratory tract infection, or otorhinolaryngological surgery. The aim of this study was to systematically review the literature regarding interdisciplinary treatment approaches, consequences of delayed or misdiagnosed GS, and upper cervical deformities resulting from misdiagnosed GS. Additionally, we share our institutional experience with this pathology. METHODS: We queried our institutional database for patients suffering from GS which were treated in our department between 2001 and 2024. A systematic literature search was conducted using Medline and the Cochrane Library, following PRISMA guidelines. RESULTS: Our database revealed three patients with GS. One patient with misdiagnosed of GS presented with rigid occipital rotation, ultimately progressing to occipito-atlantoaxial rotatory dislocation (OAARD). Two patients were early diagnosed and successfully treated with halo vest immobilization. The systematic literature review identified 13 cases of OAARD across 12 reports. Etiologies included upper respiratory infections, otorhinolaryngological surgery, juvenile idiopathic arthritis, and minor trauma. The average time to diagnosis of OAARD was 5.9 months (0.5-18 months). The treatment involved occipito-atlantal fusion (43 %), atlantoaxial fusion with halo vest (29 %), or traction followed by halo vest (21 %). CONCLUSION: GS and OAARD are underrecognized and often diagnosed late, causing irreversible deformity and permanent loss of upper cervical spine mobility. Painful torticollis following upper respiratory tract infection, otorhinolaryngological surgery, or minor trauma should be treated as GS until proven otherwise. Early recognition and interdisciplinary treatment are crucial to prevent progression and avoid invasive surgical interventions.
Wischmann S, Hammer L, Jantzen L
… +7 more, Pihl Sandager T, Rudbeck Kamper N, Toftgaard Henriksen S, Adjorlu A, Serafin S, Cayé-Thomasen P, Percy-Smith L
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41319455
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Patient education empowers patients to control their own health and care. Taking responsibility of own hearing is important for children with hearing loss to navigate effectively in noisy environments at school. However,...Patient education empowers patients to control their own health and care. Taking responsibility of own hearing is important for children with hearing loss to navigate effectively in noisy environments at school. However, children must never stand alone with this responsibility. Raising positive awareness about hearing might enhance teachers' and classmates' understanding of hearing loss, making them more competent in supporting children with hearing loss to achieve the best possible listening conditions. In this study we explored how to create positive and timely awareness of hearing loss in middle- and secondary school. We developed a playful virtual reality game about the hearing sense and tested a setup that was suitable for group-use in classrooms. A total of 538 pupils between 10 and 16 years of age, including 26 children with hearing loss, participated in the study. Pupils, teachers and speech and language pathologists from the schools evaluated the game positively, and test before and after intervention showed a significant effect of learning. However, our study also highlighted that some children experience symptoms of cybersickness that shall not be ignored. Furthermore, implementing virtual reality in mainstream schools may present challenges in terms of economic costs and limited teacher resources. Educational gaming certainly has the potential to support learning in schools, but future studies must investigate if virtual reality or other digital platforms are the best solution.
Ogawa M, Maruta T, Kamakura T
… +9 more, Otami Y, Sudo T, Fujita H, Fujisawa N, Okamoto S, Yamashita M, Okazaki S, Hosokawa K, Mishiro Y
Int J Pediatr Otorhinolaryngol
· 2026 Jan · PMID 41317454
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OBJECTIVES: To evaluate the impact of the coronavirus disease (COVID-19) pandemic and public health measures, including emergency declarations and reclassification of COVID-19, on pediatric adenoidectomy (Ad) volume and...OBJECTIVES: To evaluate the impact of the coronavirus disease (COVID-19) pandemic and public health measures, including emergency declarations and reclassification of COVID-19, on pediatric adenoidectomy (Ad) volume and referrals diagnosed with adenoidal hypertrophy (AH) accompanied by obstructive sleep apnea (OSA) and/or otitis media with effusion (OME) in Japan. METHODS: Monthly case volumes from January 2019 to December 2024 were analyzed at a regional tertiary hospital. Trends were assessed for pediatric Ad, new referrals, general anesthesia surgeries (all departments and ENT), and regional COVID-19 cases. Ad cases were classified according to the presence of concomitant tonsillectomy (T) or tympanostomy tube insertion (TTI); referrals based on the presence of OSA or OME symptoms. The annual age trends were also evaluated. RESULTS: General anesthesia surgeries across the hospital and in the adult ENT department declined temporarily during the emergency declarations but rapidly recovered afterward, whereas those in the pediatric ENT department remained below the baseline even after each declaration. Notably, Ad volumes showed no apparent post-declaration recoveries and remained suppressed until 2023, except for a transient increase in summer 2021, followed by a sharp rebound after the COVID-19 reclassification. In 2024, the volumes of Ad with concurrent T and referrals for AH with OSA or OME symptoms both exceeded the pre-pandemic baseline. Surgical age declined during the pandemic, while referral age remained stable until 2023. Both ages increased in 2024. CONCLUSION: The total Ad volume-especially Ad with concurrent T-and referrals for AH with OSA symptoms showed an abrupt decline immediately after the pandemic onset, followed by a sharp recovery exceeding pre-pandemic levels. These findings suggest that public health crises can disrupt elective care for chronic pediatric conditions and that the post-pandemic surge reflects behavioral changes and pent-up demand as well as possible epidemiological alterations in tonsillar tissue dynamics.
Kloosterman N, de Alarcon A, Schauberger E
… +1 more, Wilcox LJ
Int J Pediatr Otorhinolaryngol
· 2025 Dec · PMID 41274058
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INTRODUCTION: Children with an active larynx have a decreased success rate of airway reconstruction and, therefore, require evaluation and management of laryngeal inflammation and associated factors prior to undertaking...INTRODUCTION: Children with an active larynx have a decreased success rate of airway reconstruction and, therefore, require evaluation and management of laryngeal inflammation and associated factors prior to undertaking reconstructive surgery and decannulation. Allergy to the tracheostomy tube is an additional potential cause of active larynx. STUDY DESIGN: Retrospective case series. METHODS: Patients ages 0-18 years with a tracheostomy who were previously diagnosed with active larynx or peristomal inflammation and underwent patch testing to tracheostomy components at a single quaternary academic children's hospital from January 1, 2014 to May 1, 2018 were identified. Pre-testing, testing, and post-testing results and clinical courses were documented. RESULTS: Eight patients who met criteria and underwent patch testing for tracheostomy components were identified. Four (50 %) of the patients had positive allergy tests - three for metal components and one to silicone. These four patients subsequently underwent tracheostomy changes. All four patients had improvement in active larynx with proceeding with successful airway reconstruction and/or decannulation. CONCLUSIONS: Tracheostomy allergy should be considered in children with idiopathic active larynx or peristomal inflammation that is not responding to typical measures. Allergy testing is low-risk and a relatively simple intervention which has the potential to demonstrate an intervenable cause of inflammation. Airway inflammation is often multifactorial and future studies require additional investigation regarding the pathophysiology and improvement of the management of the active larynx.
Int J Pediatr Otorhinolaryngol
· 2025 Dec · PMID 41274057
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OBJECTIVE: To evaluate the long-term safety, efficacy, and satisfaction of Bonebridge implantation in children under 12 years. METHODS: This retrospective study followed 34 patients (aged 5.4-11.8 years) who underwent Bo...OBJECTIVE: To evaluate the long-term safety, efficacy, and satisfaction of Bonebridge implantation in children under 12 years. METHODS: This retrospective study followed 34 patients (aged 5.4-11.8 years) who underwent Bonebridge implantation between 2016 and 2020, with a median follow-up of 55 months. Audiological outcomes, including pure-tone audiometry (PTA), speech reception thresholds (SRTs), speech discrimination scores (SDSs), and sound field hearing thresholds (SFHTs) were assessed. Adverse events and patient-reported satisfaction (HDSS) were recorded. RESULTS: Bonebridge significantly improved speech perception (SRT: -6.20 dB in unilateral; -0.18 dB in bilateral) and SFHT (mean improvement: 20.80 dB unilateral; 29.07 dB bilateral). SDS for monosyllables, disyllables, and sentences showed substantial gains in aided conditions. Adverse events were mild to moderate, except for one serious device failure resolved with revision surgery. Sound localization accuracy decreased in patients with bilateral hearing loss who used a unilateral Bonebridge due to unilateral auditory stimulation. Patient satisfaction was high, with bilateral hearing loss reporting longer daily usage. CONCLUSION: Bonebridge is a safe and effective intervention for young children under 12 years with conductive hearing loss, enhancing auditory access and quality of life.
Alghamdi A, Aubry K, Cussinet L
… +1 more, Bonnafous F
Int J Pediatr Otorhinolaryngol
· 2025 Dec · PMID 41274056
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INTRODUCTION: Acute bacterial rhinosinusitis is frequently seen in children. While complications are uncommon, they can be serious. Risk factors associated with complicated cases remain poorly defined. This study aimed p...INTRODUCTION: Acute bacterial rhinosinusitis is frequently seen in children. While complications are uncommon, they can be serious. Risk factors associated with complicated cases remain poorly defined. This study aimed primarily to identify predictors of complications in pediatric rhinosinusitis. Secondary objectives included evaluating factors associated with treatment failure and the occurrence of severe complications. METHODS: We conducted a retrospective study of all children hospitalized for acute sinusitis at Limoges University Hospital between 2010 and 2020. Data on demographics, medical history, clinical presentation, laboratory tests, and imaging were collected. Statistical analyses included multivariate logistic regression. RESULTS: A total of 109 patients were included. Asthma and prior use of NSAIDs were associated with higher risk of complications. Elevated CRP and lymphopenia were significant biological indicators of severity. Anaerobic Streptococci were more often associated with severe cases. CONCLUSION: Asthma, NSAID use, and high CRP levels appear to be reliable indicators of complications in pediatric acute bacterial rhinosinusitis. These findings support the need for clinical vigilance and early imaging in such cases.
Florentine M, Civantos AM, Luu K
… +1 more, Jacobson L
Int J Pediatr Otorhinolaryngol
· 2025 Dec · PMID 41270329
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OBJECTIVE: A Tracheostomy-Safe Bronchoscopy Protocol was developed at our institution in 2019, which aimed to identify and treat upper airway pathologies early and establish emergency airway plans. The objective of this...OBJECTIVE: A Tracheostomy-Safe Bronchoscopy Protocol was developed at our institution in 2019, which aimed to identify and treat upper airway pathologies early and establish emergency airway plans. The objective of this study was to assess the impact of this protocol on tracheostomy-related complications and outcomes. METHODS: A retrospective chart review of pediatric patients who underwent tracheostomy between 2015 and 2022 at our institution's two tertiary children's hospitals was conducted. Demographic, operative, and clinical data were collected. Univariate and multivariable analyses were used to assess impact on outcomes, including need for event-initiated intervention, tracheostomy-related complications in the year after surgery, and time to decannulation. RESULTS: A total of 106 patients were included, of which 62 % underwent tracheostomy after implementation of the protocol. The average age at tracheostomy was 42 months. Of the 42 patients who underwent their first rigid bronchoscopy within 8 weeks, 64 % had at least one intervention, most commonly granulation tissue removal (40 %). Average time to first rigid bronchoscopy was significantly decreased after the protocol compared to before (mean 2.76 vs. 6.61 months, p = 0.01). The post-implementation cohort had significant decreases in the number of first bronchoscopies being adverse-event-induced (36.36 % vs 14.29 %, p = 0.02), in respiratory-related admissions in the year after surgery (mean 0.35 vs 1.61, p = 0.002), and in the average time to decannulation (46.0 months vs 10.45 months, p = 0.012) compared to the pre-implementation cohort. CONCLUSION: Pediatric patients with tracheostomies are at risk of developing upper airway pathologies. Implementation of a Tracheostomy-Safe Bronchoscopy Protocol may allow for early identification of potential complications.
Song X, Duo Y, Li S
… +3 more, Li X, Hou L, Geng Y
Int J Pediatr Otorhinolaryngol
· 2025 Dec · PMID 41265291
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OBJECTIVE: To investigate the effects of parent-child interactive medical games combined with voice training on the vocal function and quality of life of school-aged children with vocal nodules, and to identify effective...OBJECTIVE: To investigate the effects of parent-child interactive medical games combined with voice training on the vocal function and quality of life of school-aged children with vocal nodules, and to identify effective methods for improving the vocal function of children with vocal nodules. METHODS: Eighty school-aged children with vocal nodules were randomly assigned to a control group (n = 40) and an intervention group (n = 40). The control group received conventional voice training, while the intervention group underwent parent-child interactive medical games combined with voice training. After an 8-week intervention period, objective voice acoustic parameter scores, pediatric voice disorder index scores, and voice-related quality of life scores were compared between groups. RESULTS: Forty subjects in each group completed the study. After 8 weeks of intervention, the intervention group demonstrated significantly improved scores for Jitter, Shimmer, and F0 compared to the control group. Additionally, the intervention group exhibited lower scores on the Pediatric Voice Disorder Index and lower scores on voice-related quality of life measures than the control group (all P < 0.01). CONCLUSION: Combining parent-child interactive medical games with voice training can improve objective acoustic parameters of the voice in school-aged children with vocal nodules, reduce voice disorders in this population, enhance their quality of life, and promote vocal fold recovery.