Purpose: The aim of this study was to determine and compare the short-term effects of two intensive semi-occluded vocal tract programs, ‘straw phonation’ and ‘resonant voice therapy’, on the phonation of children with vocal fold nodules.

Methods: A pretest-posttest randomized controlled study design was used. Thirty children aged 6 to 12 years were assigned to the straw phonation group (n = 11), resonant voice therapy group (n = 11), or control group receiving indirect treatment (n = 8). Participants received 11 hours of voice therapy over four consecutive days. A multidimensional voice assessment consisting of both objective (Dysphonia Severity Index and Acoustic Voice Quality Index) and subjective (Pediatric Voice Handicap Index and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)) measures was performed pre- and posttherapy. Voice therapy effectiveness was evaluated using group-level analyses (linear mixed models) and individual-level analyses to investigate what proportion of participants changed to a clinically relevant degree.

Results: Group-level analyses showed no significant time-by-group interactions, indicating no differences in evolution over time between the three groups. Within-group effects of time revealed a significant and equal improvement in Dysphonia Severity Index in the straw phonation and resonant voice therapy group, and a significant improvement in CAPE-V overall severity in the straw phonation group. For Dysphonia Severity Index, individual-level analyses showed that 36% and 45% of participants improved to a clinically relevant degree in the straw phonation and resonant voice therapy group, respectively. For Acoustic Voice Quality Index, 38% improved to a clinically relevant degree in the straw phonation group.

Conclusion: Results suggest that short-term intensive semi-occluded vocal tract programs may have a positive effect on vocal quality and vocal capacities of children with vocal fold nodules. There seems to be a preference for straw phonation over resonant voice therapy. _