The Prevalence of Self-Reported Voice Disorders in Israel.

OBJECTIVE: Data on the prevalence of voice disorders is vital in order to describe and understand the phenomenon. The aim of this study was to estimate the prevalence of voice disorders in Israel, and perform a preliminary comparison between the two major societies in the country. METHODS: A sample of 1146 people participated in a survey on voice disorders. This sample comprised 510 Israeli Jews and 627 Israeli Arabs. Each participant completed a questionnaire concerned with voice and its disorders as well as the shortened Voice Handicap Index-10 (VHI-10). RESULTS: The overall prevalence of voice disorders within our sample was 13.90%. In addition, 30.26% of the participants reported experiencing a voice problem over the last year, while 12.81% reported seeing a physician for that reason. No significant differences were found in the prevalence of voice disorders between participants who identified themselves as either Jews or Arabs. A higher prevalence of voice disorders was found in the older age groups, and among people who reside in the southern region of the country. In contrast, no significant differences in the prevalence of reported voice disorders were found between men and women. CONCLUSION: The prevalence of reported voice disorders in Israel is comparable with previous prevalence reports from other regions and societies. Data show that despite cultural, religion, language, and other factors, the prevalence of voice disorder among Israeli Jews and Arabs is very similar.

Health disparities among adults with voice problems in the United States.

OBJECTIVE: To assess differences in access to care and healthcare utilization among adults who reported voice problems in 2012. STUDY DESIGN: Cross-sectional study. METHODS: The 2012 National Health Interview Survey was utilized to evaluate adults who had a "voice problem in the past 12 months." Multivariate analyses determined the influence of sociodemographic variables on the prevalence of voice problems in adults and access to care. RESULTS: Among 243 million adults in the United States, 17.9 ± 0.05 million adults (7.63% ± 0.21%) report experiencing voice problems. After controlling for age, education, income level, geographic region, and health insurance status, African Americans (odds ratio [OR]: 0.83, P < 0.05), Hispanics (OR: 0.61, P < 0.01), and other minorities (OR: 0.69, P < 0.01) had a lower OR for reporting voice problems in the last year relative to white adults. Among adults with voice problems, Hispanics were more likely to delay care because they could not reach a medical office by telephone (OR: 1.85, P < 0.01) and due to long wait times at the doctor's office (OR: 2.04, P < 0.01) compared to white adults. Adults with voice problems who were a racial minority, low income, or had public health insurance were more likely to postpone care because they lacked a mode of transportation. CONCLUSION: Targeted programs are necessary to address the health disparities and barriers to care among those who suffer from voice problems. LEVEL OF EVIDENCE: IV. Laryngoscope, 128:915-920, 2018.

Comparative Analysis of Characteristics of Voice Use Amidst Clergy.

The development of "Care of the Professional Voice" as a subspecialty of Otolaryngology-Head and Neck Surgery has expanded the concept of professional voice users. Although sometimes uncompensated, the clergy represents a unique group of voice users who are required to perform at a professional level. Additionally, cultural norms create great diversity in terms of style of delivery and typical venues, adding to the interest in this subset of professional voice users. We surveyed 403 respondents and found certain factors predictive of voice problems for members of the clergy. Age, length of sermon, and ethnicity were all found to be statistically significant indicators. Further investigations are needed.

Aging Effect on Korean Female Voice: Acoustic and Perceptual Examinations of Breathiness.

OBJECTIVE: This paper sought to examine perceptual and acoustic characteristics in Korean female voices, focusing on the 'breathy' quality as a function of aging. In addition, we aimed to investigate if the three selected measures, H1-H2, H1-A1, and H1-A3, demonstrated any changes along a sustained vowel production. PARTICIPANTS AND METHODS: A total of 42 participants were assigned to two age groups, young women and elderly women. All participants were asked to sustain /a/ as long and as steadily as possible. Perceptual judgments of breathiness were made on the GRBAS scale and by a direct magnitude estimation technique, while three acoustic parameters, H1-H2, H1-A1, and H1-A3, were measured at five measurement time points during the sustained vowel test. RESULTS: Results indicated that the H1-H2 and H1-A1 values were significantly lower for elderly women compared to young women, although no difference in the perceptual estimation of breathiness was found between the age groups. Among the acoustic measures, only H1-A1 was significantly regressed against the perceptual estimate of breathiness. In addition, no significant acoustic difference in the measures was found across the five measurement points. CONCLUSION: Our findings suggest that the aging voice might not be universally characterized by the breathy quality, which hints at the need for further research on ethnic diversity in vocal quality.

Multiparameter voice assessment for voice disorder patients: a correlation analysis between objective and subjective parameters.

OBJECTIVE: The aim of this study was to establish a multiparameter voice assessment profile using objective multiparameter test and subjective voice quality assessment. METHODS: We assessed 50 patients with voice disorders before and after operation. The assessment incorporates (1) subjective voice quality assessment, (2) patients' self-assessment, and (3) objective acoustic analysis. The subjective voice quality assessment uses GRABS system to evaluates the grade of hoarseness (G), proposed by the Japanese Society for Logopedics and Phoniatrics. Patients' self-assessment is modified based on the Chinese version of voice handicap index (VHI) scale, composed of functional (F), physiological (P), emotional (E) part, and a total score (T). The acoustical analysis evaluate the patients' voice sample by voice analysis software "Dr. Speech". Three parameters, jitter (J), shimmer(S), and normalized noise energy (NNE), were taken in analysis. RESULTS: We observed high correlations among subentries F, P, and the total score TvH of the VHI scale in patients' subjective assessment. Parameter E does not correlate well with other assessed parameters. The Chinese version of VHI, which incorporate multifactors including age, education, and especially the cultural difference may account for the inconsistent correction in parameter E. In the objective acoustic analysis, high correlation among the three parameters J, S, and NNE is observed. CONCLUSION: Systemic assessment combining a subjective voice quality assessment, an objective acoustic analysis, and a self-assessment is helpful in clinical practice in the diagnosis and treatment for voice disorders. The E component in VHI scale assessment may not be a reliable parameter to evaluate treatment outcome.

Perceptions of voice disorders: a survey of Arab adults.

A disordered voice may lead to social stigma as well as reduced occupational opportunities. Much of the research on this topic has investigated the effects of voice disorders from a Western perspective. The societal attitudes of international populations toward people with voice disorders (PWVD) are less well known. The purpose of this study was to investigate the attitudes of adults living in Kuwait toward PWVD. Participants completed a questionnaire that addressed social, educational, and occupational aspects of life for PWVD. The results indicated that while Kuwaiti adults hold generally positive attitudes toward PWVD, they may also perceive PWVD as more likely to be emotionally disturbed, have difficulty making friends or getting married, and experience trouble in finding a good job.

Racial disparities in voice outcomes after thyroid and parathyroid surgery.

BACKGROUND: There is evidence that the outcomes of head and neck surgery may differ across racial and ethnic groups. Vocal changes related to the operation are an anticipated risk of thyroidectomy and parathyroidectomy. Race-specific voice outcomes after thyroid and parathyroid operations have not been reported. Therefore, our aim was to examine the potential disparity in voice outcomes between white and black patients after thyroid or parathyroid operations. PATIENTS AND METHODS: Eighty-seven patients (59 white and 28 black) were included in a prospective observational trial. Subjects were evaluated before operation, and 2 weeks, 3 months, and 6 months postoperatively using a comprehensive battery of functional voice assessments of voice characteristics. The association of race with voice outcomes over time was evaluated with generalized linear models. RESULTS: Aside from volume of pathologic specimen (black, 117.5 cm3 vs. white, 43.2 cm3; P = .004), presence of multinodular goiter (black, 32.1% vs. white, 6.8%; P = .004) or Hashimoto's thyroiditis (black, 3.6% vs. white, 28.8%; P = .009), there were no differences between racial groups. Blacks were more likely than whites to have negative voice outcomes (odds ratio, 2.6; 95% confidence interval, 1.1-6.2; P = .034] throughout the postoperative period, especially at 6 months (black, 25% vs. white, 4%; P = .018). This finding was related principally to divergent scores on the voice-related quality-of-life scale, the voice handicap index. CONCLUSION: We observed greater rates of self-reported, negative voice outcomes among blacks than whites after thyroid or parathyroid operations. The precise mechanism for this disparity has not been described. The observed racial disparity in self-perceived voice impairment in this study merits further investigation.

Reliability and validity of the Korean version of Pediatric Voice Handicap Index: in school age children.

OBJECTIVE: The aim of this study was to assess the reliability and validity of the Pediatric Voice Handicap Index (pVHI) for cross-cultural adaptation of the Korean version with school age children. METHODS: The questionnaire was translated into Korean and was completed by 101 Korean parents who have children with or without disordered voice. The Korean version-pVHI scores were obtained with 60 parents of normal children and 41 parents who have children with voice problems. Content validity was verified by five experienced speech-language pathologists with clinical specialization in voice disorders. Internal consistency was calculated through Cronbach's α coefficient and test-retest reliability of the Korean version-pVHI score was determined using Pearson product-moment correlation coefficients. Mann-Whitney U test was used to compare GRBAS with the Korean version-pVHI scores between normal and dysphonia group. The relationship between the parent-reported the Korean version-pVHI total scores and perceptual ratings of voice quality from experts was investigated using Spearman correlation coefficients. RESULTS: The results showed that the Korean version-pVHI provided a high internal consistency (α=0.92) and test-retest reliability of its subscales: total (T) 0.97, functional (F) 0.90, physical (P) 0.95, emotional (E) 0.92. The Korean version-pVHI mean scores in normal group were 1.28 (T), 0.62 (F), 0.35 (P) and 0.32 (E), respectively whereas those of the Korean version-pVHI in children group with dysphonia were 23.13 (T), 8.90 (F), 9.54 (P) and 4.93 (E). Significant differences in the Korean version-pVHI (T, F, P, E) and perceptual evaluation (grade, rough, breathy) between normal and dysphonia group were revealed (P<0.05). Moreover, relatively moderate-to-high correlation between the Korean version-pVHI parameters (T) and perceptual measures (G) was exhibited in children with dysphonia. CONCLUSIONS: The subjective Korean version-pVHI can be applicable and useful supplementary tool for evaluating parents' perception of their children's voice dysfunction, identifying multifactors on daily life affecting their children's voice and measuring treatment efficacy before and after therapeutic intervention.

Japanese version of voice handicap index for subjective evaluation of voice disorder.

Recently, the Voice Handicap Index (VHI), developed in the United States, has been highlighted as a means to assess a patient's perceptions of the severity of his or her voice disorder. The VHI is based on a self-administered questionnaire that quantifies the degree of a patient's disability related to his/her voice disorder. The questionnaire was translated into Japanese and applied to Japanese patients with various kinds of disordered voice or dysphonia. The results were analyzed and the usefulness discussed. In this study, 546 patients (281 males and 265 females) were included. Mean VHI scores were 36.2/120 in males and 44.1/120 in females. In the male patients, VHI scores were the highest among teens. However, VHI scores did not vary with age in the female patients. Patients with vocal fold paralysis, functional dysphonia, psychological dysphonia, and spasmodic dysphonia showed relatively high VHI scores, whereas those with laryngeal granuloma and laryngopharyngeal reflux disease showed low scores. In most diseases, functional and physiological scores were higher than emotional scores. In any treated patients, those with vocal nodule, vocal polyp, polypoid vocal fold, and recurrent laryngeal nerve paralysis, VHI scores decreased after therapeutic intervention. These findings suggest that the Japanese VHI is a useful tool for monitoring a patient's psychological status, choosing appropriate treatment, and assessing the therapeutic outcome.

Study on the simplified Chinese version of the voice handicap index.

OBJECTIVES: To investigate the characteristics of the simplified Chinese versions of the Voice Handicap Index (VHI). METHODS: Cluster analysis was performed on the VHI scores of 1766 dysphonic patients to screen for items to compile different simplified Chinese VHI versions. The VHI scores of 3825 dysphonic patients (in which 424 patients have undertaken surgical treatment) and 120 control subjects were assessed using the simplified versions, and the results were compared between the simplified versions and the original version. RESULTS: Two simplified versions of VHI-10 (10 items) and VHI-13 (13 items) were compiled after the cluster analysis. Their internal consistency reliabilities were 0.939 and 0.936, the test-retest reliability coefficients were 0.995 and 0.993, and their correlation coefficients to the original VHI questionnaire were 0.972 and 0.973, respectively. The scores of VHI-10 and VHI-13 were significantly higher in dysphonic patients than in control subjects (Z=17.42, Z=17.46; P=0.000). The mean ratios of the VHI-10 and VHI-13 scores to the original VHI questionnaire scores in dysphonic groups were found to be consistently greater than expected (0.333 and 0.433, respectively). The VHI scores from the simplified versions were classified on the basis of the overall grade severity of dysphonia according to the physicians' subjective auditory assessment, and when the scores among the different groups were compared, there was a statistical difference between the VHI-10 and VHI-13 scores (Z=5.735-9.861, P=0.000). The VHI-10 and VHI-13 patient scores declined significantly after treatment (P<0.05). CONCLUSIONS: Both of the simplified Chinese versions, VHI-10 and VHI-13, had good reliability and validity. They could be used in the dysphonic self-assessment as the simplified Chinese VHI questionnaire. VHI-10 was found to be more concise and more widely applicable than VHI-13.

Objective assessment of nasality in Flemish adults with neurofibromatosis type 1.

When characterizing the speech of a patient with neurofibromatosis type 1 (NF1), hypernasality is often mentioned. As few studies applied technically assisted evaluations of nasality in NF1 patients, the aim of the present study was to document the nasal resonance of adults with NF1 using nasometry. The nasometric data obtained from the NF1 patients were compared with the nasalance scores of a healthy control group and with normative data. The final study group consisted of 24 adult NF1 patients and 16 controls, all living in the East Flemish part of Belgium. Nasalance scores were obtained while the participants sustained three vowels (/a:/, /i./, and /u./) and one consonant (/m/) and read three standard nasalance passages. Despite the inter- and intra-subject variability, we observed that NF1 patients as a group exhibited higher mean nasalance scores than controls. This finding was especially clear in males. Potential genotype-phenotype correlations between NF1 mutation type and hypernasality were examined but could not be demonstrated. Conversely, comparison of the nasometric data obtained from the NF1 patients with magnetic resonance imaging findings showed some degree of interesting correlation. We conclude that, notwithstanding the small sample size for some analyses, nasality is an area of interest in the NF1 population. As altered nasality influences speech intelligibility, nasality requires attention during follow-up visits, particularly when it concerns a male NF1 patient.

Maximizing health literacy and client recall in a developing context: speech-language therapist and client perspectives.

BACKGROUND: In the field of speech-language therapy, limited research has been conducted with regards to health literacy and client recall. However, speech-language therapists frequently provide a considerable amount of information for clients to understand, apply and review in order to manage their (or their child's) health. AIMS: This study aimed to investigate (1) issues around clients' health literacy and recall of information; and (2) how these issues can be overcome in speech-language therapy in a developing context. METHOD & PROCEDURES: An exploratory study was undertaken with specific focus on speech-language therapists and their clients who had previously received treatment for dysphagia, voice disorders (including laryngectomies), and cleft lip and/or palate management. They were recruited at public tertiary hospitals and primary healthcare clinics in Cape Town, South Africa. Data were gathered through focus group discussions and qualitatively analysed using a content-driven immersion/crystallization style. OUTCOMES & RESULTS: Five themes and 13 subthemes were identified. Speech-language therapists currently use mostly low-technology strategies to manage issues of health literacy and client recall, and frequently view poor outcomes as being related to clients themselves and a lack of compliance. CONCLUSIONS & IMPLICATIONS: An understanding of context, intercultural health literacy and client-provider concordance are important factors that should inform the clinical practice of speech-language therapy. There is a need to develop effective strategies for information provision and review post-consultation. Speech-language therapists have an important mediating role in cross-cultural communication.

Cross-cultural adaptation and validation of the voice handicap index into Brazilian Portuguese.

The purpose of the present study was to culturally adapt and validate the Voice Handicap Index (VHI) to Brazilian Portuguese. Psychometric analyses were performed on the translated version as described by the Scientific Advisory Committee of the Medical Outcomes Trust. The translated version was completed by 52 individuals with vocal complaints and by a control group of 64 subjects. Validation, reliability, reproducibility, and responsiveness were evaluated. All participants also completed a self-rating vocal quality scale. Statistical analyses demonstrated high internal consistency and high test-retest reliability both for the overall VHI score and for the functional, physical, and emotional domains of the VHI. A positive correlation was found between the VHI and the self-rating vocal quality scale. The subjects in the control group had lower scores compared with the subjects with voice disorders for the overall VHI score and for the three domains. Based on these data, the Brazilian Portuguese version of VHI is a valid and reliable measure for use in the Brazilian population.

Análise comparativa da qualidade de vida e estratégias de enfrentamento de indivíduos com alterações vocais decorrentes ou não do tratamento do câncer de laringe / Comparative analysis of quality of life and coping strategies in cancer and behavioral dysphonia

Objetivo: Comparar qualidade de vida, qualidade de vida relacionada à voz e estratégias de enfrentamento de pacientes com disfonias de base comportamental com pacientes com disfonias decorrentes do tratamento do câncer de laringe e analisar o impacto das variáveis demográficas na qualidade de vida e nas estratégias de enfrentamento de ambos os grupos. Métodos: estudo multiinstitucional, de coorte transversal, em indivíduos com disfonia decorrente do tratamento para câncer de laringe e indivíduos com disfonia de base comportamental, em relação à qualidade de vida geral, qualidade de vida em voz e estratégias de enfrentamento, por meio da aplicação dos questionários SF-36, V-RQOL (QVV), Coping (Enfrentamento). Resultados: Foram avaliados 213 sujeitos, dos quais 109 com disfonia decorrente do tratamento do câncer e 104 com disfonia de base comportamental. O impacto da disfonia na qualidade de vida dos indivíduos foi de grau leve e todas as estratégias de enfrentamento foram utilizadas por ambos os grupos. Devido à heterogeneidade da amostra, realizou-se a análise de regressão linear múltipla para verificar a influência das variáveis na qualidade de vida e no enfrentamento. Isolando as variáveis demográficas, observou-se diferenças entre os dois grupos estudados somente em relação ao domínio sócio-emocional do questionário V-RQOL. Conclusão: Pacientes com disfonias decorrentes do tratamento do câncer de laringe e pacientes com disfonias de base comportamental apresentam qualidade de vida e enfrentamento semelhantes. Pacientes com disfonia de base comportamental apresentam pior qualidade de vida relacionada à voz no domínio sócio-emocional. Idade, gênero, consumo de cigarro e álcool, escolaridade, estado civil e trabalho interferem na qualidade de vida geral e nas estratégias de enfrentamento de ambos os grupos. Dentre as variáveis demográficas analisadas, somente o etilismo interfere na qualidade de vida relacionada à voz. ...

Standardization of the Arabic version of the Voice Handicap Index: an investigation of validity and reliability.

Validity and reliability of the Arabic version of the VHI (VHI-Arab) were investigated. Possible effects of participant-inherent factors (i.e. age, sex) on participant (77 females, 35 males) responses were also investigated. Results showed high internal consistency (Cronbach's alpha r > 0.857 for all scores). Test-retest reliability was found to be strong (r > 0.87 for all scores). Validity results indicated significant moderate correlations between total VHI score and responses to severity (r = 0.521, P = 0.015) and satisfaction (r = 20.556, P = 0.009) questions. VHI-Arab was found to be unaffected by age (P > 0.10 for all scores) or sex (P > 0.05). This study produced a valid and reliable instrument for measuring participation restriction in Arabic-speaking individuals with voice disorders.

Cross-cultural adaptation and validation of the Voice Handicap Index into Italian.

OBJECTIVES: To evaluate the internal consistency, reliability, and clinical validity of the Italian version of the Voice Handicap Index (VHI). STUDY DESIGN: Cross-sectional survey study was carried out. METHODS: One hundred and seventy-five patients with voice disorders, divided in four groups according to the etiology of the disease (neurogenic, structural, functional, and inflammatory), and 84 asymptomatic subjects were included in the study. Internal consistency was analyzed through Cronbach α coefficient. For the VHI test-retest reliability analysis, the Italian VHI was filled twice by 56 patients and 56 control subjects. The test-retest reliability was assessed through the Pearson correlation test. For the clinical validity assessment, the scores obtained in the pathological group were compared with those found in asymptomatic individuals through the Kruskal-Wallis test. Also, the correlation between VHI and the grade of voice disorder was assessed. Finally, the effect of age and gender on overall VHI and its three subscales was analyzed. RESULTS: Optimal internal consistency was found (α=0.93); the test-retest reliability in both groups was high (r>0.86). Nonparametric Kruskal-Wallis analysis of variance for the overall VHI score and its three domains revealed a significant main effect for group (P=0.000). The control group scored significantly lower than the four groups of voice-disordered patients. The overall VHI score positively correlated with the grade of voice disorder (r=0.43). In the voice-disorder group, age and gender were not correlated to the overall VHI score and to their three domains. CONCLUSION: The Italian VHI is highly reproducible, and exhibits excellent clinical validity.

Disfonias Neurológicas / Dysphonias Neurologic

Os autores fazem uma revisão bibliográfica sobre disfonias neurológica, suas definições incidência, fisiopatologia, manifestações clinicas, diagnostico e tratamento.

Cross-cultural adaptation and validation of the Chinese Voice Handicap Index-10.

OBJECTIVES/HYPOTHESIS: Recent developments in voice assessment propose the use of quality of life measurements. The Voice Handicap Index (VHI) is one of the most psychometrically robust and well-studied instruments among the various instruments for measuring quality of life. Two versions of VHI (VHI-30 and VHI-10) have been shown to be valid instruments for distinguishing dysphonic from nondysphonic individuals and also for documenting treatment effect for dysphonic patients. The VHI has been used worldwide; however, the psychometric properties of the Chinese version of VHI remains untested. This study aimed to investigate such properties of the Chinese VHI-30 and VHI-10 in the Hong Kong Chinese population. STUDY DESIGN: Psychometric analysis of the Chinese VHI-30 and VHI-10 in dysphonic patients and control subjects. METHODS: The original VHI-30 was translated into Chinese and was completed by 131 dysphonic patients and 54 nondysphonic individuals. The dysphonic patients also self-rated their dysphonic severity. RESULTS: Results showed high test-retest reliability and high item-total correlation for both Chinese VHI-30 and VHI-10. Both Chinese versions could be used to distinguish different dysphonic groups and between dysphonic and nondysphonic groups. Significant correlation was found between the VHI scores and the patients' self-rated dysphonic severity. CONCLUSION: The present study supported the original three-factorial structures of the VHI-30 and the use of the VHI for the Chinese population. It is shown that the Chinese VHI-10 is a strong representation of VHI-30 and is recommended for use in clinics because of its validity and ease of use by patients.

Prevalence of voice disorders in African American and European American preschoolers.

Several studies have reported prevalence rates for voice disorders in school-aged children. Less is known, however, about such prevalence in preschoolers, and whether racial, ethnic, or cultural diversity may influence it. The presence of voice disorders in a total of 2445 African-American and European-American preschool children, 1246 males and 1199 females, from 2 to 6 years of age is reported here. Presence of a voice disorder characterized by hoarseness was identified by a three-prong approach including teacher identification, investigator screening, and parent identification. Speech-language pathologists listened individually to each child's speech as they engaged each child in play-conversation activities. A voice disorder was identified on the basis of the judgment of two speech-language pathologists. Voice disorders characterized by hoarseness were identified in 95 children or 3.9% of the total sample by the investigators. Statistical analysis revealed no significant differences for age, gender, or race.