Shah et al developed a grading scale to describe the endoscopic appearance of a vocal cord nodule in a pediatric patient. These nodules are a common cause of hoarseness in children. The authors are from Children's National Medical Center in Washington, D.C., and Children's Hospital, Boston.
Symptoms:
(1) hoarseness
(2) breathiness
(3) straining
(4) aphonia
Parameters:
(1) protrusion of nodule in mm
(2) base
Protrusion
Code
none
0
< 0.5 mm
1
0.5 to 1.0 mm
2
> 1.0 mm
3
Base
Base Code
sessile, broad
s
discrete (not broad)
d
where:
• A base was termed sessile if it is > 2 times the "width" of the nodule. The width is presumably the protrusion of the nodule above the surrounding mucosa.
grade for the nodule =
= CONCATENATION(two codes)
Adduction is normal for Grade 0 and 1 nodules.
With a Grade 2 nodule there may be an anterior gap on glottic adduction.
With a Grade 3 nodule an hourglass appearance on glottic adduction is typical.
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