Item reduction of the voice handicap index based on the original version and on European translations.

OBJECTIVE: Constructing an internationally applicable short-scale of the Voice Handicap Index (VHI). METHODS: Subjects were 1,052 patients with 5 different types of voice disorder groups from Belgium, France, Sweden, Germany, Italy, The Netherlands, Portugal, and the USA. Different 9- and 12-item subsets were selected from the 30 VHI items using (1) the first factor of an unrotated factor analysis (narrow range subsets) and (2) the first three factors after promax rotation (broad range subsets). Country-specific subsets were selected to test deviations from the international subsets. For all subsets, reliability was investigated using Cronbach's alphas and correlations with the total VHI. Validity was investigated using regression on voice disorder groups. All analyses were performed for the total and for all country-specific subject samples. RESULTS: Reliability was high for all item subsets. It was lower for the international compared to the country-specific subsets and for the broad range compared to the narrow range subsets. Validity was best for the broad range subsets. Validity was better for the international than for the country-specific subsets. For all statistics the 12-item subsets were not essentially better than the 9-item subsets. CONCLUSION: The international broad range 9-item subset forms a scale which approximates well the total VHI.

Validation of the voice handicap index by assessing equivalence of European translations.

OBJECTIVE: We aimed to assess the equivalence of translations of the Voice Handicap Index (VHI). PATIENTS AND METHODS: Confirmatory factor analysis was used to assess equivalence of the US version and several translations including (1) Dutch, (2) Flemish Dutch (Belgium), (3) UK English, (4) French, (5) German, (6) Italian, (7) Portuguese and (8) Swedish. VHI questionnaires were gathered from 1,281 subjects. Patients were classified into 11 voice lesion categories. Patients with incomplete response (4%) and patients within voice lesion categories with small numbers were excluded from further analyses, leaving a cohort of 1,052 patients from 8 countries. RESULTS: The internal consistency of the VHI proved to be good. Confirmatory factor analysis across countries revealed that a 3-factor fixed measurement model best fitted the data; the 3 subscales appeared to highly intercorrelated, especially in the US data. The underlying structure of the VHI was also equivalent regarding various voice lesions, but distinct groups were recognized with respect to the height of the VHI scores, indicating that various voice lesions lead to a diversity of voice problems in daily life. CONCLUSION: The US VHI and the translations appeared to be equivalent, which means that the results from studies from the various included countries can be compared.

The development of genomics-derived pharmaceuticals.

Messenger RNAs for the large majority of human genes are now available. Most of those contained in the Human Genome Sciences database are capable of producing functional proteins. We have sequenced the clones of approximately 8000 that are believed to be involved in cell signaling, and have produced small amounts of the corresponding proteins. These are being screened for biological activity; four have been entered into clinical trials, with one demonstrating clinical activity thus far.

Use of a whole genome approach to identify vaccine molecules affording protection against Streptococcus pneumoniae infection.

Microbial targets for protective humoral immunity are typically surface-localized proteins and contain common sequence motifs related to their secretion or surface binding. Exploiting the whole genome sequence of the human bacterial pathogen Streptococcus pneumoniae, we identified 130 open reading frames encoding proteins with secretion motifs or similarity to predicted virulence factors. Mice were immunized with 108 of these proteins, and 6 conferred protection against disseminated S. pneumoniae infection. Flow cytometry confirmed the surface localization of several of these targets. Each of the six protective antigens showed broad strain distribution and immunogenicity during human infection. Our results validate the use of a genomic approach for the identification of novel microbial targets that elicit a protective immune response. These new antigens may play a role in the development of improved vaccines against S. pneumoniae.

Phonotrauma associated with crying.

Vocal fold hemorrhage often results in a sudden change in voice quality. Traumatic use of the voice (phonation or singing) is generally thought to be the cause of the vocal fold hemorrhage. The current report reviews three cases in which the traumatic event was crying. In one case, the patient's voice was only used for crying. All three patients were female and all were professional singers. The treatment of these individuals consisted of voice rest and subsequent phonomicrosurgery for lesions associated with the vocal fold hemorrhage. These case studies suggest that crying as a traumatic vocal behavior may result in vocal fold hemorrhage.

Voice handicap index change following treatment of voice disorders.

Outcome measurements of voice disorders is an important new area for both the evaluation of voice-disordered patients and evaluation of treatment efficacy. The Voice Handicap Index (VHI) measures the patient's perception of the impact of his or her voice-disorder. The VHI was used in this study to measure the changes of the patient's perception following treatment for four different voice disorders. The VHI showed a significant change following treatment for unilateral vocal fold paralysis, vocal cyst/polyp, and muscle tension dysphonia. Results of this paper indicate that the VHI is a useful instrument to monitor the treatment efficacy for voice disorders.

Voice handicap index in singers.

The Voice Handicap Index (VHI) was developed to assess patients' perception of the severity of their voice disorder. The purpose of this study was to determine the degree of handicap expressed by professional and recreational presenters with a voice complaint. Singers (n = 106) and nonsingers (n = 369) with voice symptoms were studied. The results of the VHI for singers indicate that singers score significantly lower (less severe) on the VHI compared to nonsingers. Singers with vocal fold nodules had a lower mean VHI than singers with vocal fold cysts or polyps. Singers who perform classical music had the lowest mean VHI of all types of singers studied. A low VHI in singers may represent a significant handicap and should not be ignored when considering the severity of a singer's voice problem.

Acute management of the performing voice.

Management of a singer's acute voice problem carries repercussions that may affect his or her career. When a vocalist develops a problem before a performance, the clinician is required to make a prompt diagnosis, determine the safety of the vocal performance, and provide treatment. The ability of the singer to fulfill the pending vocal performance is also of paramount importance. Therefore, it is important for the clinician to understand the presenting complaints, to evaluate the emergent vocal need of the singer, and to combine the art and science of laryngology to formulate the treatment plan.

Vocal education for the professional voice user and singer.

Providing education on voice-related anatomy, physiology, and vocal hygiene information is the responsibility of every voice care professional. This article discusses the importance of a vocal education program for singers and professional voice users. An outline of a vocal education lecture is provided.

Vocal fold scar: evaluation and treatment.

This article provides the framework for the comprehensive evaluation and treatment of patients with vocal fold scar. Nonsurgical and surgical treatment methods are discussed including the use of voice therapy, singing voice therapy, phonosurgical collagen injection, and fat graft vocal fold reconstruction.

Phonosurgical vocal fold injection: procedures and materials.

Significant advances have recently occurred in the area of vocal fold injection. Phonosurgical vocal fold injection is now a precise set of techniques used to improve voice quality through vocal fold injection. Lipoinjection and collagen injection are discussed in detail. The different vocal fold injection techniques and materials are discussed in this article.

Acoustic, aerodynamic, and videostroboscopic features of bilateral vocal fold lesions.

Successful treatment of bilateral vocal fold lesions depends on the accuracy of the diagnosis. For example, the preferred treatment for vocal fold nodules is voice therapy: in contrast. treatment for a unilateral vocal fold lesion with a contralateral reactive vocal fold lesion (UVFL/RL) usually involves phonosurgery and voice therapy. Differentiation between vocal fold nodules and a UVFL/ RL is often challenging. The purpose of this study was to facilitate diagnostic accuracy and improve treatment for patients with bilateral vocal fold lesions by attempting to identify distinct features of patients with either vocal fold nodules or a UVFL/RL with acoustic, aerodynamic, stroboscopic, and patient self-perception measures. The objective voice analysis, Voice Handicap Index, and laryngovideostroboscopic examinations of 85 patients with bilateral vocal fold lesions were reviewed. The results indicated that the patients with a UVFL/RL presented a diagnostic profile that was significantly different from that of patients with vocal fold nodules. Statistically significant differences were found for 1) symmetry of vocal fold vibration, 2) amplitude perturbations, 3) estimated subglottic pressure, and 4) Voice Handicap Index. These results suggest that a composite assessment of acoustic, aerodynamic, and videostroboscopic phonatory features facilitates differentiation between patients with vocal fold nodules and those with a UVFL/RL. The improved diagnostic accuracy afforded by multiparametric assessment provides a comprehensive framework for the treatment of these two distinct vocal fold disorders.

Nomenclature of voice disorders and vocal pathology.

An improved nomenclature framework is crucial to improve communication regarding voice problems and to advance the field of voice disorders. The subjective nature of the voice evaluation process does not lend itself readily to uniformity and most voice-disordered patients demonstrate multiple pathologic processes. In this article, the authors offer a broad-based nomenclature paradigm for the classification of voice disorders and vocal pathology. Four major categories of voice disorders are identified based on pathophysiology and auditory-perceptual and visual-perceptual observations. As the understanding of vocal fold biomechanics and pathophysiology evolves, it is expected that this nomenclature system will also increase in specificity.

Diagnostic laryngeal endoscopy.

Diagnostic laryngeal endoscopy is a crucial part of the evaluation of patients with dysphonia. Multiple methods are available, and often several are required to provide a comprehensive physiologic and anatomic evaluation. The pros and cons of each method are discussed and the development of a standardized examination protocol is reviewed.

Laryngeal electromyography: diagnostic and prognostic applications.

Laryngeal electromyography is a crucial diagnostic test in laryngology. Laryngeal electromyography is important for the diagnosis of vocal fold paresis and cricoarytenoid joint pathology (e.g., arytenoid dislocation). In addition, laryngeal electromyography offers prognostic information regarding potential vocal fold paralysis recovery, which can improve the management strategies for vocal fold paralysis.

Outcome measurements and quality of life in voice disorders.

Although outcome research in the area of voice is truly in its beginning stages, the clinician who treats voice disorders should be aware of its potential usefulness. It is possible to identify a patient's perception of severity using one of several voice-specific outcome measures. Using these measures may also direct treatment in a more specific manner. For example, although a patient may have a vocal fold polyp or cyst, a low Voice Handicap Index may indicate that immediate surgery is unnecessary. A more conservative treatment approach or observation only may be appropriate. In this way, medical resources and time can be used most appropriately. Certainly one must never compromise treatment when significant disease is suspected. In the absence of significant disease, however, the patient's perceived severity and need to recover vocal function may determine treatment.

24 hours prior to curtain.

A retrospective review was conducted of 40 singers presenting with acute voice problems prior to performance. The purpose of this study was to determine the reasons for seeking emergent voice treatment, the types of acute voice disorders, and the performance outcome. The patients were assessed by age, singing style, years of experience, chief complaint, laryngovideostroboscopic findings, and treatment regimens. The outcomes were classified as full, restricted, or no performance. The majority of patients were classical singers. Laryngovideostroboscopy frequently revealed a pattern of early glottic contact at the mid-portion of the membranous vocal fold in patients with acute laryngitis. Experienced singers uniformly sought treatment many days before their performance compared with inexperienced singers who presented closer in time to performance. Six patients initially withheld information, which had a bearing on their acute management. The results of this study suggest that there is a need to accurately diagnose and treat the singer's emergent problem and educate singers regarding early evaluation of medical problems. With modern evaluation techniques and multi-modality treatment, 85% of the singers proceeded to full performance without negative sequelae.