Normative Values for the Children Voice Handicap Index-10 (CVHI-10) and for the Children Voice Handicap Index-10 for Parents (CVHI-10-P).

OBJECTIVES: The objective of this study was to establish normative data and cut-off scores for the Children Voice Handicap Index-10 (CVHI-10) and the Children Voice Handicap Index-10 for Parents (CVHI-10-P) METHODS: For normative data, CVHI-10 and CVHI-10-P questionnaires originally developed in the Italian language were completed by 201 children without dysphonia and with no history of voice disorders, and by 1 of their parents. The results were analyzed for mean, standard deviation (SD), and standard error of the mean (SEM) for both questionnaires. For cut-off values determination, data from 49 dysphonic children and from 1 of their parents were also used. This analysis was based on the sensitivity and specificity indicators of the questionnaires using the "receiver operating characteristic" (ROC) curve. RESULTS: Analysis of the questionnaires related to healthy children revealed a mean of 0.26 (SD 0.74; SEM 0.06) for CVHI-10 and a mean of 0.15 (SD 0.49; SEM 0.04) for CVHI-10-P for the normative values. ROC curve analysis allowed us to establish the cut-off scores of 2.5 for CVHI-10 and 1.5 for CVHI-10-P. CONCLUSIONS: This study offers normative data for CVHI-10 and CVHI-10-P and provides cut-off values for both questionnaires to distinguish healthy and pathologic responders.

Adaptation and Validation of the Persian Version of the Voice Handicap Index-10 (VHI-10).

OBJECTIVES: Voice disorders can profoundly impact health, quality of life, job performance, and social interactions. Traditional evaluations have expanded to include quality-of-life assessments, emphasizing self-reported outcomes. The Voice Handicap Index (VHI) stands out among relevant questionnaires, with the VHI-10 being a concise derivative. This study was conducted to translate and validate the Voice Handicap Index-10 (VHI-10) questionnaire for Persian speakers, enhancing clinical assessments of voice disorders and quality of life. METHODS: This cross-sectional study, conducted in Iran, involved (1) translating the VHI-10 into Persian, (2) confirming face and content validity using Content Validity Ratio (CVR), and Content Validity Index (CVI), and (3) evaluating its reliability through a survey. A panel of experts confirmed the validity, and reliability of the study, which was assessed using Cronbach's alpha, Spearman-Brown, and Guttman coefficients. The survey involved 225 participants, including 150 healthy people and 75 patients with voice disorders, who were selected using a convenience sampling method. RESULTS: All question items demonstrated a CVI greater than 0.79 and a CVR between 0.62 and 1. Reliability analysis yielded high Cronbach's alpha values for functional, physical, and emotional domains (0.909) and total (0.961). The mean overall scores of VHI-10 for healthy and disordered groups were 18.78 and 0.74, respectively. The VHI-10 effectively discriminated between healthy and disordered groups in all domains, with an accuracy of 97.33%. The determined cut-off point was 4.5, with a strong area under the Receiver Operating Characteristic (ROC) curve (0.989). CONCLUSION: This study successfully adapted and validated the Persian version of the VHI-10. The questionnaire demonstrated high reliability and validity, distinguishing between individuals with and without voice disorders. This Persian version is now a valuable tool for speech and language pathologists conducting clinical voice evaluations in Iran and also it could be applied in studies to determine the effects of voice problems on participant's quality of life.

Vocal fold cryptococcal granuloma: A rare occurrence in immunocompetent patient.

INTRODUCTION AND IMPORTANCE: Cryptoccous infection or cryptococcosis is a severe opportunistic infection occurring mainly in immunocompromised patients. Laryngeal cryptococcus infection is rare. In an immunocompetent patient, inhaled corticosteroid was reported to be a possible risk factor. CASE PRESENTATION: We discuss a case of right vocal fold cryptococcus infection in a healthy, immunocompetent 71-year-old man with no history of inhaled corticosteroid, presented with hoarseness and intermittent aspiration symptom for 1 year duration. Further examination showed right anterior vocal fold mass with presence of right vallecular cyst. CLINICAL DISCUSSION: Patient underwent direct laryngoscopy, excision of right vocal fold mass and marsupialization of vallecular cyst. Histopathological examination revealed cryptococcal infection. Patient subsequently treated with oral fluconazole 400 mg daily for 6 months. To date, hoarseness and aspiration symptoms have resolved. CONCLUSION: We are sharing our experience in managing laryngeal cryptococcus infection in an immunocompetent patient where the associated risk factors discussed in previous literatures are absent.

Adaptation and validation of the Persian Version of the Singing Voice Handicap Index-10 (SVHI-10).

OBJECTIVES: Singers' self-reporting of their voice problems can be helpful in the treatment of voice disorders by speech-language pathologists (SLP), which requires a valid questionnaire. This study was conducted to translate and validate the Singing Voice Handicap Index-10 (SVHI-10) questionnaire in the Persian language. METHODS: This cross-sectional study was conducted in two main steps (1) translation of the questionnaire and determination of face and content validity and (2) survey of singers. The questionnaire was first translated by a SLP who was an expert in voice disorder and also proficient in the English language. The face and content validity of the questionnaire was confirmed by experts through impact score, content validity ratio, and content validity index. Then it was translated into English and adapted to its original version. A valid questionnaire was given to 70 singers to determine their ability to distinguish singers with voice problems from healthy singers and their internal consistency. RESULTS: The face and content validity of the questionnaire was confirmed without excluding any item. The results showed that the questionnaire has excellent internal consistency (α = 0.930). With the optimal cut-off point of 14.5, this questionnaire was able to identify singers with voice problems with 90% accuracy. Also, the sensitivity and specificity were 84.85% and 94.59%, respectively. Also, the area under the Receiver Operating Characteristic (ROC) curve was equal to 0.937. CONCLUSION: The results revealed that the Persian version of SVHI-10 is a reliable and valid instrument to identify singers with voice problems, so it can be used by SLPs.

Utility of Smart Phones as a Voice Acquisition Device for Assessing Pre and Post Treatment Voice Using PRAAT.

Voice assessment before and after treatment helps the clinician to assess the effectiveness of the treatment given and facilitates comparison between different treatment modalities. Voice handicap index -10(VHI-10) questionnaire is a tool which allows the voice to be evaluated subjectively from the patient's perspective. PRAAT is a freely available, software programme that acoustically analyse voice signals. Smart phones are widely used and the high quality of the embedded microphone in it makes it a suitable and easily available voice recording device. This study aims at using PRAAT and VHI-10 questionnaire in evaluating voice before and after treatment. The utility of smart phones as a voice acquisition device is also explored in the study. Prospective, observational study, carried out from 1st November 2019 to 30th September 2021in the ENT out- patient department at a tertiary hospital in Punjab. 58 patients complaining of dysphonia were enrolled consecutively in the study. All patients underwent detailed history, examination of the larynx using 70-degree rigid laryngoscope. The voice handicap was scored by (VHI-10) questionnaire and acoustic evaluation of voice was done using the PRAAT software. Patients' voice was further evaluated 3 months post-therapy with VHI 10 questionnaire and acoustic analysis. The parameters measured on PRAAT were mean pitch, jitter (local), shimmer (local), and mean harmonics to noise ratio (HNR). The voice was recorded using a smart phone and later transferred onto a laptop for analysis. The pre and post treatment acoustic parameters and VHI-10 scores were compared and correlated. There was significant difference (p < 0.001) between the pre and post treatment VHI-10 scores and all the acoustic parameters measured except for median pitch (p = 0.995). A poor positive correlation was found between the pre treatment VHI-10 scores and jitter(r = 0.188, p = 0.157) and shimmer (r = 0.288, p = 0.028) values. A negative correlation was observed between pre treatment VHI-10 scores and pitch (r = - 0.151, p = 0.259) and HNR(r = - 0.424, p = 0.001). Post treatment VHI-10 scores showed positive correlation with jitter (r = 0.302, p = 0.021) and shimmer (0.162, p = 0.225) values and negative correlation with pitch (r = - 0.10, p = 0.457) and HNR (r = - 0.356, p = 0.006) values. We found significant differences in the VHI-10 scores and PRAAT voice analysis results before and after treatment in patients complaining with voice change (dysphonia). VHI-10 questionnaire and PRAAT are good and convenient tools for assessing the voice subjectively and objectively. Only a poor to fair correlation was found between VHI-10 scores and PRAAT analysis results. More studies must be done to confirm the utility of smart phones as a voice acquisition device and PRAAT software in voice analysis.

Voice Handicap Index: Cut-Off Points for Screening European Portuguese With Voice Disorders.

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.

Determining Cutoff Point in Bahasa Malaysia Version of Voice Handicap Index-10 (mVHI-10).

OBJECTIVE: Determining the cutoff point on Bahasa Malaysia version of Voice Handicap Index (mVHI-10) questionnaire scores for distinguishing between dysphonic and normal voice samples. STUDY DESIGN: A cross-sectional study was conducted in the tertiary hospital, Otorhinolaryngology-Head and Neck clinic. METHODS: The study involved 205 subjects (105 in the dysphonia group; 100 in the normal group) with a complete database of flexible laryngoscopy/stroboscopy, voice recording, acoustic analysis, and mVHI-10 score. A sample with a discrepancy between subjective evaluation and acoustic analysis results was excluded from the study. Each classified dataset matched with the respective mVHI-10 questionnaire score. Finally, all the collected data were subjected to data analysis. RESULTS: The best cutoff point for mVHI-10 was 7.5 by the receiver operating characteristic curve, with an area under the curve value of 0.997. Its sensitivity, specificity, positive predictive value, and negative predictive value were 92.4%, 100.0%, 100.0%, and 93.0%, respectively. CONCLUSIONS: The best cutoff point for mVHI-10 is 7.5, as determined by stringent data evaluation and rigorous statistical analysis. With excellent diagnostic accuracy properties, it enhances the usage of the mVHI-10 questionnaire as an excellent screening tool. Nevertheless, we advocate multidimensional voice assessment for diagnostic purposes.

Surgical and Functional Outcome After Endoscopic Resection Via Transthyrohyoid for Early Glottic Cancer.

Transthyrohyoid access to the larynx for endoscopic resection (TTER) for early-stage glottic cancer in patients with difficult laryngeal exposure (DLE) has recently been developed. However, little is known about the postoperative conditions of patients. Twelve early-stage glottic cancer patients with DLE who received TTER were retrospectively reviewed. Clinical information was collected during the perioperative period. Functional outcome was evaluated using Voice Handicap Index-10 (VHI-10) and Eating Assessment Tool-10 (EAT-10) preoperatively and 12 months after surgery. None of the patients experienced serious complications after TTER. The tracheotomy tube was removed in all patients. The 3-year local control rate was 91.6%. The VHI-10 score decreased from 18.92 to 11.75 (p < .001), and the EAT-10 scores of the 3 patients changed slightly. Thus, TTER may be a good option for early-stage glottic cancer patients with DLE.

Validation of the Portuguese Version of the Voice Handicap Index-10.

INTRODUCTION: The aim of this study is to validate the Voice Handicap Index 10, to be implemented on the Portuguese population. MATERIAL AND METHODS: Fourty-five subjects were included on the study with vocal complaints and 45 subjects with no vocal complaints, followed on Otorhinolaryngology external appointment at Centro Hospitalar Universitário of Porto. The Voice Handicap Index 30 (VHI-30) and The Voice Handicap Index 10 (VHI-10) questionnaires were applied to the subjects by phone call. Posteriorly, VHI-10 was again applied in the next two to seven days after the first call. These procedures helped validating VHI-10 according to its reproducibility, internal consistency and correlation between questionnaires. RESULTS: In the group with vocal complaints, we verified a significant statistical correlation and a strong linear correlation between VHI-30 and VHI-10 (r = 0.915; P< 0.001). The group without vocal complaints has shown a significant statistical correlation and a moderate linear correlation between VHI-30 and VHI-10 (r = 0.647; P< 0.001). Regarding VHI-10, It was detected a significant statistical difference between patients with and without vocal complaints. DISCUSSION: VHI-10 in Portuguese of Portugal was applied to a sample that included, not only subjects with different ages, but also subjects with and without vocal complaints. Among patients with vocal complaints, it was included subjects with different diagnosis (organic and functional pathology). Thus, the sample was representative, and VHI-10 was reliable and reproducible. CONCLUSION: VHI-10 is a valid representation of VHI-30 that helps evaluate the impact of vocal complaints on life quality, with proven psychometric properties to be implemented on the Portuguese population.

Cross-cultural Adaptation and Validation of the Hong Kong-Chinese version of Children's Voice Handicap Index-10 for Parents (CVHI-10-P(HK)).

OBJECTIVES: The purpose of this study was to cross-culturally adapt and validate the Hong Kong Chinese version of the Children's Voice Handicap Index-10 for Parents (CVHI-10-P(HK)), a parent-proxied quality of life (QOL) questionnaire that pairs with the Children's Voice Handicap Index-10 (CVHI-10(HK)). METHOD: The English version of the (CVHI-10-P(HK)) underwent forward-backward translation and pretesting. Content validity was computed from an expert panel rating on relevance and test-retest reliability was obtained from parents and/or guardians of six dysphonic and five vocally-healthy children. Other validity and reliability measures were analyzed from CVHI-10-P(HK) completed by parents and/or guardians of 28 dysphonic and 35 vocally-healthy children who had completed CVHI-10(HK). RESULTS: The CVHI-10-P(HK) demonstrated excellent internal consistency (α = 0.091), excellent content validity (item- and scale-level content validity indices = 1.00), good construct validity (between group difference in total CVHI-10-P(HK) score: t(30.904) = -6.449, P < 0.001, Cohen's d = 1.709) and excellent test-retest reliability (r = 0.966, P < 0.001). Criterion validity analysis showed a moderate correlation between the total CVHI-10-P(HK) score and auditory-perceptual ratings on overall severity (r = 0.515, P < 0.001). Area under the curve of the receiver operating characteristic plot was found to be 0.855. The CVHI-10-P(HK) has excellent intrinsic accuracy. A cutoff of score of four may be adopted for the optimal sensitivity and specificity match. A moderate correlation was found between the total scores of CVHI-10-P(HK) and CVHI-10(HK) (r = 0.684, P < 0.001). CONCLUSION: The CVHI-10-P(HK) is a valid tool that measures QOL of dysphonic children from the parents' perspective. It is recommended to be used in parallel to the CVHI-10(HK) as part of a comprehensive voice assessment for children in Hong Kong.

Oncological and functional outcomes following treatment of T1a glottic squamous cell carcinoma with transoral laser microsurgery.

BACKGROUND: Laryngeal cancers of glottic origin comprise a large proportion of head and neck malignancies. Transoral laser microsurgery (TLM) and radiation therapy are mainstays in the treatment of early stage glottic cancer, but debate persists as to which modality is functionally superior. Furthermore, there is a paucity of North American data related to functional and oncological outcomes in T1a glottic cancer. Here, we assessed oncological and functional outcomes of T1a glottic squamous cell carcinoma (SCC) with TLM to supplement evidence from jurisdictions outside North America. METHODS: This study is a retrospective cohort study performed from a prospectively collected tertiary center institutional TLM database. Patients who were diagnosed with T1a glottic SCC and underwent TLM as their primary treatment were included. Functional outcomes were analyzed using the Voice Handicap Index-10 (VHI-10) questionnaire. Ultimate control with TLM only was considered to be those patients with locoregional control with repeat TLM procedures, but without addition of other modalities. Student's t-test was used to test significance and Kaplan-Meier survival analysis was used to assess oncological outcomes. RESULTS: 48 patients met study criteria. The mean follow-up time was 74 months. The 5-year locoregional, ultimate control with TLM only and laryngeal preservation rates were 83.2%, 90.4% and 100%, respectively. The overall survival and disease-specific survival were 87.2% and 100%, respectively. VHI-10 scores were available for 13/48 patients and mean scores improved non-significantly from pre-op (mean: 11.23; range: 2 to 30; median: 10) and post op (mean: 7.92; range: 0 to 18; median: 8) scoring (p-value = 0.15). Sub-stratification of voice data revealed a significant improvement between pre and post-operative scores (mean difference - 10.6, 95% CI: - 0.99 to - 20.21, p-value = 0.035) for patients with abnormal pre-operative scores (VHI > 11). CONCLUSION: To our knowledge, the current work represents one of the first North American studies to report both functional and oncologic outcomes for TLM treatment of T1a glottic SCC. The oncologic and functional outcomes presented here add to existing evidence in favor of TLM as a safe and effective primary treatment option for early staged T1a glottic cancer.

A Comparative Study Utilizing the Voice Handicap Index-10 (VHI-10) in Teachers and the General Population of Kuwait.

OBJECTIVES: The objective of this study was to determine the prevalence of voice handicap perception of teachers in Kuwait and compare them within the general population by using the validated Arabic version of the voice handicap index-10 (VHI-10). Moreover, we explored variations within the teaching profession itself with regards to specific characteristics. METHODS: The study was a cross-sectional survey design, in which participants from all governates of Kuwait (1820 teachers and 755 controls) completed the validated Arabic VHI-10, health-related, and demographic questions. The questionnaires were distributed among a random sample of elementary, middle, and high school teachers of both genders, and a random sample of the control population. RESULTS: The mean VHI-10 of teachers was significantly higher than nonteachers (mean VHI-10 of teachers = 5.7, mean VHI-10 of nonteachers = 3.7, P < 0.001). Furthermore, there was a significant difference between teachers and controls in those who scored >11 in the VHI-10 (>11 = 17.6%, 10.2% respectively, P = <0.001). Female teachers scored a higher mean VHI-10 than male teachers (B = 0.66, P < 0.001). There was no difference in the mean VHI-10 among the different teaching class levels. However, elementary school teachers were the most group to exceed the cut-off point (VHI-10 >11) (Odds Ratio = 1.38, P = 0.04). With regards to smoking, we found no difference in the mean VHI-10 and scoring >11 in the questionnaire. Art and science teachers had the highest mean VHI-10 (P = 0.005 and 0.03, respectively). CONCLUSION: The results of the study revealed a higher perception of voice handicap in teachers than nonteachers. Therefore, emphasis should be on teachers in order to prevent voice damage.

Objective Analysis Of Voice Quality In Patients With Thyroid Pathology.

OBJECTIVE: The goal of this study is to analyze the voice in patients with thyroid pathology through two objective indexes with great diagnostic accuracy. Overall vocal quality was evaluated with the Acoustic Voice Quality Index (AVQI v.03.01) and the breathy voice with the Acoustic Breathiness Index (ABI). DESIGN: Observational case-control study. SETTING: Hospital Universitario Nuestra Señora de Candelaria. PARTICIPANTS: Fifty-eight subjects, 29 controls and 29 thyroidectomy candidates. MAIN OUTCOME MEASURES: All participants with thyroid pathology completed the Spanish version of Voice Handicap Index-10. Also, patient complaints relating to possible laryngeal dysfunction were assessed through closed questions. A sustained vowel and three phonetically balanced sentences were recorded for each subject (118 samples). AVQI v.03.01 and ABI were assessed using the Praat program. Two raters perceptually evaluated each voice sample by using the Grade parameter of GRABS scale. RESULTS: Acoustic analysis shows that 55.17% of subjects present values above the pathological threshold of the AVQI, and 58.62% above that of the ABI. Results of the Student's test comparisons of the AVQI and ABI values between the control group and the thyroid group show significantly higher values of AVQI (t[56]  = -3.85, p < .001) and ABI (t[54.39]  = -4.82, p < .001) in thyroidectomy candidates. CONCLUSION: A mild decrease in vocal quality is part of the symptomatology presented by thyroidectomy candidates.

Voice Assessment in Patients With Obstructive Sleep Apnea Syndrome After Transoral Robotic Surgery.

Objectives: Removal of part of the tongue base, in combination with uvulopharyngopalatoplasty via transoral robotic surgery (TORS), for treating obstructive sleep apnea syndrome (OSAS) results in enlargement of the oropharynx and hypopharynx and change in the size of the resonance chamber. These procedures may also alter the laryngeal-hyoid bone complex, which is linked to vocal fold tension. Thus, there is the potential for change in phonation and pitch after surgery. Study Design: Prospective, nonrandomized, institutional board-approved study. Methods: From January to August 2018, 15 patients with OSAS receiving TORS underwent voice and pitch sampling. The multi-dimensional voice program (MDVP) was applied to the evaluation of preoperative sound parameters. Highest pitch and lowest pitch were obtained with real-time pitch software, with pitch synchronized to electronic organ or tuner. Subjects also completed the Voice Handicap Index-10 scale (VHI-10), to assess their subjective perception and to detect factors affecting the VHI-10 score. The relevant parameters were analyzed again 3 months after the operation. Results: There was an increase in VHI-10 score 3 months after operation that did not reach statistical significance. There were also no significant differences in sound parameters. Increases in highest pitch (353.18 Hz shift to 387.99 Hz), highest semitone ( F 5 # shift to F 5 # ), lowest pitch (117.45 Hz shift to 131.42 Hz), and lowest semitone (C3 shift to C3) did not reach statistical significance. The increase in the lowest semitone was significantly related to change in VHI-10 score (r = -0.808, P = 0.028). Conclusion: Patients with OSA undergoing TORS showed a negative correlation coefficient over 0.8 with change in VHI-10 score. That is, increase in the lowest semitone after operation correlated with increase in VHI-10 score which may cause perceive changes in subjective pronunciation.

Crosscultural Adaption and Validation of the Danish Voice Handicap Index-10.

BACKGROUND: The Voice Handicap Index 30 (VHI-30) is a much-used voice specific quality of life questionnaire. A shortened 10 item version has been developed by eliminating redundant items using item analyses. This is the first Danish translation of the VHI-10. OBJECTIVES: To evaluate the psychometric properties of the Danish VHI-10 questionnaire. STUDY DESIGN: Cross-sectional survey study. METHODS: A Danish translation of the VHI-10 was answered by 72 patients with voice disorders of different etiology (neurogenic, functional, and structural) and by a control group of 94 vocally healthy individuals. Thirty-two patients and 68 controls participated in a test-retest reliability analysis. The internal consistency, test-retest reliability, and clinical validity were assessed. RESULTS: Excellent internal consistency was found in the patient group with a Cronbach's α of >0.90. In the control group the internal consistency was good with a Cronbach's α of 0.88. Test-retest reliability was good with intra class correlation coefficient of 0.94 (95% confidence interval [95%CI]: 0.88-0.97) for patients and 0.82 (95%CI: 0.73-0.89) for the control group. This indicates a sufficient reliability of the questionnaire. The correlation between the Danish VHI-10 score and the patient's perception of the severity of the voice disorder was 0.75 (P < 0.001) indicating good clinical validity of the Danish VHI-10. CONCLUSION: The newly translated Danish VHI-10 was validated and performs similar to the original VHI-10. It showed good internal consistency, test-retest reliability, and clinical validity. The questionnaire is preferably for use in patients with moderate to severe voice complaints as its ability to distinguish mild voice changes from healthy voices is limited. However, the questionnaire is capable of assessing patients' perception of the severity of their voice disorder and is available for use in daily practice and in research projects.

A panel of jitter/shimmer may identify functional dysphonia at risk of failure after speech therapy.

BACKGROUND: There are no reliable outcome predictors for functional dysphonia (FD) patients. OBJECTIVES: To investigate if any clinical or phoniatric characteristics could identify FD patients at risk of negative outcome after speech therapy. METHODS: We retrospectively reviewed the results of 78 FD patients treated with the proprioceptive elastic method. Before and one-month after therapy, patients underwent endoscopy, acoustic analysis with Multi-Dimensional Voice Program, and Voice Handicap Index-10 questionnaire (VHI-10). Negative outcome was the persistence of VHI-10 ≥ 13. RESULTS: 26 FD patients had negative outcome (i.e. VHI-10 ≥ 13) after speech therapy. At univariate analysis, clinical variables (i.e. sex, age, comorbidities, dysphonia duration, and professional voice use) were not associated with the outcome. Elevated Jitter% (Jitt; p = 0.03), Shimmer% (Shim; statistical trend, p = 0.06), and Noise to Harmonics Ratio (statistical trend, p = 0.06) were found in patients with poor results. At multivariate analysis, higher Jitt was an independent negative prognostic factor (p = 0.02), while a statically trend was identified for Shim (p = 0.06). A panel of Jitt >1.5 and Shim >5.1 showed an acceptable discriminatory power (AUC [ROC] = 0.76) according to Hosmer and Lemeshow scale. CONCLUSION: A panel of two acoustic analysis parameters could help in identifying FD patients at risk of speech therapy failure. Further studies in these patients are needed to evaluate the most efficient treatment protocol.

Translation and Validation of Tamil Version of Singing Voice Handicap Index-10 (TSVHI-10).

AIM: To translate and validate the singing voice handicap index (SVHI-10) for the Tamil speaking Indian population and to evaluate the psychometric properties of the Tamil version SVHI-10 (TSVHI-10) in classically trained Carnatic singers. METHOD: Following standard translation, a total of 120 classically trained Carnatic singers: 83 singers without voice complaint and 37 singers with voice complaints answered the Tamil translation of the SVHI-10. RESULTS: The TSVHI -10 scores obatined from classically trained Carnatic singers with and singers without voice complaints were analyzed. SVHI-10 has excellent internal consistency and test retest reliability. Singers without/with voice complaint scored 7.08/22.86 total scores and for each domain Emotional (E): 1.73/5.32, Functional (F): 2.11/7.08, and Physical (P): 3.3/10.35 respectively. CONCLUSION: The TSVHI-10 questionnaire seems to be psychometrically sound and is a valuable instrument for the self-evaluation of handicaps related to voice problems in the context of singing and for making subsequent clinical decisions. The Tamil version of the SVHI-10 was successfully validated as an instrument with proper internal consistency and reliability.

Cross-cultural Adaptation and Validation of the Greek Voice Handicap Index-10 (GVHI-10) With Additional Receiver Operating Characteristic Analysis.

OBJECTIVE(S): The use of subjective evaluation tools are proven useful and of high clinical value in the case of voice disordered population. For that type of evaluation, self-assessment questionnaires about the severity of the voice like Voice Handicap Index-30 (VHI-30) have been developed. The VHI-30 is the most studied tool which includes psychometrically robustness while guiding physician's therapeutic decision making. Additionally, a valid abbreviated version of VHI-30 was developed for the first time in the Greek Language which is named as Greek Voice Handicap Index-10 (GVHI-10). Consequently, the aim of our study was to validate the proposed version of the VHI-10. METHODS: Ninety nondysphonic individuals and 90 dysphonic patients were classified by Otolaryngologists and Speech Language Pathologists. The study's subjects were evaluated with endoscopy and stroboscopy. Also, they were administrated the GVHI-30 and the translated version of the Voice Evaluation Template (VEF). The GVHI-10 was extracted by the Greek version of VHI-30. RESULTS: The group with voice disorders exhibited higher statistical significance in all GVHI-10 scores compared to those of the control group. The GVHI-10 showed a high internal consistency (Cronbach's a = 0.915 and split-half reliability coefficient equal to 0.86), good sensitivity compared to Greek VHI-30 (r = 0.764, P = 0.000) and intraclass correlation. A total cut-off point equal to 6.50 (AUC: 0.964; P < 0.001) was also calculated. CONCLUSIONS: The proposed version of GVHI-10 distinguished the perceived levels of voice between dysphonic and nondysphonic groups and between different voice disordered populations. The GVHI-10 is shown to be clinically valid and sensitive exhibiting high reliability.

Prevalence and Risk Factors of Voice Disorders in French Tour Guides.

OBJECTIVE/HYPOTHESIS: Voice disorders are frequently observed among professionals using their voice as their main working tool (ie, occupational voice users). The objective of this study is to establish the prevalence of voice disorders in tour guides and to evaluate the risk factors associated with these disorders. STUDY DESIGN: An online survey, containing the VHI-10 test, was sent to the metropolitan France guides in November 2017. The results were analyzed using answers of tour guides dispatched in all metropolitan French departments. RESULTS: We received 465 replies. Voice disorders were highly prevalent (up to 21.29%) according to the VHI-10 and were comparable to observed rates in other professional categories (teachers and telecommunicators). The proportion of guides complaining about voice disorders episodes (44.94%) is greater than in the overall general population. Specific work-related factors emerged in this study. First, the use of a high-intensity voice for more than 6 hours a week is a factor significantly associated with a higher risk of having a pathological score at VHI-10. Second, a significant proportion of the guides noted that noise pollution and changes in temperature affected their vocal quality. CONCLUSIONS: In light of these results, we can conclude that the tour guide profession is subject to voice-related risks. The prevalence of voice disorders is particularly higher than in the general population and risk factors specific to tour guide population exist.

Predicting the Outcome of Unilateral Vocal Fold Paralysis: A Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10.

OBJECTIVES: The aim of this study was to investigate if any clinical and phoniatric characteristics or quality-of-life measures could predict the outcome of unilateral vocal fold paralysis (UVFP) initially managed with speech therapy. METHODS: Forty-six patients with UVFP were evaluated using laryngostroboscopy, the GIRBAS (grade, instability, roughness, breathiness, asthenia, and strain) scale, acoustic analysis, and the Voice Handicap Index-10 (VHI-10) questionnaire. Treatment was speech therapy according to a 3-phase protocol. The main outcome measure was incomplete vocal fold mobility 12 months after symptom onset. Univariate and multivariate modeling ( k-nearest neighbors model) were applied. RESULTS: Fifteen patients had incomplete motion recovery 12 months after the onset of UVFP. On univariate analysis, time to diagnosis (0.01), global grade of dysphonia (0.018), jitter (0.01), shimmer (0.012), and VHI-10 score (0.006) were associated with the outcome of vocal fold paralysis. Using a k-nearest neighbors multivariate discriminating model, the best discrimination of UVFP outcome was achieved with 4 parameters: global grade of dysphonia 2 or 3, jitter > 2.46%, shimmer > 6.97%, and VHI-10 score > 13. The model's misclassification rate for incomplete motion recovery was only 6%. The model showed sensitivity of 93% and specificity of 74%. CONCLUSIONS: Delayed diagnosis and speech therapy was associated with negative outcomes. Higher grade of dysphonia, jitter, shimmer, and VHI-10 score on initial phoniatric assessment may help clinicians in predicting the outcomes of UVFP patients.