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To determine whether there is a correlation between Voice Handicap Index 10 (VHI-10) and degree of vocal fold paresis as determined by laryngeal EMG. Secondary objective was to determine the incidence of vocal fold paresis in a tertiary laryngology practice. A retrospective chart review of all new voice patients seen by the senior author (RTS) from January 1, 2016 to December 31, 2017. Subjects completed VHI at their initial visit. Patients were examined with flexible and rigid laryngoscopy and videostroboscopy and referred for laryngeal electromyography (LEMG) if neuromuscular weakness was suspected. LEMG was used to identify the affected nerves and to quantify subjectively the degree of paresis. Patients who did not complete LEMG and or handicap index were excluded from the correlation analysis. The prevalence of vocal fold paresis was determined by reviewing the records of each subject. The number of patients diagnosed clinically with paresis or paralysis and referred for LEMG was documented. The subjects, who had paresis confirmed on LEMG (n = 210) were grouped according to the nerves involved and by the degree of paresis. The unilateral superior laryngeal nerve and ipsilateral recurrent laryngeal nerve paresis group (n = 29) had a reasonably even distribution of patients in each sub-group (n = 11; 12; 6) and was analyzed for correlation. There was a strong positive correlation between the degree of paresis and the VHI score (r = 0.59, P < 0.001). Other groups did not have an even distribution among sub-groups and could not be to be analyzed for correlation. The senior author examined 344 new voice patients during years of 2016 and 2017. Based on laryngoscopy, 335 patients were referred for LEMG (97.4%). Two hundred thirty-seven patients had LEMG performed, and 234 patients confirmed to have vocal fold paresis were confirmed (98.7%.). The incidence of vocal fold paresis in subjects who underwent LEMG or who had normal motion during laryngoscopy was 95.1% (234 out of 246). The incidence in the 98 subjects who did not complete the recommended LEMG is unknown. The unilateral superior laryngeal nerve with ipsilateral recurrent laryngeal nerve paresis was the only group that allowed for analysis whether patient's perception of their voice problem as measured VHI-10 correlated with increasing degree of vocal fold paresis. A strong significant positive correlation in this group was identified. Additional studies with a larger patient cohort are recommended. [ABSTRACT FROM AUTHOR]

Benign vocal fold lesions affect the vibratory function of the vocal folds and cause dysphonia. Surgical excision has been the mainstay of management of benign vocal fold lesions for decades. This study compares the surgical outcomes of cold instruments versus carbon dioxide (CO2) laser excision of benign vocal fold lesions. A total of 49 cases diagnosed with benign vocal fold lesions were divided randomly to undergo excision either by conventional cold steel method or by CO2 laser. The postoperative assessment of the groups was done by videostroboscopy, acoustic analysis and voice handicap index. There was a significant improvement (P value < 0.05) when preoperative values of the parameters were compared with postoperative values in the individual groups. However, there was no significant difference when the two groups were compared with each other in terms of outcomes. Both the surgical techniques provide good outcomes in management of benign vocal fold lesions and each has its own advantages and disadvantages. [ABSTRACT FROM AUTHOR]

Office based Injection Laryngoplasty has become a common and feasible method of addressing vocal fold insufficiency (VFI) resulting from a plethora of aetiologies. Contemporary to various injectates, Calcium Hydroxylapatite has met with great success across usage with various techniques. But, irrespective of the technique and injectate material, the burning question in mind of "realistic" clientele remains, "How soon will I have by voice back?". Aim of this study is to evaluate the short term (3 months postoperative) effects of Injection Laryngoplasty in cases of VFI using Calcium Hydroxylapatite via trans cricothyroid route, in terms of both objective and subjective parameters. 12 patients with mean age of 35.67 years underwent vocal fold injections (via transnasal flexible fibreoptic laryngoscopic guided trans-cricothyroid membrane approach using CaHA) for VFI. The pre injection and 1, 2- and 3-months post injection scores' changes in outcome measures in form of videostroboscopic parameters, Voice Handicap Index scores and acoustic analysis were compiled and analysed. 91.6% of patients showed statistically significant benefit after 3 months post injection. 0.1% patients showed loss of benefit of the CaHA material even 3 months post injection. Average length of benefit was 1-month post injection. No significant complication was observed in any patient. We conclude that the objective evidence of structural and functional improvement may be seen immediately post injection laryngoplasty, minimum of 3 months is required for evident improvement in patient's perception of his own voice in terms of Quality of Life parameters. [ABSTRACT FROM AUTHOR]

Teaching voice is the professional voice; often different in quality from our day-to-day speaking voice, and is supposed to be subjected to vocal abuse, misuse and overuse. This paper aims towards highlighting the various classroom determinants that may impact teacher's voice and how these impacts can affect the daily activities in terms of functional emotional and psychosocial aspects. To understand the same, a cross sectional prospective study was conducted across eight English medium institutions of Indore (a city in central India) region. The study was carried out in three phases: formulation of a questionnaire, data collection (through administration of the questionnaire and VHI among sixty school teachers) followed by data analysis, to determine whether any association exists between the various classroom determinants and voice impairment. Significant association was found between determinants like teaching experience; number of classes, duration of breaks, use of any alternate method of teaching and alternate use of any amplification device with physical, emotional and functional aspects of life. The findings holistically indicate that various factors within the classroom environment only has a significant bearing on the voice disturbances of a school teacher's life thus deteriorating their quality of life. Thus it is substantial to begin a training programme by speech language pathologists in order to heighten awareness among teachers. After all voice disturbances are a real and treatable condition and with the right amount of training can be avoided. [ABSTRACT FROM AUTHOR]

Benign vocal cord lesion is a benign mass formed in vocal cord in form of vocul nodule, vocal cord polyp, vocal cord cyst and vocal cord granuloma. Voice handicap index (VHI) is one of subjective voice analyses. This study aimed to analyse correlation between VHI score and praat voice analysis in benign vocal cord lesion before and after microscopic laryngeal surgery. This study was carried out from November 2009 to December 2010 at Outpatient Unit of Otorhinolaryngology, Head and Neck Surgery and Integrated Oncology Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. Pearson's correlation test found a negative correlation between total VHI score with base frequency and harmonic-to-noise ratio (HNR) (r = − 0.186, p = 0.689; r = − 0.650, p = 0.114). On the other hand, there was a positive correlation between total VHI score with jitter and shimmer (r = 0.812, p = 0.027; r = 0.638, p = 0.123). It could be inferred that base frequency, shimmer and HNR after surgery had no significant correlation (p > 0.05), while VHI total score significantly correlated with jitter after surgery (p < 0.05). We found no correlation between VHI score and Praat voice analysis in patients with benign vocal cord lesion before and after surgery, except correlation between VHI functional subscale with HNR and VHI total score with jitter. [ABSTRACT FROM AUTHOR]

Voice disorders have been estimated to be present in between 3 and 9% of general population. Sports children have vocal abusive behavior i.e. the extra effort which they put on their voice while playing, leading to voice disorders. It is imperative to find out the voice characteristics of children involved in sports activity. To assess voice characteristics of school aged children, who are active participants in a basket ball team. A group of twenty children (13 males and 7 females) were included in the study. He or she was member of school basket ball team and had participated in many events. The perceptual voice assessment was conducted using GRBAS scale, Buffalo III Voice Profile and Voice Handicap Index (VHI). Findings on GRBAS voice rating scale—In the first parameter i.e. grade 46.7% of the subjects reported slight hoarse component. In the second parameter i.e. Roughness 46.7% of the subjects showed slight roughness component. In another parameter i.e. the asthenia 20% % of the subjects reported slight asthenia component in their voice. In the next parameter i.e. strain in the voice, 26.7% of the subjects showed slight strain component in their voice. Finding on BUFFALO III voice screening profile—In the laryngeal tone, 46.7% of the subjects showed mild hoarse component. Findings on voice handicap index (VHI)—28% of the subjects had functional symptoms of voice problems. 43% of the subjects had some physical symptoms while 28% had affected emotional component. Present study is first of its kind to focus on voice disorders among school going children who are members of a basket ball team. During sport events players tend to scream in order to communicate among their team mates, to show their aggressiveness to their opponents and to show excitement of win or frustration of the lost match leading to various voice problems. There is a high probability of occurrence of voice disorders among children who are active participants of basket ball. Proper counselling of these children is required for preventive measures and to seek voice therapy when required. [ABSTRACT FROM AUTHOR]

To determine pre and postoperative vocal fold vibratory changes using videostroboscopy (VS) and effect of surgery on functional, physical and emotional levels of voice using voice handicap index (VHI). To determine correlation between VHI and VS in patients with benign vocal fold pathology. This is a prospective study done at Pushpagiri Medical College. 40 patients in the age group of 14–75 years who presented with complaints of voice change were included. VS and VHI of patients done preoperatively in 40 patients. Patients were re-evaluated postoperatively at 1 month by VHI and VS. All patients underwent microlaryngoscopic excision of the benign vocal cord lesion with biopsy under GA in the conventional manner. One month postoperatively, these patients were evaluated by VS and VHI and the findings noted. There was statistically significant improvement in the stroboscopy ratings and VHI scores post operatively (p < 0.0001). The mucosal wave was diminished or absent in 100% of the studied TVC cysts and present in approximately 60% of vocal polyps. There was no significant correlation found between preoperative VHI scores and stroboscopy ratings except for mucosal waves. Whereas there was significant correlation noted between the VHI subscales and total scores with stroboscopic scores postoperatively except for symmetry. All but 6 patients in this study benefitted from surgery and 85% had a normal voice post-operatively. Pre and post operative assessment of patients with benign vocal fold lesions by stroboscopy and VHI is a useful way to determine the degree of improvement following surgery. [ABSTRACT FROM AUTHOR]

Benign vocal cord mass lesions are common causes of dysphonia which are often surgically correctable. They include lesions like vocal polyps, vocal cysts, vocal nodules and Reinke's edema. A prospective study of 30 patients was carried out at SMS medical college and hospital between April 2014 to November 2015 after institutional ethical committee clearance. The purpose of our study was to evaluate outcome of microlaryngeal surgery for benign lesions of vocal cord using videostroboscopy and voice handicap index. All cases between the age group 15–60 years with clinical evidence of benign lesions of vocal cord were included in study. Preoperative amplitude, mucosal wave, glottic closure was seen by videostroboscopy and subjective assessment of severity of handicap in voice was assessed by set of questionnaire using voice handicap index (Jacobson et al. in Am J Speech Lang Pathol 6: 66–70, 1997). Postoperative follow up was done at 3rd week and 10th week, and outcome of microlaryngeal surgery was assessed using videostroboscope and voice handicap index. At the end of study data was compiled systemically and analysed using paired 't' test and Chi square test. Our study observed statistically significant improvement in amplitude and mucosal wave and glottic closure. Subjective improvement in perception of severity of handicap in voice was analysed by voice handicap index which shows statistically significant data. Overall our study conclude microlaryngeal surgery as an effective way for improvement in speech parameters, that can be assessed by use of videostroboscopy and voice handicap index. [ABSTRACT FROM AUTHOR]

We aimed to assess psychometric properties, including internal consistency, reliability, and clinical validity of the Danish version of the Voice Handicap Index (VHI). A cross-sectional survey study was carried out. For validation, the existing nonvalidated Danish version of the VHI was used. Data from 208 patients with voice disorders of different etiology (neurogenic, functional, and structural) and a control group of 85 vocally healthy individuals were included. A test-retest reliability analysis of 42 patients and 45 control persons was performed. The internal consistency, test-retest reliability, and clinical validity of the questionnaire were assessed. Internal consistency was high with a Cronbach α >0.90 for both the patient and control group. Test-retest reliability measured as intraclass correlation coefficient was good with 0.93 (95% confidence interval [95% confidence interval]: 0.87–0.96) for patients and 0.78 (95% confidence interval: 0.63–0.87) for the control group which indicates sufficient reliability of the questionnaire. The Danish VHI has good clinical validity as it has a strong correlation between patient's perception of the severity of their voice disorder and the VHI score from the Spearman correlation of 0.69. The existing Danish version of the VHI has been thoroughly validated and found to be in line with the original VHI from Jacobsen et al. It showed good internal consistency, test-retest reliability, and clinical validity. It is suitable for use in daily practice and in research projects as it is able to assess patients' perception of their voice disorder severity. [ABSTRACT FROM AUTHOR]

Summary Objectives Acute phonotrauma is the result of sound production by shouting or straining one's voice. In this study, we aimed to investigate the acute changes in the vocal folds and voices of soccer fans who voluntarily applied to our clinic after the soccer match where they engaged in acute phonotrauma. There are no other studies in the literature conducted on a similar sample group. Study design This is a case-control study. Methods Videolaryngostroboscopic (VLS) examination, acoustic voice analysis, and Voice Handicap Index (VHI) questionnaire were performed on 29 voluntary soccer fans included to the study before the match and at the first hour after the match. The values obtained were compared statistically with each other and with 29 control groups without voice pathology. Results The jitter, shimmer, and normalized noise energy values measured after the match increased significantly statistically compared with the pre-match level, but harmonic noise ratio value decreased significantly (P < 0.05). VHI scores increased significantly after the match according to the pre-match scores (P < 0.05). In the VLS examinations, there was no difference in the images before and after the match. Conclusions It has been concluded that people who are using their voices loudly and intensely by shouting during the match are exposed to sound changes after the match, and if this situation becomes persistent, it may cause permanent voice pathologies. It is thought that VHI and acoustic voice analysis should be done together with VLS for diagnosis and follow-up of voice changes for which the VLS examination alone is not sufficient. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Voice quality has emerged as an additional long-term outcome measure for patients with a history of airway surgery. The goal of this study was to evaluate the impact of preoperative voice assessment on the surgical management of patients who required complex airway surgery.Study Design: Retrospective case series.Methods: We analyzed clinical data for all patients who underwent an airway reconstruction procedure from September 1, 2012 to September 1, 2017 and had a voice clinic evaluation prior to surgery at a tertiary-care pediatric hospital. Each participant underwent a full clinical voice evaluation that yielded acoustic, imaging, perceptual, and handicapping index data.Results: Six hundred forty-three patients underwent 831 airway surgeries (laryngotracheoplasty, cricotracheal resection, slide tracheoplasty, laryngeal cleft repair). Ninety-one (14.2%) of the 643 patients underwent a formal voice clinic evaluation prior to airway surgery; 39/91 (42.9%) were female. The mean age was 10.4 years (95% confidence interval [CI]: 9.2-11.6) with 31/91 (32.9%) participants demonstrating vocal fold immobility and 33/91 (36.3%) vocal fold hypomobility. A voice clinic evaluation provided new information for 62/91 (68.1%) patients, mainly for laryngeal dynamic components (vocal fold motion, source of phonation, arytenoid prolapse) and confirmed suspected disorders for the remaining patients. The average baseline Pediatric Voice Handicap Index overall score was 38.9 (95% CI: 33.3-44.5), and the average overall severity rating of the Consensus Auditory-Perceptual Evaluation of Voice was 54 (95% CI: 45.2-62.8). A voice clinic evaluation influenced management of 56/91 (61.5%) patients either by modification of the surgical plan (26/56, 46%) and/or adjusting voice therapy (21/56, 37.5%).Conclusions: Voice evaluation prior to airway reconstruction provided key information that influenced the management for most of the patients. Formal voice evaluation should be considered prior to complex airway surgery.Level Of Evidence: 4 Laryngoscope, 128:2858-2863, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Voice therapy (VT) is essential to the successful management of voice disorders. Despite this, two-thirds of patients drop out of therapy before completion. In this study we examine whether responses to specific question items or domains from the Voice Handicap Index (VHI) are associated with VT compliance.Study Design: Single-institution retrospective cohort study.Methods: All patients presented to a tertiary care center between January 2011 and June 2016 with dysphonia. Patients were excluded if seen by speech language pathology (SLP) for preoperative assessment only, there was no order for therapy, or there was no documentation of therapy performed at outside facilities. Data collected included VHI responses, demographics, diagnosis, social history, and clinical exam. Patients were divided into three groups for analysis: 1) did not attend therapy, 2) partially completed therapy, or 3) completed therapy.Results: Of 489 patients referred for VT, 36.2% did not attend, 36.0% partially completed VT, and 27.8% completed VT. Patients who did not attend had significantly lower scores in VHI, VHI-10, and each of the VHI domains. There was a significant difference in age between VT groups, with those electing to not attend representing older age. Patients who attended VT were more likely to use their voice for work (P = .015). There were statistically significant differences among the groups for six VHI question items.Conclusions: Understanding patient motivations, whether a patient uses their voice for work, and specific responses to the VHI questionnaire may allow clinicians to better understand patient engagement in voice therapy.Level Of Evidence: 4 Laryngoscope, 128:2832-2837, 2018. [ABSTRACT FROM AUTHOR]

Chronic tonsillitis contributes to the functional dysphonia emergence and voice acoustic characteristics deterioration. The study of larynx functional state in 42 occupational voice users with a compensated form of chronic tonsillitis included videolaryngostroboscopy, acoustic analysis of the voice using the "LingWaves Voice Program", and the Voice Handicap Index. After the washing course of palatine tonsil lacunas, the positive dynamics of the average values of the vibratory insufficiency index from 1.8 to 1.4 points (in patients with hypotonic dysphonia) and the dysphonia severity index from 3.2 to 4.3 points were noted. The tonal range of the speech voice has expanded by 5 semitones, and the vocal voice - by 3.5 semitones. The results of assessing the state of the voice apparatus using the Voice Handicap Index questionnaire showed a reliable positive tendency in all the criteria of the questionnaire. The duration of "S" and "Z" increased significantly, by 3.3 and 6.3 seconds, respectively. The frequency and dynamic ranges of spoken text increased by 1 semitone and 1 dB, respectively. The Maximum phonation time showed a positive tendency, having increased by 3.9 seconds, and jitter decreased by 0.05%. The irregularity coefficient of the vocal fold closure showed positive trend of 6% - from 0.83 to 0.78 according to the index. 42 patients underwent videolaryngostroboscopy, only in 8 (19%) patients no changes in the larynx were detected; in the remaining 34 the existing pathological changes were distributed among the nosological forms as follows: functional dysphonia was noted in 26 (61.9%) patients, of them, 2 patients (4.7%) had hypo-hypertonic dysphonia and in 24 (57.1%) hypotonic dysphonia; chronic laryngitis occurred in 8 (19%) patients. Chronic tonsillitis should be considered as one of the reasons for the functional dysphonia development. Sanitation of palatine tonsils lacunae improves the vocal functional state, which is confirmed by the results of acoustic analysis of the voice, videolaryngostroboscopy and Voice Handicap Index questionnaire. [ABSTRACT FROM AUTHOR]

Kelelahan bersuara akibat lingkungan kerja merupakan kombinasi dari efek vokasional, personalitas dan faktor biologi. Faktor biologi yang dimaksud adalah semua faktor yang dapat menyebabkan gangguan pada mukosa pita suara seperti merokok, minum alkohol, kafein, sinusitis, penyakit alergi dan Gastroesophageal Refluks Disease (GERD). Reaksi alergi dan infeksi saluran napas atas menyebabkan suara menjadi serak. Penelitian ini bertujuan untuk mengetahui pengaruh rinitis alergi terhadap kualitas bersuara. Penelitian analitik observasional dengan desain kohort retrospektif. Subjek penelitian ini adalah 64 mahasiswa Program Studi Pendidikan Dokter FKIK UMY yang sesuai dengan kriteria inklusi dan eksklusi. Instrumen penelitian ini menggunakan Voice Handicap Index dan kuesioner rinitis alergi yang sudah tervalidasi. Hasil uji Chi-square menunjukkan adanya hubungan antara variabel rinitis alergi dengan kelelahan bersuara secara signifikan (p 0,05). Selanjutnya uji regresi nominal didapatkan penderita rinitis alergi memiliki kecenderungan 6,9 kali lebih besar mendapatkan kelelahan bersuara dibandingkan yang tidak menderita rinitis alergi (RR=6.9). Hasil uji regresi logistik terdapat pengaruh konsumsi kafein terhadap kelelahan bersuara (p 0.05). Rinitis alergi yang berlangsung lama dapat berpengaruh pada viskoelastisitas pita suara sehingga terdapat pengaruh rinitis alergi terhadap kelelahan bersuara dibandingkan seseorang yang normal atau tidak mempunyai rinitis alergi, meskipun faktor penggunaan suara, penggunaan kafein, dan faktor lingkungan atau perilaku masih harus dipertimbangkan. Voice fatigue due to work environment is a combination of vocational, personality and biological factors. Biological factors are all factors that may cause vocal cord mucosa such as smoking, drinking alcohol, caffeine, sinusitis, allergic diseases, and Gastroesophageal Reflux Disease (GERD). Allergic reactions and upper respiratory infections cause a hoarse voice. This research aim to know influence of allergic rhinitis on quality of voice. Research used observational analytic with a retrospective cohort design. The subjects were 64 students of Medical Study Programme FKIK UMY accordance with the inclusion and exclusion criteria. The research instrument were Voice Handicap Index and allergic rhinitis questionnaire that has been validated. Chi-square test results showed there was an association between allergic rhinitis variables with voice fatigue significantly (p 0.05). Furthermore, nominal regression showed allergic rhinitis had a tendency 6,9 times more likely to get voice fatigue than non suffered allergic rhinitis (RR = 6.9). Results of logistic regression there is the influence of caffeine consumption on voice fatigue (p 0.05). Prolonged allergic rhinitis can affect the viscoelastic vocal cords so it was concluded that there was an effect of allergic rhinitis to voice fatigue of Medical students at universitas Muhammadiyah Yogyakarta. Although the factor of use of voice, use of caffeine, and environmental or behavioral factors still should be considered.

Objectives: To determine cut-off values of the Voice Handicap Index (VHI) and the shortened version (VHI-10) for European Portuguese (EP) with voice disorders. In addition, to analyze the discriminatory power of individual items of the VHI-10 and the ability to detect differences in various Ear Nose and Throat (ENT) diagnoses., Study Design: Cross-sectional cohort study., Methods: All participants completed the EP VHI and a 4-point self-assessment of voice disorder severity. The case group (subjects with voice disorders) underwent assessment through strobovideolaryngoscopy examinations by ENT surgeons and perceptual analyses by speech-language pathologists (SLPs). In contrast, the control group was evaluated solely by SLPs. Data were analyzed using a receiver-operating characteristic curve to determine the accuracy and cut-off values of the VHI and VHI-10., Results: The study involved a sample of 350 adults (171 cases and 179 controls), predominantly women aged 18-88 years. The area under curve (AUC) for VHI and VHI-10 was 0.997 [95% confidence interval (CI): 0.992-1] and 0.998 [95% CI: 0.995-0.999], respectively. Optimal cut-off values were identified as 13.5 for VHI (0.994 sensitivity and 0.989 specificity) and 5.5 for VHI-10 (0.977 sensitivity and 0.955 specificity). Each individual item within the VHI-10 significantly contributed to the overall assessment, exhibiting varying discriminatory power ranging from excellent (AUC = 0.937) to poor (AUC = 0.637). Significant differences were found in the case group between neurogenic disorders and healthy larynx (P = 0.014), structural and physiologic minor laryngeal abnormalities (P = 0.006), and inflammatory disorders (P = 0.043)., Conclusions: The VHI and the VHI-10 exhibited accurate screening properties for predicting EP speakers with voice disorders., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To analyze the internal consistency of the Voice Handicap Index (VHI) for evaluating the vocal handicap of individuals with dysphonia., Methods: This is a systematic review. Studies with a cross-sectional design and including a population of individuals with dysphonia, which validated the VHI and analyzed its internal consistency, were included. The following electronic databases were searched: Cochrane Library, EMBASE, LILACS, and PubMed, including Medline, Scopus, and Web of Science. A manual search was performed in gray literature through the Biblioteca Digital Brasileira de Teses e Dissertações and ProQuest Dissertation & Theses. In addition, the list of references of studies selected in the electronic search was mapped, and an expert in the area was consulted. Two reviewers blindly and independently conducted the selection, data extraction, and analysis of the risk of bias, the certainty of the evidence, and good psychometric measures. A meta-analysis was performed with a random effects model using the JAMOVI 2.3.2 software., Results: Forty-nine studies were analyzed. In risk of bias assessment, the studies were classified as having inadequate structural validity and very good internal consistency. The analysis of good psychometric properties indicated indeterminate structural validity and insufficient internal consistency. The overall value of Cronbach's alpha was estimated at 0.94, thus suggesting a very good internal consistency. However, there was high heterogeneity. The level of certainty of the evidence was too low for internal consistency., Conclusion: The VHI proved to be a consistent and reliable patient-reported outcome measure to evaluate voice handicap in individuals with dysphonia; however, studies are heterogeneous, and the certainty of evidence is very low., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Healthcare workers have been identified as being at risk of occupational voice disorders. Among them, nurses working in intensive care units (ICUs) are particularly vulnerable due to the risk factors that are associated with their exposure to high levels of noise. Thus, this study aimed to determine the prevalence of voice disorders among ICU nurses., Methods: A questionnaire was administered to 100 ICU nurses from four hospitals in China. The questionnaire assessed vocal-related symptoms, perceived voice handicap, frequently heard noise sources, and the quality of communications., Results: Results indicate that the most frequently reported voice symptoms were 'voice tiredness' and 'voiceless'. Nurses working more than 50 h per week experienced voice symptoms more frequently than nurses working for 40-50 h per week. The median value of the perceived voice handicap score (VHI-30) was 23, indicating mild voice handicap, while 24% of the nurses reported severe voice handicap. Longer working hours and working at patient wards were significantly associated with higher VHI-30 scores. The nurses also reported that the quality of verbal communication with patients and colleagues and voice problems worsened during the COVID-19 pandemic., Conclusion: More than 20% of nurses reported severe voice handicap, however, voice handicap among ICU nurses did not appear universally to all nurses. Further research is necessary to identify the risk factors associated with voice disorders and the mechanism behind such heterogeneity among ICU nurses., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Song, Lee and Jung.)

Background: In our experience Allergic Rhinitis (AR) patients suffer from voice problems more than health subjects. Aims: To investigate the acoustic analysis of voice, stroscopic findings of larynx and Voice Handicap Index scores in allergic rhinitis patients compared with healthy controls. Study Design: Case-control study. Methods: Thirty adult patients diagnosed with perennial allergic rhinitis were compared with 30 age- and sex-matched healthy controls without allergy. All assessments were performed in the speech physiology laboratory and the testing sequence was as follows: 1. Voice Handicap Index (VHI) questionnaire, 2. Laryngovideostroboscopy, 3. Acoustic analyses. Results: No difference was observed between the allergic rhinitis and control groups regarding mean Maximum Phonation Time (MPT) values, Fo values, and stroboscopic assessment (p>0.05). On the other hand, mean VHI score (p=0.001) and s/z ratio (p=0.011) were significantly higher in the allergic rhinitis group than in controls. Conclusion: Our findings suggest that the presence of allergies could have effects on laryngeal dysfunction and voice-related quality of life.

Aim: Nose is a resonator organ in production of voice. The aim of this study was to evaluate the effects of nasal obstruction caused by nasal polyposis on voice quality subjectively. Methods: Thirty-six patients diagnosed with nasal polyposis were included in the study. The 30-item voice handicap index 30 was used in order to evaluate subjective status of voice. Nasal endoscopy and computed tomography imaging of the paranasal sinuses were performed for each patient. Lund-Kennedy endoscopy scores and Lund-MacKay computed tomography scores were evaluated. Control group composed of 20 healthy subjects. Results: The mean voice handicap score in the patient group was 43.16 (SD 15.53) and it was 2.15 (SD 1.92) in control group. There was a statistically significant difference between the groups (p=0.001). The mean Lund-Kennedy and Lund-Mackay scores were 8.58 (SD 2.5) and 17 (SD 5.52), respectively. It was found that increased severity of nasal polyposis was the cause for decreased satisfaction with voice quality. Conclusion: Nasal obstruction caused by nasal polyposis affects voice quality adversely and as the severity of nasal polyposis increases, satisfaction with voice quality decreases.

Background: Sulcus vocalis (SV) is characterized by the appearance of a groove and fibrotic changes in the vocal fold mucosa and an often irrevocable loss of tissue viscoelasticity and vibratory potential. Although several surgical approaches have been proposed, none are ideal treatments. Basic fibroblast growth factor (bFGF) may stimulate fibroblasts in the superficial layer of the lamina propria (SLP) and increase the vibration of vocal fold mucosa. Aims/objectives: The aim of this study was to evaluate the safety and short-term outcomes of bFGF injection for SV. Materials and methods: This study was registered with the University Hospital Medical Information Network-Clinical Trials Registry (UMIN000019347). Twelve cases of pathological SV were treated using a method involving bFGF injection. The treatment regimen involved the injection of 50 µg of bFGF into the SLP. More than 3 months after the injection, aerodynamic and acoustic outcomes were examined. Results: No adverse events were recorded. Significant improvements were observed in the maximum phonation time (MPT) and Voice Handicap Index (VHI) after treatment. Multiple injections achieved additional effects. Conclusions and significance: bFGF injection may be a safe and suitable office-based surgery for the alleviation of hoarseness caused by SV based on this preliminary short-term study. [ABSTRACT FROM AUTHOR]

Summary Objective This study aimed to examine the relationships among patient occupation, laryngeal diagnosis, perceptual dysphonia severity, and patient-perceived voice impairment. Methods Adult patients presenting with a chief complaint of dysphonia over a 20-month period at a tertiary care, interdisciplinary voice center were included in this retrospective cohort study. Patients were categorized by profession: vocal performers, high occupational voice demand, low or no occupational voice demand, and retired. Associations between professional voice demand and clinician rating of dysphonia severity using the "Grade" score from the Grade, Roughness, Breathiness, Asthenia, and Strain scale and patient ratings of voice impairment using the Voice Handicap Index-10 (VHI-10) were tested using standard descriptive statistical methods. Results One hundred and sixty-three patients with a presenting complaint of dysphonia were evaluated. Significant associations were found on univariate and multivariable analysis among a patient's occupational voice demand, Grade, Roughness, Breathiness, Asthenia, and Strain grade, and VHI-10 score (P = 0.007 and P < 0.001, respectively). Patients subject to greater vocal demands as a result of their occupation had a greater perception of impairment, regardless of acoustic-perceptual severity, when compared with those with low or no occupational voice demand. Although voice diagnosis was significantly associated with VHI-10 score on univariate analysis, it failed to reach significance on multivariable analysis. Demographic measures such as gender and age also did not correlate with perceived vocal impairment. Conclusion Patient-perception of voice impairment is influenced by occupational demand, independent of acoustic-perceptual dysphonia. Performers and people with high occupational voice needs demonstrate a unique sensitivity to subtle voice changes. [ABSTRACT FROM AUTHOR]

Summary Voice performance is an inextricable key factor of everyday life. Obviously, the deterioration of voice quality can cause various problems to human communication and can therefore reduce the performance of social skills (relevant to voice). The deterioration could be originated from changes inside the system of the vocal tract and larynx. Various prognostic methods exist, and among them is the Voice Handicap Index (VHI). This tool includes self-reported questionnaires, used for determining the cutoff points of total score and of its three domains relevant to young male Greek smokers. The interpretation of the calculated cutoff points can serve as a strong indicator of imminent or future evaluation by a clinician. Consistent with previous calculation, the VHI can also act as a feedback for smokers' voice condition and as monitoring procedure toward smoking cessation. Specifically, the sample consisted of 130 male nondysphonic smokers (aged 18–33 years) who all participated in the VHI test procedure. The test results (through receiver operating characteristic analysis) concluded to a total cutoff point score of 19.50 (sensitivity: 0.838, 1-specificity: 0). Also, in terms of constructs, the Functional domain was equal to 7.50 (sensitivity: 0.676, 1-specificity: 0.032), the Physical domain was equal to 7.50 (sensitivity: 0.706, 1-specificity: 0.032), and the Emotional domain was equal to 6.50 (sensitivity: 0.809, 1-specificity: 0.048). [ABSTRACT FROM AUTHOR]

Introduction: Use of patient-based voice assessment scales is an appropriate method that is frequently used to demonstrate effectiveness of voice therapy. This study was aimed at determining the effectiveness of voice therapy among patients with secondary muscle tension dysphonia (MTD) and vocal mass lesions. Materials and Methods: The study design was prospective, with within-participant repeated measures. Thirty-three patients with secondary MTD and vocal mass lesions participated in the study, selected on the basis of voice history, laryngeal palpation, and videostroboscopy examination. An experienced otolaryngologist and one experienced speech language pathologist undertook the diagnostic process. Voice therapy included both direct and indirect techniques and lasted approximately 2 months for all included patients. The voice handicap index (VHI) was used to evaluate the effectiveness of voice therapy among included patients. Paired t-test, size of the standardized effect (ESI), and mean standardized response (ESII) were used to analyze effectiveness of the target voice therapy. Results: The findings of this study indicate a statistically significant improvement after the voice therapy protocol (P<0.05; t>1.96). Results of ESI and ESII demonstrate that the VHI scale is sufficiently responsive to detect voice therapy change (ES>0.8). Conclusion: This study recommends a combination of direct and indirect voice therapy in the vocal rehabilitation of patients with secondary MTD and vocal mass lesions. Furthermore, we recommend use of the VHI scale to show voice therapy changes for both clinical and research purposes. [ABSTRACT FROM AUTHOR]

Summary Objectives The Voice Symptom Scale (VoiSS) questionnaire is a self-reported measure of voice function. Compared with previous voice-rating tools, the VoiSS focuses more on communication difficulties, pharyngeal symptoms, and psychosocial distress. This study aimed to translate the VoiSS into the Korean language, validate it, and assess its reliability. Study Design This is a prospective patient study utilizing questionnaires and acoustic analysis. Methods A recognized methodology was used to translate the questionnaires. The final Korean version was used in 31 patients scheduled for thyroidectomy between November 2013 and February 2015 for preoperative voice assessment, and at 2 weeks, 3 months, and 6 months postoperatively. The participants included had no specific vocal disorders before surgery and no vocal cord paralysis after surgery, and completed the Korean versions of the VoiSS and Voice Handicap Index (VHI), and acoustic analysis. Results The Korean version of the VoiSS demonstrated high internal consistency (α = 0.97) and test-retest reliability of its subscales. There was a significant correlation between the VoiSS and VHI scores in the total thyroidectomy group at each time-point. With regard to subjective symptoms, the VoiSS appeared to be more accurate than the VHI in terms of physical and functional subscales. Conclusions The Korean version of the VoiSS is ready for use for the assessment of voice dysfunction in Korean patients. It is an applicable and useful supplementary tool for evaluating patients' perceptions of voice dysfunction after thyroidectomy, for identifying multiple factors affecting patients' voices, and for measuring treatment efficacy before and after therapeutic intervention. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the reliability and validity of the Chinese version of pediatric voice handicap index (pVHI). Material and methods The original English version-pVHI was translated into Chinese. Parents of 52 children with voice dysphonia and 43 children with no history or symptoms of voice problems were asked to fill the Chinese pVHI questionnaires twice with an interval of 2 weeks. GRB (Grade, Roughness, Breathiness) scale was used for perceptual assessment by two otolaryngologists and one speech pathologist for each child's voice. The internal consistency was assessed using Cronbach's alpha coefficient. Pearson's correlation coefficient was used to evaluate the test-retest reliability. The Kendall's coefficient of concordance W was used to assess the consistency of GRB scores of 3 voice specialists. The nonparametric Mann-Whitney test was used to assess the differences between the dysphonia group and controls. The correlation between pVHI and GRB scores were assessed using Pearson's correlation coefficient. Results The internal consistency of total score and three subscales scores of Chinese pVHI were 0.788–0.944. The test-retest reliability was 0.631–0.887( P  < .001). The pVHI scores of control group significantly were lower than the pathological group ( P  = .000). The GRB scores of 3 voice specialists have an excellent consistency (W = 0.694–0.807, P  = .000). The pVHI scores positively correlated with GRB assessment ( P  < .01). Conclusions The Chinese version of pVHI had a good reliability and validity. It can be applicable and useful supplementary tool for evaluating parents' perception of their children's dysphonia. [ABSTRACT FROM AUTHOR]

Summary The relationship between smoking and alterations of the vocal tract and larynx is well known. This pathology leads to the degradation of voice performance in daily living. Multiple assessment methods of vocal tract and larynx have been developed, and in recent years they were enriched with self-reported questionnaires such as Voice Handicap Index (VHI). This study determined the cutoff points of VHI's total score and its three domains for young female smokers in Greece. These estimated cutoff points could be used by voice specialists as an indicator for further clinical evaluation (foreseeing a potential risk of developing a vocal symptom because of smoking habits). A sample of 120 female nondysphonic smokers (aged 18–31) was recruited. Participants filled out the VHI and Voice Evaluation Form. VHI's cutoff point of total score was calculated at the value of 19.50 (sensitivity: 0.780, 1-specificity: 0.133). Specifically, the construct domain of functional was 7.50 (sensitivity: 0.900, 1-specificity: 0.217), for physical it was 8.50 (sensitivity: 0.867, 1-specificity: 0.483), and for emotional it was 7.50 (sensitivity: 0.833, 1-specificity: 0.200) through the use of receiver operating characteristic. Furthermore, VHI could be used as a monitoring tool for smokers and as a feedback for smoking cessation. [ABSTRACT FROM AUTHOR]