Voice Handicap Index

BACKGROUND: The goal of this study was to assess and compare voice handicap in patients with benign organic and functional dysphonia. PATIENTS AND METHODS: Voice handicap was assessed using a German version of the Voice Handicap Index. A total of 108 German speaking patients, 64 women and 44 men aged 45.3+/-15.1 years with benign organic ( n=69) or functional ( n=39) voice disorders completed the questionnaire immediately after clinical examination and without knowing their individual diagnosis. Fifty individuals without voice complaints and normal voice status, 28 women and 22 men aged 47.1+/-15.5 years, served as controls. RESULTS: Significant differences ( P<0.001) were found between all dysphonic patients and the control group. When comparing dysphonic patients according to their gender and diagnosis group (organic or functional) no significant differences were detected. CONCLUSION: It can no longer be assumed that patients with functional voice disorders over emphasize their disease. The data obtained in this study prove that there are no gender specific differences in the way a voice disorder is experienced. There are also no differences in the way patients with a different language background experience their voice handicap.     

Treatment responsiveness of the Singing Voice Handicap Index

Objectives/Hypothesis: To examine the responsiveness of the previously validated Singing Voice Handicap Index (SVHI) to treatment related changes in patients' singing voice. Study Design: Prospective. Methods: Thirty singing patients at a tertiary voice clinic prospectively completed the Voice Handicap Index and SVHI at their initial presentation, pretreatment, and posttreatment. Results: Patients had lower SVHI scores posttherapy compared with the initial SVHI scores (P ≤ .001, paired t-test). The change in SVHI scores from initial to posttreatment evaluation was greater than the change from initial to pretreatment evaluation (P < .001, paired t-test). The Spearman correlation of the Voice Handicap Index difference with the SVHI difference before and after treatment was 0.71 (P < .001). Conclusion: The SVHI measures changes in patients' singing vocal health status resulting from treatment and the change correlates with that of other validated instruments.     

Creation and validation of the Singing Voice Handicap Index

OBJECTIVES: We developed and validated a disorder-specific health status instrument (Singing Voice Handicap Index; SVHI) for use in patients with singing problems. METHODS: Prospective instrument validation was performed. Of 81 original items, those with poor statistical validity were eliminated, resulting in 36 items. The ability to discriminate dysphonic from normal singers, test-retest reliability, internal consistency, and construct validity were assessed. RESULTS: We included 112 dysphonic and 129 normal singers, professional and nonprofessional, of classical, country, rock, choral, and gospel repertoire. Dysphonic singers had worse SVHI scores than normal singers (p < or = .001, rank sum test). Test-retest reliability was high (Spearman correlation, 0.92; p < or = .001). Internal consistency demonstrated a Cronbach's alpha of .97, and the correlation between the SVHI and self-rated singing voice impairment was .63 (p < or = .001, Spearman correlation). CONCLUSIONS: The SVHI is a reliable and valid tool for assessing self-perceived handicap associated with singing problems.     

Validierung des Singing Voice Handicap Index in der deutschen Fassung

The Singing Voice Handicap Index (SVHI) was developed in the United States for the self-assessment of patients with singing problems. It has been translated into German and its reliability and validity have been assessed. In total, 54 (35 female, 19 male) dysphonic singers and 130 (74 female, 56 male) non-dysphonic professional singers were included in the study. Reliability rested on high test-retest reliability (r?=?0.960, p?≤?0.001, Pearson correlation) and a Cronbach’s α of 0.975. A principal component analysis using the Varimax method and the results of the screeplot suggest the SVHI scored as a single scale. Validity rested on a highly significant correlation between the severity of the self-rated voice impairment by the patient and the total SVHI score. Dysphonic singers have significantly higher SVHI scores than healthy singers. The SVHI is thus suited to implementation as a diagnostic tool in German-speaking countries.     

教师声带息肉患者的嗓音声学分析与嗓音障碍指数相关性研究

目的 探讨教师声带息肉患者的嗓音声学分析与嗓音障碍指数的相关性.方法 对70例教师声带息肉患者(教师息肉组,男30例,女40例)和70例嗓音正常者(对照组,男28例,女42例)进行嗓音声学分析和嗓音障碍指数(voice handicap index,VHI)评估.嗓音声学分析指标包括基频(F0)、基频微扰(jitter...     

Validation of the Italian version of the Singing Voice Handicap Index

Singers constitute a specific population that is particularly sensitive to vocal disability, which may have a higher impact on their quality of life compared to non-singers. A specific questionnaire, the Singing Voice Handicap Index (SVHI), was created and validated aimed to measure the physical, social, emotional and economic impacts of voice problems on the lives of singers. The aim of this study was to validate the Italian version of the SVHI. The validated English version of the SVHI was translated into Italian and then discussed with several voice care professionals. The Italian version of the SVHI was administered to 214 consecutive singers (91 males and 123 females, mean age: 32.62 ± 10.85). Voice problem complaints were expressed by 97 of the singers, while 117 were healthy and had no voice conditions. All subjects underwent a phoniatric consultation with videolaryngostroboscopy to ascertain the condition of the vocal folds. Internal consistency of the Italian version of the SVHI showed a Cronbach’s α of 0.97. The test–retest reliability was assessed by comparing the responses obtained by all subjects in two different administrations of the questionnaire; the difference was not significant (p = ns). The SVHI scores in healthy singers was significantly lower than the one obtained in the group of singers with a vocal fold abnormality (29.26 ± 25.72 and 45.62 ± 27.95, p < 0.001, respectively). The Italian version of the SVHI was successfully validated as an instrument with proper internal consistency and reliability. It is a suitable instrument for the self-evaluation of handicaps related to voice problems in the context of singing.     

Change of Voice Handicap Index after treatment of benign laryngeal disorders

Voice disorders can have major impact on quality of life. Problems caused by these disorders can be experienced in different domains. The Voice Handicap Index (VHI) is a well-known voice-related quality of life instrument to measure physical, emotional and functional complaints. VHI change after treatment in seven separate benign laryngeal disorders was studied. In addition, correlation between the three domains was examined. VHI forms were completed before and 3 months after treatment. In a 5-year-period, 143 patients with seven specific diagnoses were retrospectively included. VHI improved for six diagnoses polyp (p < 0.000), cyst (p = 0.001), unilateral paralysis (p = 0.001), Reinke edema (p = 0.016), papillomatosis (p = 0.001), nodules (p = 0.002). Sulcus glottidis did not change (p = 0.897). Mean VHI after treatment was higher for females (p = 0.021). The values of the three domains correlate statistically significant. For each diagnosis, the mean VHI after treatment remained higher than in subjects with a healthy voice. Because the domains are interdependent, their absolute values could not be compared. After treatment, VHI improved in six of the seven diagnoses. The scores on the physical, emotional, and functional domain are interdependent. Scores of the different domains cannot be compared.     

Validierung des Voice Handicap Index (VHI) in der deutschen Fassung

Zusammenfassung Der Voice Handicap Index (VHI) wurde zur subjektiven Bewertung einer Stimmstörung durch den Patienten in den USA entwickelt. Die Übertragung in eine deutsche Fassung wird an einer deutschen Patientenpopulation vorgestellt und validiert. Insgesamt 316 erwachsene Patienten (221 weiblich, 95 männlich) wurden untersucht. Die Reliabilität des VHI ergibt sich aus einem hohen Cronbach's (0,96). Eine Faktorenanalyse zur Strukturierung der Items führt zu 4 Faktoren, die inhaltlich als negative Stimmerfahrung (Faktor 1—20,83% der Varianzaufklärung nach Rotation), Selbstunsicherheit (Faktor 2—18,82%), mangelnde Tragfähigkeit der Stimme (Faktor 3—12,84%) und negative Emotionalität (Faktor 4—11,01%) interpretiert werden können. Die mittleren VHI-Werte lassen sich nach den von den Patienten selbst eingeschätzten Schweregraden der Stimmstörung signifikant voneinander trennen. Der Voice Handicap Index ist als diagnostisches Instrument für den deutschsprachigen Raum geeignet.Auszugsweise vorgetragen auf der 19. Wissenschaftlichen Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie, 13.–15. September 2002, Erlangen     

Complex voice assessment--Polish version of the Voice Handicap Index (VHI)

The aim of this work was to present own modification of Jacobson's The Voice Handicap Index, the self-estimation scale of the voice as a one part of the complex voice evaluation. The VHI contains three groups of questions of physical, emotional and functional subscales, which specify complaints during phonation scored in 4 points (0-4). The presented our own modification of the VHI may be useful in everyday clinical practice.     

声带息肉患者的嗓音声学分析与VHI的相关性研究

目的 探讨嗓音声学分析与嗓音障碍指数(voice handicap index,VHI)用于嗓音质量评估的临床意义及其相关性,并进一步验证VHl的实用性.方法 对35名声带息肉患者(患者组)及35名嗓音正常人(对照组)进行嗓音声学分析和VHI调查,嗓音声学分析指标包括振幅扰动商(amptitude perturbation quotient,APQ)、基频微扰(jitter)、振幅微扰(shimmer)、噪/谐比(NHR),VHI调查包括功能(F)、生理(P)、情感(E)三个范畴,记录三方面得分及总分(TVH)分值.结果患者组的APQ、jitter、shimmer、NHR均高于正常组,差异有统计学意义(P<0.05);患者组VHI的TVH平均值为43.32±4.66分,而正常组的平均值为12.51±1.88分,两组间差异有统计学意义(P<0.05).声带息肉患者嗓音声学分析参数与VHI之间无显著相关性.结论 临床上不能以嗓音声学分析为标准来判断或推测声带息肉患者症状轻重;VHI可主观反映患者嗓音障碍程度.     

Der Singing Voice Handicap Index-12

HNO - Ziel der Studie war die Entwicklung einer gekürzten deutschsprachigen Fassung des Singing Voice Handicap Index (SVHI). Der SVHI ist ein eindimensionales Instrument zur Selbstbeurteilung...     

The Voice Handicap Index: impact of the translation in French on the validation

The aim of this prospective investigation was to validate a French version of the Voice Handicap Index (VHI). A population of 52 normal subjects and 63 patients with voice disorders replied to the questionnaire at the day of their first consultation and ten to thirty days after the consultation (before any treatment). Reproducing the methodology of the American authors, the test-retest reliability and the internal consistency reliability were measured. The validity and the sensibility related to a non dysphonic population were also analysed. Regarding the normal subjects, the maximum scores for total score and subscale scores were 20 (total), 12 (physical), 7 (functional), 6 (Emotional). These scores are statistically different when compared with pathological subjects (p < 0.00001). Test-Retest stability of the pathological subjects was found to be satisfactory for both total score and subscale scores (r > 0.87). From this data set, the critical difference scores were derived for the VHI total score (15 points), for the physical subscale (9 points) and for the functional and emotional.subscales (6 points each). As for as the internal consistency reliability, Cronbach's alpha is correct (r > 7) for the pathological subjects. Yet, the analysis of the validity reply by reply, reveals some abnormalities. In conclusion, the validity of the French translation of the VHI is confirmed but the results prompt us to improve the quality of the translation.     

Social Hearing Handicap Index

As a supplement to the acoustic examination at the hearing centre, a questionnaire has devised to reflect patients’ hearing handicaps in daily life. It consists of 21 questions, with which a patient's bias to answer in scored. The principles on which the test was prepared are discussed in general and can therefore be applied to other languages. 25 normally-hearing individuals were examined, together with 198 patients with all kinds of hearing disorders; a rather high correlation (90%) was found between the social hearing handicap index (SHI), and the degree of hearing handicap (SRT). It has, however, been proved that other factor, such as lip-reading capacity, influence the social handicap. The SHI, before and after audiological treatment at the hearing centre, serves as a useful standard to control the effectiveness of our measures, since they are experienced by the patient himself.     

Pediatric Voice Handicap Index (pVHI): a new tool for evaluating pediatric dysphonia

PURPOSE: The Voice Handicap Index (VHI) is widely used and accepted into adult clinical practice. The present study was initiated to adapt the VHI to the pediatric population and to validate it in the form of a parental proxy. METHODS: The initial modification of the adult VHI involved changing the language of the statements to reflect a parent's responses about their child and eliminating questions that would not relate to children. It was administered in conjunction with 10 open-ended questions regarding the impact of the child's voice quality on overall communication, development, education, social and family life. The pVHI was then modified in content and language, and the final 23-item parental proxy product was used for the validation process. The modified pVHI was administered to two groups of patients following IRB approval from Cincinnati Children's Hospital Medical Center. RESULTS: Normative data was obtained from 45 parents of healthy children. The group consisted of 21 males, age ranges 3-12 years old. The mean scores of the total pVHI and its subscales are: functional (F) 1.47, physical (P) 0.20, emotional (E) 0.18 and total (T) 1.84. The test group consisted of 33 guardians of children presenting for a voice evaluation pre- or post-laryngotracheal reconstruction. This group differed greatly from the control group on each subscale and total score. The mean scores of the airway group were as follows: F 13.94, P 15.48, E 12.15 and T 41.58. Test-retest reliability of the total pVHI score was measured using Pearson's correlation coefficient. The scores were 0.95, 0.77, 0.79 and 0.82, respectively. A correlation matrix for pVHI subscore and total score showed significance, with results similar to those reported for the original adult VHI. CONCLUSIONS: The aim of the present study was to modify the VHI to serve a similar role in the evaluation of the effects of dysphonia on the pediatric population. The statistical results reveal a high correlation between the VHI and the pVHI. The pVHI provides a high internal consistency and test-retest reliability. This tool will be utilized to follow a child's development following surgical, medical and behavioral interventions.     

Very long‐term Voice Handicap Index Voice Outcomes after Montgomery Thyroplasty: A cross‐sectional study

Objective

The aim of this multicentric cross‐sectional study was to examine the permanency of Montgomery thyroplasty (MTIS) results from a patient's perspective.

Design

The study consisted of collecting Voice Handicap Index (VHI‐30) questionnaires from patients who had previously been operated with MTIS between 2 and 12 years before. Very long‐term (>2 years) postoperative data were compared with the previously acquired preoperative and early postoperative VHI results. Influence of factors such as age, gender, size/side of the prosthesis and length of the follow‐up were also analysed.

Setting

Multicentric study involving three tertiary European voice centres.

Participants

Forty‐nine unilateral vocal fold paralysis (UVFP) patients, treated by MTIS, were included in the study.

Main outcome measures

The Voice Handicap Index‐30 score.

Results & Conclusions

The median VHI was significantly different over time‐points (Friedman's test P < .001), with a significant difference between preoperative and early postoperative time‐points (median VHI: 70 vs 21, respectively; P < .001) and between preoperative and very long‐term postoperative time‐points (median VHI: 70 vs 16, respectively; P < .001). The median VHI did not differ for the early and very long‐term postoperative time‐points (median VHI: 21 vs 16; P = .470). Age differences, gender differences and size/side differences of the prostheses, centres where surgery took place and length of the follow‐up showed no significant influence. Medialisation thyroplasty (MT) overall and MTIS, in particular, should be considered as a possible standard of care for UVFP when permanency of voice results is sought.     

Voice quality after endoscopic laser surgery and radiotherapy for early glottic cancer: objective measurements emphasizing the Voice Handicap Index

We analyzed the functional outcome and self-evaluation of the voice of patients with T1 glottic carcinoma treated with endoscopic laser surgery and radiotherapy. We performed an objective voice evaluation, as well as a physical, emotional and functional well being assessment of 19 patients treated with laser surgery and 18 patients treated with radiotherapy. Voice quality is affected both by surgery and radiotherapy. Voice parameters only show differences in the maximum phonation time between both treatments. Results in the Voice Handicap Index show that radiotherapy has less effect on patient voice quality perception. There is a reduced impact on the patient’s perception of voice quality after radiotherapy, despite there being no significant differences in vocal quality between radiotherapy and laser cordectomy.     

嗓音障碍指数量表简化中文版的研究

目的 对嗓音障碍指数(voice handicap index,VHI)量表中文版进行简化筛选研究.方法 对1 766例嗓音疾病患者的VHI评分行聚类分析,筛选简化版的条目;分析3 825例嗓音疾病患者及120例健康对照者的VHI简化版评分,并对其中424例嗓音疾病患者治疗前后VHI评分进行比较以评估简化版.结果 聚类分析筛选出10个条目(VHI-10)和13个条目(VHI-13)两个简化版,其内部一致性分别为0.939、0.936,重测信度分别为0.995、0.993,与VHI量表的相关性分别为0.972、0.973.不同嗓音疾病组患者VHI-10、VHI-13评分均明显高于对照组,差异有统计学意义(Z值分别为17.42、17.46,P值均为0.000),且VHI-10、VHI-13与VHI评分之比均大于期望值0.333、0.433(VHI-10、VHI-13与VHI条目数之比);按主观听觉评估总嘶哑度G(grade)分级分组比较,VHI-10、VHI-13评分各级间差异均有统计学意义(Z值范围5.735～9.861,P值均为0.000);治疗后量表评分显著下降,术前术后VHI-10、VHI-13评分差异有统计学意义(P值均＜0.05).结论 VHI-10、VHI-13量表均具有良好的信度和效度,可以作为嗓音障碍指数量表的简化中文版应用于发音障碍的自我评估,其中,VHI-10比VHI-13更加简洁,更易于推广使用.