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Objectives: Mutational falsetto (MF) is a functional voice disorder involving failure to transition from the high-pitched voice of childhood to the lower-pitched voice of adolescence and adulthood. The low mandible maneuver (LMM) is used by professional singers to relax the larynx and expand the resonance space. It relaxes suprahyoid muscles and pushes the larynx backwards, so it can be used as a therapy for MF. Material and Methods: The data of 20 MF patients treated by the LMM were analyzed in this study. All of the patients were asked to complete the Voice Handicap Index-10 (VHI-10) before the first session, and again 2 weeks after the second visit. The Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale scores and fundamental frequency (F0) were analyzed for each patient. Results: All except 1 patient reported that they completed the exercises without difficulty; the patient who did not perform the exercises cited reasons other than their difficulty. Only 2 patients failed to transition from MF to a lower-pitched voice. The GRBAS scale scores (all parameters) differed significantly between the first and second sessions. The VHI-10 score also changed, i.e., self-perceived voice quality was improved significantly, as was the F0. Conclusions: Our results showed that the LMM is an efficient and rapid technique for treating MF patients and shows high patient compliance.

Objectives: To assess the effect of EVES (Education for a Healthy and Efficient Voice), a voice training program aimed at promoting the use of an efficient and healthy voice in teachers. Sample and Method: Twenty-two teachers in the city of Granollers (Catalonia, Spain) were included in this research. The effect of the EVES program was evaluated focusing on the analysis of physiologic parameters on the one side (stroboscopy analysis), and on perceptual parameters on the other (Q-EVES questionnaire, Voice Handicap Index-10 [VHI-10], and GRBAS [Grade, Roughness, Breathiness, Asthenia, Strain Scale]). Results: The teachers incorporated the vocal strategies in their professional life and reported that the perception of difficulty in using their voice decreased. We observed a significant improvement in VHI-10 markers, in voice management abilities in the classroom, in perceptive and subjective voice parameters, and in some functional lesions. Conclusions: The results suggest that the educational intervention model may have a positive effect on teachers’ vocal care.

Background: The Voice Handicap Index-10 (VHI-10) is used in clinics because of its validity and ease of use by patients. Objectives: The aim of this paper was to evaluate the internal consistency, reliability, and clinical validity of the Serbian version of the VHI-10. Method: In this cross-sectional study, we translated the original English version of the VHI-10 into Serbian, after which it was back-translated into English. The Serbian version of the VHI-10 was completed by 161 patients with voice disorders, divided into 4 groups according disease etiology (structural, neurological, functional, and inflammatory) and 73 healthy control subjects. Results: The VHI-10 internal consistency was 0.88. Spearman’s rank correlation coefficient for VHI-10 test-retest reliability was ρ = 0.991 (p< 0.001). Patients with voice disorders had higher median total VHI-10 scores compared with controls (p< 0.001). The patients’ Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale scores were significantly correlated with the VHI-10 test scores (ρ = 0,682, p < 0.001) and VHI-10 retest scores (ρ = 0.716, p < 0.001). Conclusion: The Serbian version of the VHI-10 had good validity and reliability and can be used by Serbian patients with voice disorders.

Objectives: The purpose of this study was to assess and compare the total score and subscale scores of the Voice Handicap Index (VHI) in speakers with and without hearing loss. A further aim was to determine if a correlation exists between severities of hearing loss with total scores and VHI subscale scores. Patients and Methods: In this cross-sectional, descriptive analytical study, 100 participants, divided in 2 groups of participants with and without hearing loss, were studied. Background information was gathered by interview, and VHI questionnaires were filled in by all participants. Results: For all variables, including mean total score and VHI subscale scores, there was a considerable difference in speakers with and without hearing loss (p < 0.05). The correlation between severity of hearing loss with total score and VHI subscale scores was significant. Conclusion: Speakers with hearing loss were found to have higher mean VHI scores than speakers with normal hearing. This indicates a high voice handicap related to voice in speakers with hearing loss. In addition, increased severity of hearing loss leads to more severe voice handicap. This finding emphasizes the need for a multilateral assessment and treatment of voice disorders in speakers with hearing loss.

Background/Aims: Psychological factors have been claimed to play a role in the predisposition for laryngopharyngeal reflux (LPR) symptoms. The aims of this work were to study the relationship between psychological disorders and LPR and to investigate the effect of potential psychological disorders on patients' self-perception of reflux-related problems. Methods: Forty-two patients with symptoms suggestive of LPR were psychologically evaluated using the Social Readjustment Rating Scale, the Symptom Checklist-90 Revised, the Manifest Anxiety Scale of Taylor, the Minnesota Multiphasic Personality Inventory, and the Zung Self-Rating Depression Scale. Oropharyngeal 24-hour pH monitoring was used to diagnose LPR. LPR-related symptoms were assessed using the reflux symptom index (RSI) and the voice handicap index-10 (VHI-10). Patients were divided into groups based on psychiatric evaluation and pH results. Correlations between psychological profile characteristics and LPR-related parameters were also investigated. Results: No significant difference was found between the positive and negative LPR group for any of the assessed psychological disorders. Also, no significant difference was detected between the positive and negative psychological disorder groups regarding RSI, VHI-10, and pH results. Correlations between psychological profile parameters and LPR-related measures were also nonsignificant. Conclusion: It appears that there is no association between psychological disorders and LPR. The psychological background of the LPR patients had no influence on patients' self-perception of their reflux-related problems.

Objective: The aim of this study was to investigate the relationship between acoustic analysis and biopsychosocial implications of voice problems, evaluated by the Voice Handicap Index (VHI). Materials and Methods: The study comprised 120 female teachers with voice disorders, evaluated by videolaryngostroboscopy. 60.8% of this group were diagnosed as having functional dysphonia and 39.2% had dysphonia with benign vocal fold masses (nodules and polyps). The controls consisted of 30 euphonic women. The correlations between VHI and acoustic analysis were assessed in both groups using the Pearson correlation coefficient and regression analysis. Results: In teachers, the total VHI score was over 5 times as high as in controls (p < 0.001). Moreover, in teachers, significant positive correlations were found between the total VHI score and the frequency perturbation parameters and amplitude perturbation parameters when both statistical methods were used. These acoustic parameters also significantly correlated with the score on the functional and emotional subscales, but rarely with the physical subscale of the VHI. Conclusions: The study revealed a significant relationship between the objective voice measurements and the VHI. The results confirmed that VHI can be a valuable tool for assessing biopsychosocial implications of occupational dysphonia and should be incorporated in multidimensional voice evaluation.

Objective: This study focuses on the relation between objective voice quality and the self-perception of a voice handicap. Patients and Methods: The study group consisted of 86 German-speaking patients (51 women, 35 men) suffering from benign dysphonia. The test persons completed the German version of the Voice-Related Quality of Life (V-RQOL) Questionnaire without prior information about their diagnosis and underwent voice analysis with the Dysphonia Severity Index (DSI) being the parameter of this study. Results: No correlation between V-RQOL and DSI could be found (p > 0.05). On the V-RQOL, women scored worse than men, but not at a significant level. Patients with dysphonia of organic origin scored significantly worse than patients with functional dysphonia (p = 0.026). On the DSI, men’s values were significantly lower than women’s (p = 0.001). Organic dysphonia caused significantly lower DSI values than functional dysphonia (p = 0.011). Conclusion: Objective voice quality and the individual perception of voice quality by the patient are independent parameters. Both need to be assessed in clinical practice.

Aims: To investigate the Voice Handicap Index (VHI), the health-related quality of life (HRQL), and the correlations between VHI and HRQL in laryngectomees. Methods: Forty-three laryngectomized persons participated (mean age 68;6 years, time since laryngectomy between 0;6 and 12 years). Evaluation of voice handicap was done with the VHI. HRQL was evaluated with questionnaires from the European Organization for Research and Treatment of Cancer, EORTC QLQ-C30 and EORTC QLQ-H&N35. Results: VHI for the whole group demonstrated a moderate voice handicap, with a mean score of 48/120. The functional scales of EORTC QLQ-C30 resulted in scores on the same level as the normal population with the exception of a lower global quality of life scale (Global QOL). EORTC QLQ-H&N35 revealed problems with smell and taste, speech, coughing, xerostomia, and sexuality. VHI correlated significantly with the Global QOL, the functional scales, dyspnea, pain, nausea and financial difficulties (EORTC QLQ-C30). Significant correlations were also found between VHI and speech problems, social contact, pain from the head and neck area, sense problems, sexuality and social eating (EORTC QLQ-H&N35). Conclusion: The EORTC questionnaires in combination with the VHI questionnaire seem to capture most of the problems following laryngectomy, including voice problems.

The evaluation of diagnostics and therapies includes more and more subjective, i.e. emotional and social aspects. Focussing on the handicap experienced by dysphonic patients, the Voice Handicap Index (VHI) has previously been found to be of significant clinical and scientific value for different voices. In this study the VHI questionnaire was applied to demonstrate the voice handicap of 20 male laryngectomees using tracheoesophageal voice (Provox®), aged 65.5 ± 8.7 years. Their VHI was 45.5 ± 24.1, which was significantly higher than the score of patients with functional voice disorders, but differed only slightly from patients with organic laryngeal dysphonia. Focussing on individual data, VHI scores ranged from values similar to persons without voice disorder to maximum handicap of 101. Comparing the VHI scores with the laryngectomees’ gradual self-perception of voice disorder severity, no consistent relationship was found. Considering the large interindividual differences, the VHI may serve as a valuable instrument for the assessment of individual interventional needs rather than for the identification of a general laryngectomees’ handicap.