VoiSS: a patient-derived Voice Symptom Scale

Validated patient reported outcome measures in speech-language pathology: A scoping review of adult practice

PURPOSE

Patient reported outcome measures (PROMs) are increasingly used to inform value-based healthcare. Within speech-language pathology (SLP), there is no synthesis of validated PROMs to guide professional practice. This scoping review systematically identifies and evaluates condition-specific PROMs across adult SLP practice.

METHOD

A literature search was performed to identify studies published until 18th February 2022 from MEDLINE, Embase, CINAHL, PsycInfo, Scopus, Cochrane Collaboration, and Web of Science. Abstracts and full texts were screened in Covidence. Relevant studies that validated PROMs in English were extracted and assessed using the "Checklist to operationalise measurement characteristics of PROMs" by two independent reviewers.

RESULT

Ninety-seven articles provided validation data for 71 PROMS across seven SLP practice areas. These included voice (n = 18), swallowing (n = 14), language (n = 11), fluency (n = 8), speech (n = 4), laryngectomy (n = 3), and cognitive-communication (n = 2). No PROMs were identified for augmentative and alternative communication (AAC) (n = 0). Quality ratings were variable on the Francis et al. checklist.

CONCLUSION

A range of validated PROMs were identified to guide SLP practice in measuring patient perceptions across a range of practice areas in adults. Opportunities for further development in SLP practice areas with limited PROMs, such as speech, cognitive-communication, and AAC are also highlighted.

Validation of the Spanish Version of the Voice-Related Quality of Life Questionnaire: Psychometric Properties and Clinical Applications

INTRODUCTION

The present study aimed to validate the Voice-Related Quality of Life (V-RQOL), vocal self-assessment questionnaire for Spanish.

METHODS

The validation and psychometric properties were developed according to the criteria of the Scientific Advisory Committee of Medical Outcomes Trust (SAC). The Spanish translation for linguistic and cultural adaptation of the V-RQOL was used. The study involved 193 participants, including 90 vocally healthy individuals and 103 patients with voice disorders, to establish validity. To evaluate reliability, the protocol was applied to 40 participants with dysphonia, who answered it twice before the treatment. Then to determine response changes, the responses of 13 dysphonic participants to the V-RQOL for Spanish were analyzed after intervention and then compared to the initial ones. Clinicians contrasted subjects' V-RQOL results with a perceptual analysis of voice quality using the GRBAS scale. In order to determine sensitivity and specificity cut-off values, tools results were subjected to the receiver operating characteristic curve analysis. The sensitivity was obtained from the experimental group (dysphonic group) and the specificity from the control group (non-dysphonic group).

RESULTS

This version of the V-RQOL questionnaire may be used as part of the standard assessment process of people with voice complaints and as an outcome of treatment efficacy in clinical trials.

CONCLUSION

A validation of the V-RQOL for Spanish in Chilean population was achieved.

Auditory Perception of Roughness and Breathiness by Dysphonic Women

OBJECTIVE

To investigate the auditory perception of roughness and breathiness by dysphonic women.

METHODS

Twenty-two dysphonic native Brazilian Portuguese women participated in this research. All participants underwent audiological evaluation and laryngeal examination to confirm the diagnosis. During the tests, they recorded the sustained vowel /Ɛ/. A speech-language pathologist performed the auditory-perceptual judgment of voice quality for these vocal samples, categorizing the general degree of vocal deviation (mild, moderate, and severe degree) and the predominant type of deviation (roughness or breathiness). Thirty-two (32) stimuli were selected from a voice database, including twenty-four (24) dysphonic voice samples and eight (8) voice samples from vocally healthy women. The authors conducted five perception experiments, being three categorization tasks (normal vs. deviated, breathy vs. nonbreathy, rough vs. nonrough) and two tasks for discriminating the degree of deviation (roughness degree and breathiness degree).

RESULTS

The experiments showed a difference between the answers for presence/absence of deviation, presence/absence of breathiness, and presence/absence of roughness in the stimuli, and a difference in the proportion of similar answers of dysphonic women (P < 0.001) regarding the identification of the deviation. Participants classified a large part of the deviated (57.9%), breathy (63.13%), and rough (65.31%) voices as normal. The degree of vocal deviation (P = 0.008) and the degree of roughness in the stimuli correlated positively with the proportion of similar answers of the participants. As for the discrimination of breathiness degrees, less deviated (normal and mild) voices were less discriminated, and more deviated (moderate and severe) voices were better discriminated. Regarding the discrimination of roughness degrees, only the voices with severe deviations showed good discrimination.

CONCLUSION

Dysphonic women had a high rate of not similar answers in the identification of normal and deviated voices. They identified more than half of the deviated voices as normal. Samples with more severe deviations were proportionally more identified as deviated by the participants. The greater the vocal deviation of the participants' voices, the smallest the number of similar answers. Participants had a high rate of not similar answers in the identification of normal and breathy voices. Dysphonic women show less ability to perceive mildly and moderately breathy voices in the breathy category. Participants had a high rate of similar answers in the identification of normal and rough voices. Dysphonic women show less ability to perceive mildly and moderately breathy voices in the breathy category. Participants show less ability to perceive only mildly roughness voices with similar responses. Dysphonic women could discriminate between voices with adjacent degrees of roughness but had a low percentage of similar answers for discrimination between voices with adjacent degrees of breathiness.

Voice Symptoms and Wellbeing in School Teachers in England

INTRODUCTION

Negative psychological factors such as depression and other common mental disorders have been found to be associated with voice problems in teachers. However, there is little research with teachers that investigates the relationship between positive psychological factors such as wellbeing and voice problems. Although negative and positive mental states are on a continuum of psychological health, research suggests negative and positive effects are not necessarily inversely correlated and therefore need to be investigated separately.

OBJECTIVE/HYPOTHESIS

To explore the relationship between voice symptoms and wellbeing in teachers working in primary and secondary schools in England. We hypothesise that as wellbeing increases voice symptoms will decrease.

DESIGN

Cross sectional study using a self-administered web-based questionnaire conducted with primary and secondary school teachers in England.

METHODS

The study included 1205 teachers from 608 primary and secondary schools, including state and fee paying, and mainstream and special schools. Voice symptoms were measured using The Voice Symptom Scale and wellbeing was measured using the Warwick Edinburgh Mental Wellbeing Scale. Information was also obtained on health, lifestyle, sociodemographic and environmental factors. Analysis was conducted using a linear multi-level regression model.

RESULTS

A statistically significant relationship between voice symptoms and wellbeing was identified (-0.31 95% CI -0.41, -0.20 P =< 0.001). Other factors found to be statistically significantly associated with voice symptoms were age, sex, gastroesophageal reflux, class size, background noise, speaking louder than normal and respiratory infection. Hours teaching per week, deprivation of school, voice training, teaching subject, smoking status and asthma were not associated with voice symptoms.

CONCLUSIONS

This study suggests that there is an association between vocal symptoms and wellbeing. Teachers with higher wellbeing had fewer voice symptoms.

The Immediate Impact of Targeted Exercises on Voice Characteristics in Female Speakers With Phonotraumatic Vocal Fold Lesions

OBJECTIVE

To examine the immediate impact of 30 minutes of targeted voice exercises on measures of vocal function and lesion characteristics in female speakers with phonotraumatic vocal fold lesions (PVFLs).

STUDY DESIGN

Prospective cohort study.

METHOD

Twenty-nine (n = 29) female subjects with PVFLs completed a 30 minutes targeted voice exercise protocol and a multidimensional voice analysis was conducted immediately pre and post-exercise. Analysis included expert perceptual evaluation of connected speech and stroboscopy recordings, instrumental analysis by selected aerodynamic and acoustic parameters, and self-ratings of effort and vocal function by participants. The direction and magnitude of the change from pre- to post-exercise for each individual across parameters was assessed against a Minimal Clinically Important Difference criteria.

RESULTS

Variability was observed among participants in their response to exercise and across parameters. Multidirectional change in function was demonstrated across instrumental parameters, with observations of both improvement and decline. The most consistent change observed was a reduced PTP post-exercises for 38% of participants (n = 11), and the greatest magnitude of change was observed in aerodynamic measures of airflow and pressure, and the acoustic parameter semitone range. Variability in the direction of change across instrumental measures was observed for 24% of participants (n = 7), while consistent improved function was seen for 45% (n = 13), declined function for 17% (n = 5) and no change for 14% (n = 4). Participant's self-reported effort and function post-exercise was also multidirectional, with the greatest number reporting improvement. Comparatively little change was observed in perceptual evaluation of speech and stroboscopy recordings. Findings suggest that individuals with all lesion types, sizes and liabilities have the potential to improve vocal function immediately post-exercises according to instrumental measures, with the greatest magnitude of change observed in participants with large lesions. Although participants' characteristics did not differentiate, those with nodules or polyps tended to report improvement in function and reduced effort post-exercise, whereas those with a diagnosis of pseudocyst/s or a unilateral lesion appeared to report no change or declined function.

CONCLUSION

Change in measures of vocal function was observed in female speakers with PVFLs immediately following a 30 minutes targeted exercises protocol. Many demonstrated improvement but a high degree of variability was observed in the way speakers respond, and it is likely an individual's response is influenced by a range of factors. Self-rating scales, along with key instrumental parameters sensitive to the presence of PVFLs, may prove most useful in tracking initial change in the immediate and short-term duration in this population, and in assessing stimulability and candidacy for therapy. Further exploration is warranted of stimulability for immediate and cumulative change to achieve sustained improvement in function and efficiency across time.

Validation and Cultural Adaptation of the Arabic Version of the Aging Voice Index

BACKGROUND

The aging voice index (AVI) is a 23-item self-administered, patient-reported outcome measure. It was developed in the English language to assess the impact of voice disorders on the elderly population.

OBJECTIVES

This study aimed to develop an Arabic version of the AVI (A-AVI), test its reliability and validity, and assess its psychometric aspects in Arabic-speaking elderly persons with voice disorders.

STUDY DESIGN/METHODS

This was an observational, cross-sectional study involving elderly patients aged ≥60 years. Eighty-two patients with voice disorders were included in the dysphonia group and 77 patients without voice disorders were included in the vocally healthy group. The translated A-AVI and Arabic voice handicap index 10 (A-VHI10) were distributed to the study groups. The A-AVI was tested for its reliability (test-retest reliability and internal consistency) and validity (content, construct, and concurrent with A-VHI10).

RESULTS

The A-AVI showed excellent test-retest reliability and internal consistency (intraclass correlation coefficient = 0.987 and Cronbach's alpha = 0.954, respectively). There was a significant difference in A-AVI scores between the elderly in the dysphonia and vocally healthy groups (P < 0.001). In addition, a significant correlation was demonstrated between A-AVI and A-VHI10 (r = 0.89). Unilateral vocal fold immobility and inflammatory laryngeal disorders were most frequently reported by the dysphonia group (28%).

CONCLUSIONS

A-AVI has excellent validity and reliability in Arab-speaking elderly patients with voice disorders. It can be considered in the assessment of the effect of voice disorders on the quality of life of the elderly.

Prospective Teacher's Voice Questionnaire (PTVQ): Development of a Questionnaire to Assess Training-Related Voice Symptoms Among Prospective Teachers

AIM

To develop and validate a self-administered population-specific survey, available in Spanish, Portuguese, and English, which investigates the prevalence of voice symptoms and perceptions of risk factors associated with training among prospective teachers.

METHODS

The present study had three stages: the first stage included a literature review and content validation by experts that supported the survey development. From this phase, we defined five aspects of the Prospective Teacher's Voice Questionnaire (PTVQ): (1) target population, (2) research objectives, (3) questions to be included, (4) scales for the answers, and (5) relevance, comprehensiveness, clarityclarity, and understandability of the questions. This process was performed in parallel for the three languages (Spanish, Portuguese, and English). The second stage included pilot testing. This involved administering the first draft of the survey to a group of 120 students to evaluate the feasibility and effectiveness of the survey instrument, identify any potential problems with the survey, and refine the instrument based on feedback from the pilot participants. The third stage includes the restructuring of the questionnaire's voice quality section to eliminate redundant questions. Through Principal Component Analysis, multicollinear variables were condensed, facilitating the removal of redundant items, and ensuring that the final questionnaire comprised only the most relevant and discriminative questions.

RESULTS AND DISCUSSION

The final version of the survey, available in Spanish, Portuguese, and English, consists of four sections with a total of 57 questions. The development of the PTVQ represents a significant step toward better understanding and addressing voice disorders among prospective teachers. Future research could further refine the questionnaire and explore its predictive validity in identifying individuals at risk of voice disorders early in their teaching careers. Additionally, interventions based on the findings from the PTVQ could be developed to support the voice health and well-being of prospective teachers, ultimately improving teaching quality and job satisfaction in educational settings.

Translation and Cross-Cultural Adaptation of the Thyroidectomy-Related Voice Questionnaire (TVSQ) in Greek Population

OBJECTIVES

The Thyroidectomy-Related Voice Questionnaire (TVSQ) is a useful tool in the detection of voice changes and dysfunctions and the diagnosis of other symptoms related to transient or permanent laryngeal nerve damage in patients after thyroidectomy. The aim of our study is the translation and validation of (TVSQ) in the Greek language and in Greek population for the first time.

METHODS

The TVSQ was translated from English to Greek and vice versa by two independent researchers, while before the application of the TVSQ in clinical practice, a control group of 20 people was used. The following methods were used for the weighting and analysis of the TVSQ: Polychoric correlation, Cronbach's alpha, confirmatory factor analysis, and item response theory (IRT).

RESULTS

Polychoric correlations revealed that questions 1-10 have a strong positive correlation with each other, while the correlation of the rest of the TVSQ items is positive. Subsequently, for the first subgroup of questions ("voice change") Cronbach's alpha was equal to 0.950, while for the second ("throat and neck discomfort") Cronbach's alpha was equal to 0.846. Thus, we conclude that the internal consistency reliability is high for both subgroups of TVSQ questions. With the IRT method we showed that for the first subgroup of questions ("voice change"), the item with the least predictive value is question 5, while for the second subgroup of questions ("throat and neck discomfort"), the item with the least educational value was question 15.

CONCLUSIONS

Our team translated and validated the TVSQ with the above statistical methods in the Greek language, so that it can be used as a valuable tool in clinical practice, and more specifically in patients undergoing thyroidectomy. TVSQ can play a significant role on the diagnosis of either postoperative voice disorders and other symptoms related to thyroidectomy.

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.

The Impact of a Vocal Loading Task on Voice Characteristics of Female Speakers With Benign Vocal Fold Lesions

OBJECTIVES

To examine the effect of a vocal loading task on measures of vocal structure and function in females with benign vocal fold lesions (BVFLs) and determine if change is observed in voice and lesion characteristics.

STUDY DESIGN

Prospective cohort study.

METHODS

Twenty-eight (n = 28) female subjects with phonotraumatic BVFLs completed a vocal loading task of 30 minutes of reading aloud at 75-85 dBA. Multidimensional voice evaluation was completed pre- and post-load, including audio and videostroboscopy recordings and images for expert perceptual ratings and acoustic and aerodynamic evaluation. Subjects also scored themselves using a 10 cm visual analogue scale for Perceived Phonatory Effort, and completed the Evaluation of Ability to Voice Easily, a 12 item self-report scale of current perceived speaking voice function. An exploratory rather than confirmatory approach to data analysis was adopted. The direction and magnitude of the change scores (pre- to post-load) for each individual, across a wide variety of instrumental and self-report measures, were assessed against a Minimal Clinically Important Difference criteria.

RESULTS

Observations of change and the direction of change in vocal response of individuals with BVFLs to 30 minutes of loud vocal load was variable. Minimal to no change was noted for participants pre- to post-load as rated perceptually, for auditory and videostroboscopy samples. For most instrumental measures, change was shown for many participants including an overall improvement in aerodynamic and acoustic measures of function and efficiency post-load for 20 participants (77%) and decline in function for 4 participants (15%). Self-reported effort and vocal function post-load was multidirectional with similar numbers of participants reporting no change, improved function or a decline.

CONCLUSION

Subjects with BVFLs demonstrate change in vocal function following 30 minutes of vocal load. While this change can be variable and multidirectional, overall improvement was observed in instrumental measures of function and efficiency for most participants. Some participants perceived this change to be an increase in effort, some a reduction in effort and some perceived no change. Improved vocal function despite relative lesion stability can seemingly occur after loading in some pathological voices.

Voice self-assessment in individuals with Parkinson's Disease as compared to general voice disorders

BACKGROUND

Individuals with Parkinson's Disease (IwPD) often fail to adjust their voice in different situations, without awareness of this limitation. Clinicians use self-report questionnaires that are typically designed for individuals with General Voice Disorders (GVD) in the vocal assessment of IwPD. However, these instruments may not consider that IwPD have a reduced self-perception of their vocal deficits. This study aimed to compare self-reported vocal symptoms and voice loudness between IwPD and GVD.

METHODS

28 IwPD and 26 with GVD completed the Voice Symptom Scale (VoiSS) questionnaire to evaluate their voice self-perception. Vocal loudness (dB) was also assessed. Univariate and multivariate analyses were used to compare the outcomes from these measures between the two groups. Principal Component Analysis and Hierarchical Clustering Analysis were applied to explore data patterns related to voice symptoms.

RESULTS

IwPD reported significantly fewer vocal symptoms than those with GVD in all VoiSS questionnaire domains. Multivariate principal component analysis found no significant correlations between VoiSS scores and participant similarities in voice measures. Despite experiencing hypophonia, IwPD scored lower in all VoiSS domains but still fell in the healthy voice range. Hierarchical Clustering Analysis grouped participants into three distinct categories, primarily based on age, vocal loudness, and VoiSS domain scores, distinguishing between PD and GVD individuals.

CONCLUSIONS

IwPD reported fewer vocal symptoms than GVD. The voice self-assessment seems to be unreliable to assess vocal symptoms in IwPD, at least regarding loudness. New self-report instruments tailored to PD individuals are needed due to their particular voice characteristics.

Clinical Parameters of the Speech-Language Pathology Assessment of the Chronic Cough: A Scoping Review

OBJECTIVE

to map the clinical parameters used in the speech-language pathology assessment of the chronic cough.

METHODS

a scoping review was performed to answer the clinical question: "What are the clinical parameters included in the speech-language pathology assessment of patients with chronic cough?" Evidence was searched by electronic and manual search. The electronic search included: MEDLINE, Cochrane Library, EMBASE, Web of Science, SCOPUS, and LILACS. Each database had a specific search strategy. The manual search included Journal of Voice, Chest, and Thorax, Brazilian Library of Theses and Dissertations, Open Grey, and Clinical Trials, in addition to scanning the references of the included studies. The extracted data considered information regarding the publication, sample, assessment, and measures used when assessing chronic cough.

RESULTS

the electronic search found 289 studies; the manual search found 1036 studies; 12 were selected for the present study. The most used assessments were: self-assessment (75%), aerodynamic analysis (66.67%), the perceptual auditory judgment of the voice quality (58.33%), acoustic analysis of the voice (41.67%), cough frequency, and cough threshold (41.67%) and electroglottography (25%).

CONCLUSIONS

the subjective instruments were used more frequently, while specific objective instruments, which are recent, were used less frequently. Complementary assessments such as vocal assessment, have been frequently used, also, with no other parameter. A lack of homogeneity was identified in the speech-language pathology assessment and measures of patients with chronic cough, thus, the comparison among studies and clinical analysis is difficult.

Vocal Tract Discomfort Scale-Brazil (VTDS-BR): Validation Based on Internal Consistency, Reliability, and Accuracy

OBJECTIVE

To validate the Vocal Tract Discomfort Scale for the Brazilian Portuguese (VTDS-BR), based on internal consistency, reliability, and accuracy.

METHODS

The participants were 431 adults of both sexes, divided in two groups: dysphonia (DG) and vocally healthy (VHG). We built a digital database with personal, professional information and the item-by-item VTDS-BR responses of the participants. We applied Cronbach's alpha, exploratory factor analysis; confirmatory factor analysis; Item Response Theory (IRT) using the Samejima model; and ROC (Receiver Operating Characteristic) curve analysis to obtain the VTDS-BR cut-off point.

RESULTS

The VTDS-BR has an eight-item structure and two factors: vocal hyperfunction without phonotraumatic injury and with phonotraumatic injury. Each item is evaluated based on two facets related to frequency and intensity, with a Likert scale response key. There are four possible answers: never, sometimes, often, and always for frequency and none, mild, moderate, and intense for intensity. We applied an IRT model, which allowed the identification of which items are more related to dysphonia, based on higher values in the parameters discrimination (a) and difficulty (b), which contributed to the calculation of each participant's aptitude for the development of voice problems, by means of a score. The cut-off value was determined using the ROC curve, in which values greater than - 1.432 indicate a higher probability of voice alterations.

CONCLUSION

VTDS-BR went through the stages of validation of internal consistency, reliability, and accuracy. It presents an 8-item, two-factor, and two-facet structure to assess frequency and intensity of vocal tract discomfort symptoms. VTDS-BR is suitable for clinical use or in screening activities, as it is quick to apply and its interpretation is indicative of people with and without phonotraumatic injury.

A Systematic Review of Voice-Related Patient-Reported Outcome Measures for Use with Adults

PURPOSE

This paper's purpose is to provide a resource for clinicians and researchers of select voice-related patient-reported outcome measures (PROMs) available in the English language.

METHOD

A systematic search for voice-related PROMs was conducted between September 2020 and July 17, 2021. Databases included APA PsychInfo, Nursing and Allied Health Source, MEDLINE via the EBSCO interface, and Science Direct. Reference lists for PROMs-related articles were mined for reference to PROMs protocols.

RESULTS

Thirty voice-related PROMs were identified and categorized as either developed primarily for use in the clinic (n = 12), developed primarily for use in a specific research study (n = 6), or translated into English for publication (n = 12). Twelve PROMs were summarized: Aging Voice Index, Disease Specific Self-Efficacy in Spasmodic Dysphonia, Evaluation of the Ability to Sing Easily, Evaluating Voice Disability - Quality of Life Questionnaire, Glottal Function Index, Linear Analog Scale of Assessment of Voice Quality, Quality of Life in Recurrent Respiratory Papillomatosis, Speech Disability Questionnaire, Trans Woman Voice Questionnaire, Vocal Cord Dysfunction Questionnaire, Vocal Fatigue Index, and the Vocal Tract Discomfort Scale.

CONCLUSION

The PROMs can be categorized into English-language voice-related PROMs developed primarily for clinical use, English-language PROMs developed primarily for research use, and English-language PROMs translated into English. The extent of reliability and validity testing completed varies in the PROMs developed primarily for clinical use. A PROM's psychometric properties as well as the language in which the PROM was tested, should guide clinicians and researchers as they consider which instrument(s) to use.

The Patient Experience: The Relationship Between Vocal Handicap, Congruency, Perceived Present Control, and Mood Across Four Voice Disorders

OBJECTIVE

The potential for negative sequalae in psychosocial well-being presents clinical importance to the assessment of voice disorders. Despite the impairment voice disorders cause in the psychosocial domain, the clinical assessment of these disorders relies heavily on visual perceptual judgments of the larynx, audio-perceptual, as well as acoustic and aerodynamic measures. While these measures aid in accurate diagnosis and are necessary for standard of care, they present little insight into the patient experience of having a voice disorder.

DESIGN

Retrospective between-subject, non-experimental design.

METHODS

Data from 335 patients from the University of Pittsburgh Voice Center were collected from scores of the Voice Handicap Index-10 (VHI-10) and two recent questionnaires, the Voice Present Perceived Control scale (VPPC), and the Vocal Congruency Scale (VCS). Examining how these voice-specific scales related to three mental health screeners for stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) were also examined. Patient diagnoses included primary muscle tension dysphonia (pMTD), unilateral vocal fold paralysis (UVFP), vocal fold atrophy, and mid membranous vocal fold lesions.

RESULTS

There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures.

DISCUSSION

This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments.

Voice Changes Without Laryngeal Nerve Alterations After Thyroidectomy: The Need For Prospective Trials - A Review Study

BACKGROUND

Thyroidectomy is a commonly performed surgical procedure that is offered for different thyroid pathologies. The most frequent complication after total thyroidectomy is transient or permanent hypoparathyroidism followed by transient or permanent recurrent laryngeal nerve palsy. Patients may experience voice impairment despite intact laryngeal nerve function. These patients are of special interest because they experience subjective symptoms which are difficult to measure and therefore to treat.

SUMMARY

The Voice Handicap Index (VHI) and VHI-10 are the most commonly used subjective questionnaires. Their results correlate with objective findings. Female sex, in particular after menopause, is a dominant factor for developing voice impairment after thyroidectomy. The extent of neck surgery and the weight and volume of the removed thyroid correlates directly with both objective and subjective voice impairment after surgery. Videolaryngostroboscopy should be considered to examine vocal cord pathologies in this patient group. Surprisingly, there are no studies showing that speech and voice therapy are beneficial for patients with voice alterations but with intact laryngeal nerves.

CONCLUSIONS

While recurrent laryngeal nerve (RLN) paralysis can be evaluated by objective exams postoperatively, we are still left with the issue of possible partial or complete external branch of superior laryngeal nerve (EBSLN) injury. It is therefore quite difficult to segregate neural (RLN and EBSLN) and non-neural voice change populations, regardless of the method of literature evaluation. Perhaps patients' perspectives on how they experience voice functionality should play a superior role in deciding which patients should be investigated further with laryngoscopy, acoustic or perceptual analysis, and which patients should be offered treatment.

Voice Acoustic Parameters as Predictors of Depression

OBJECTIVE

To analyze whether voice acoustic parameters are discriminant and predictive in patients with and without depression.

METHODS

Observational case-control study. The following instruments were administered to the participants: Self-Reporting Questionnaire (SRQ-20), Beck Depression Inventory-Second Edition (BDI-II), Voice Symptom Scale (VoiSS) and voice collection for subsequent extraction of the following acoustic parameters: mean, mode and standard deviation (SD) of the fundamental frequency (F0); jitter; shimmer; glottal to noise excitation ratio (GNE); cepstral peak prominence-smoothed (CPPS); and spectral tilt. A total of 144 individuals participated in the study: 54 patients diagnosed with depression (case group) and 90 without a diagnosis of depression (control group).

RESULTS

The means of the acoustic parameters showed differences between the groups: F0 (SD), jitter, and shimmer values were high, while values for GNE, CPPS and spectral tilt were lower in the case group than in the control group. There was a significant association between BDI-II and jitter, shimmer, CPPS, and spectral tilt and between CPPS and the class of antidepressants used. The multiple linear regression model showed that jitter and CPPS were predictors of depression, as measured by the BDI-II.

CONCLUSION

Acoustic parameters were able to discriminate between patients with and without depression and were associated with BDI-II scores. The class of antidepressants used was associated with CPPS, and the jitter and CPPS parameters were able to predict the presence of depression, as measured by the BDI-II clinical score.

Vocal Tract Discomfort Scale: Adaptation, Validity, and Reliability of the Turkish Version

BACKGROUND

Currently, there is no Turkish assessment tool available for the evaluation of vocal tract discomfort. The objective of this study is to cross-cultural adaptation of the Vocal Tract Discomfort Scale (VTDS) to Turkish and assess its validity and reliability.

METHOD

The study was conducted with a total of 214 participants, consisting of 121 individuals with voice disorders and 93 individuals without voice disorders. All participants completed the Voice Handicap Index (VHI), Voice-Related Quality of Life (VRQOL), and VTDS. To conduct a test-retest reliability assessment, the VTDS was administered again to 54 participants within 7-14 days.

RESULTS

The internal consistency of VTDS was evaluated using Cronbach's alpha coefficient. The Cronbach's alpha coefficient for the scale was calculated at 0.964, while it was 0.922 for the frequency subscale and 0.930 for the severity subscale. It was found that there was a high degree of correlation (rho = 0.868, frequency rho = 0.847, severity rho = 0.875, P < 0.001) between the two administrations, indicating the reliability of the test-retest assessment. To assess the criterion validity of the scale, correlations between VTDS total scores and VHI and VRQOL scales were examined. Accordingly, it was found that there was a high degree of correlation between VTDS and VHI (rho = 0.631, frequency rho = 0.635, severity rho = 0.616, P < 0.001). It was also observed that there was a high degree of negative correlation between VTDS and VRQOL (rho = -0.701, frequency rho = -0.702, severity rho = -0.692, P < 0.001). It was assumed that there would be statistically significant differences in VTDS total scores among the diagnostic groups, and it was found that there was a significant difference between the two groups (U = 1095.000, z = -10.110, P < 0.001). These findings support the discriminative validity of VTDS.

CONCLUSIONS

The Turkish version of VTDS is a valid and reliable scale that can assess perceptible symptoms and sensations in the vocal tract in terms of both frequency and severity.

Urica-VV Scale: A New Research Perspective of The Stage of Readiness for Treatment in Patients with Dysphonia

OBJECTIVE

To obtain evidence of validity for the URICA-V scale and estimate the psychometric properties of its items based on item response theory (IRT).

METHOD

A total of 658 individuals of both sexes over 18 years of age were allocated into two groups: with dysphonia group (WDG) and vocally healthy group (VHG). A digital database was constructed with personal and professional data and item-by-item responses on the URICA-V scale. Subsequently, Cronbach's alpha, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), application of IRT using Samejima's model and ROC curve analysis were used to obtain the cutoff point for the URICA-V scale.

RESULTS

A different version of the original URICA-V scale was obtained. Of the 32 items from the original protocol, 25 better explained the instrument and were regrouped into two domains: contemplation and maintenance. It was possible to identify which items generated higher difficulty (b) and discrimination (a) values and which contributed to the presentation of a calculation based on the theta of each participant. The ROC curve was analyzed, and a cutoff point of -0.236 was established; establishing a cutoff point facilitates the decision of which individuals are in a state of readiness for voice treatment.

CONCLUSION

The present study provided evidence that allows us to propose the URICA-Voice validated (URICA-VV) scale within a more contemporary perspective and with a reduced number of items and domains. In addition, a cutoff point was obtained based on IRT to measure, with greater accuracy, sensitivity and specificity, the stage of readiness and to differentiate individuals who have an indication for speech therapy.

Prevalence of Laryngopharyngeal Reflux Symptoms, Dysphonia, and Vocal Tract Discomfort in Amateur Choir Singers

INTRODUCTION

Vocal tract discomfort (VTD), dysphonia, and laryngopharyngeal reflux (LPR) symptoms are complaints frequently reported by amateur singers. There are two aims of this study. The first is to evaluate the prevalence of these symptoms using validated questionnaires. The second is to correlate singing-related variables with the questionnaire responses.

METHODS

A total of 392 amateur choir singers (ACS) and 514 control subjects completed an online survey divided into four parts: (1) clinical and demographic characteristics, (2) training in singing and singing experience, (3) history of gastroesophageal reflux disease and LPR symptoms, (4) validated questionnaires. Specifically, the reflux symptom index (RSI), the vocal tract discomfort scale (VTDS), and the voice symptom scale (VoiSS) were included to analyze the actual burden related to LPR symptoms, VTD, and dysphonia.

RESULTS

ACS demonstrated a healthier lifestyle and a lower prevalence of gastroesophageal reflux disease symptoms in comparison with control subjects. ACS scored significantly higher in VTDS and VoiSS than control subjects, while no differences in the RSI results were found. Significant correlations among the questionnaires' results were demonstrated. Occasional professional singing was the variable influencing VTDS and VoiSS results the most.

CONCLUSION

ACS do not evidently manifest a higher impairment connected to LPR (RSI score), while they do report higher levels of voice (VoiSS score) and vocal tract (VTDS score) impairments, in comparison with control subjects. The relevant correlations among the PRO measures suggest that LPR symptoms, VTD, and dysphonia are related to each other. Given the relevant repercussion on the severity of VTD and dysphonia, providers should specifically ask about occasional professional singing when treating amateur singers.

Future teachers and the self-perception of vocal symptoms and knowledge about vocal health and hygiene

PURPOSE

To analyze responses of future teachers regarding the self-perception of vocal symptoms and knowledge about vocal health and vocal hygiene, relating them to sociodemographic and occupational variables and previous knowledge about voice.

METHODS

Observational, analytical and cross-sectional study. A total of 264 undergraduate students participated and the Vocal Health and Hygiene Questionnaire (QSHV), Vocal Symptoms Scale (ESV) and a questionnaire with sociodemographic, occupational and vocal questions were applied. Data were statistically analyzed considering a 5% significance level.

RESULTS

QSHV of future teachers had a total mean score of 21.89, suggestive of lack of knowledge about vocal health and hygiene. The results of the ESV are above the instrument's cutoff score, in each of the three domains and in the total score, there was greater symptomatology in first-year students when compared to other students, in the emotional, limitation and total domains. There was a difference when comparing the QSHV with the year of graduation (p=0.001), in which third and fourth year students obtained higher scores. A positive correlation was observed between the total QSHV score and the age variable (p=0.019).

CONCLUSION

Future teachers present important vocal symptomatology, compatible with dysphonic individuals, and have insufficient knowledge about vocal health and hygiene. Knowledge is even lower among students in the early undergraduate years and at a younger age. Older future teachers demonstrate more knowledge about vocal health and hygiene. It is necessary to propose preventive actions with this population, even during the graduation period, aiming to reduce the risks of developing vocal problems in the medium or long term during teaching.

Psychometric Properties of the Voice Handicap Index-10 in Kannada

OBJECTIVES

This study aimed to derive the 10-item voice handicap index in the Kannada language (VHI-K10) from the existing VHI-30 in Kannada (VHI-K30). We also aimed to examine several psychometric properties of the newly derived VHI-K10, such as internal consistency, reliability, concurrent validity, discriminant validity, and diagnostic accuracy.

METHODS

Initially, VHI-K10 was derived from the existing VHI-K30 through item reduction, consistent with the recommendations for item reduction of the voice handicap index. This newly derived VHI-K10 was administered to 273 individuals (199 individuals with dysphonia and 74 individuals with normal voice quality). We also obtained phonation and reading samples from the participants. The obtained data were subjected to appropriate statistical analysis to determine several psychometric properties.

RESULTS

The newly derived VHI-K10 was found to have a strong internal consistency (Cronbach's α = 0.93). We also found strong test-retest reliability for VHI-K10, with an intraclass correlation coefficient of 0.933. There was a strong statistically significant correlation between the VHI-K10 and the existing VHI-K30 for both individuals with dysphonia (ρ = 0.924, P < 0.001) and individuals with normal voice quality (ρ = 0.798, P < 0.001). However, the correlation of VHI-K10 with the auditory-perceptual measure of GRBAS was fair (ρ = 0.353, P < 0.001) for individuals with dysphonia and was not statistically significant for individuals with normal voice quality. Further, the diagnostic accuracy of VHI-K10 was found to be excellent, with an area under the curve (AROC) value of 0.926 with a cut-off point of ≥6.5, which was slightly superior to that of VHI-K30 (AROC = 0.909, cut-off point ≥21.5).

CONCLUSIONS

The shortened 10-item version of the voice handicap index in Kannada is consistent with versions of the VHI-10 in other languages. This version of the VHI-10 in Kannada is found to be a robust tool with strong psychometric properties.

Functional and quality-of-life outcomes following salvage surgery for recurrent squamous cell carcinoma of the head and neck: a systematic review and meta-analysis

BACKGROUND

Recurrent head and neck squamous cell carcinomas (HNSCC) are frequently managed with salvage surgery, but the impact these operations have on function and quality-of-life (QoL) is understudied. This review aimed to provide a quantitative and qualitative assessment of the functional and QoL effects of salvage surgical procedures.

METHODS

Systematic review and meta-analysis were conducted of studies reporting QoL and function following salvage HNSCC resections.

RESULTS

The search identified 415 articles and 34 were selected for inclusion. Pooled random effects analysis revealed long-term feeding and tracheostomy tube rates of 18% and 7%. Pooled long-term feeding tube rates in open oral and oropharyngeal, transoral robotic, total and partial laryngectomy surgeries were 41%, 25%, 11% and 4%. Eight studies used validated QoL questionnaires.

CONCLUSIONS

Functional and QoL outcomes from salvage surgery are acceptable, but appear to be worse following open procedures. Prospective studies measuring changes over time are needed to assess these procedures impact on patient well-being.

Persistent Features of Laryngeal Injury Following Endotracheal Intubation: A Systematic Review

This systematic review examined (i) prevalence, severity, and impact of persistent post-extubation laryngeal injury beyond hospital discharge and (ii) differences in persistent laryngeal injury between COVID-19 and non-COVID-19 populations. The review was completed following PRISMA-2020 guidelines. Four databases (PubMed, CINHAL complete, EMBASE, Web of Science) were searched (inception to March 2021). Screening, full text review and data extraction were completed by two reviewers. Primary outcomes were swallow, voice and cough and airway measures obtained after hospital discharge. Quality assessment was measured using Downs & Black Tool and Johanna Briggs Institute Checklist for Cohort Studies. Meta-analysis was not completed due to study heterogeneity. Six cohort studies were included. Total number of participants across the included studies was 436. ICU admission diagnoses included respiratory disease 46% (COVID-19 and non-COVID-19), sepsis 14%, non-sepsis-related organ dysfunction 9%, general medical 11%, general surgical 10%, trauma 2%, ENT 0.6% and other not specified by authors 7%. Outcomes were obtained between 2 and 60 months post hospital discharge. Assessment methods included endoscopic evaluation, clinician ratings and patient-reported outcomes. Persistent features of laryngeal injury identified were airway abnormalities (18.9-27%), dysphonia (13.2-60%) and dysphagia (23-33%). Persistent laryngeal injury was associated with ICU length of stay, respiratory diagnosis and tracheostomy. Study quality ranged from poor-good. This is the first systematic review to examine post-extubation laryngeal injury beyond hospital discharge. Significant gaps in the literature were identified. Given the impact on clinical and patient outcomes, large scale, well-designed research is needed to guide post-ICU service delivery.

University Professors' Communicative Competence and Its Relationship With Interpersonal Communication and Voice Symptoms

OBJECTIVE

To analyze the association between communicative competence self-assessment and interpersonal communication self-perception and voice symptoms in university professors.

METHOD

Cross-sectional, analytical, observational study in 322 professors, who answered sociodemographic and occupational questions and three self-perception protocols: Self-Assessment of Communication Competence (SACCom), Interpersonal Communication Competence Scale (ICCS), and Voice Symptom Scale (VoiSS). The dependent variable was SACCom's yes/no answers. Univariate and multivariate descriptive and inferential data analyses were performed through logistic regression.

RESULTS

Most professors were females (55.3%), worked 40 hours (96.6%), and self-reported voice symptoms (72.7%). The largest portion had been in the career for 11-22 years (38.2%). The final multivariate model demonstrated that better self-assessed communicative competence among professors (SACCom) is related to an absence of voice complaints (odds ratio (OR) = 2.17; 95% confidence interval (CI) 1.29-3.65) and better self-perceived interpersonal communication (ICCS) (OR = 1.05; 95% CI 1.02-1.08). The older the professor (OR = 1.03; 95% CI 1.01-1.06), the better their communicative competence (SACCom).

CONCLUSIONS

Study professors' self-assessed communicative competence is predominantly high. Those with a better communicative competence self-assessment are older and vocally healthy and self-perceive greater interpersonal communication skills.

Internal Consistency of the Voice Handicap Index in Individuals With Dysphonia: A Systematic Review and Meta-Analysis

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.

Adaptation and Validation of the Voice Symptom Scale into Kannada (VoiSS-K)

BACKGROUND

The Voice Symptom Scale (VoiSS) is a self-assessment tool that assesses vocal symptoms and measures the effect of dysphonia. Adapting VoiSS into Kannada can be beneficial in evaluating dysphonia-related symptoms, especially in the Kannada-speaking population.

OBJECTIVES

To adapt the VoiSS into Kannada and to assess the reliability, validity, and cut-off values of the VoiSS Kannada version (VoiSS-K).

STUDY DESIGN

The study used a prospective nonrandomized standard group comparison.

METHODS

Initially, the VoiSS was translated into Kannada. The VoiSS-K was administered to 76 participants (34 females and 42 males) with a mean age of 46.4 ± 14.5 years having voice disorders. The VoiSS-K was also administered to 76 respondents having clinically normal voice who were age and gender-matched to the participants with voice disorders.

RESULTS

Cronbach's alpha was utilized to evaluate the internal consistency, and the intraclass correlation coefficient to evaluate the test-retest reliability. The findings indicated that the VoiSS-K had excellent test-retest reliability and internal consistency. The study group participants had significantly higher VoiSS-K scores than the control group participants. Thus, the outcomes indicated that the VoiSS-K had good discriminative validity. Receiver operating characteristic curve analysis was conducted, and the cut-off score of VoiSS-K was 40.50.

CONCLUSION

As the VoiSS-K is a rigorous, robust, and detailed self-assessment questionnaire, it can be used as a clinically sensitive tool to evaluate voice symptoms in Kannada-speaking individuals.

The effect of hearing impairment and social participation on depressive symptoms in older adults: a cross-lagged analysis

Objective

This study aimed to investigate the relationship between hearing impairment, depressive symptoms, and social participation in older adults.

Methods

The study used data from the China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2018, which included 3,980 samples. The analysis was conducted using cross-lagged structural equation modeling with SPSS 23.0 and Mplus 7.4.

Results

The findings show that from 2013 to 2018, older people had significantly more hearing impairment and depressive symptoms and significantly less social participation. Hearing impairment was a significant negative predictor of social participation, and older adults with hearing impairment were less likely to participate in social activities. In addition, there may be a bidirectional relationship between hearing impairment and depressive symptoms, with both being positive predictors of each other. Finally, the study found that social participation played an important mediating role in the relationship between hearing impairment and depressive symptoms.

Conclusion

The study's findings highlight the complex interplay between hearing impairment, social participation, and depressive symptoms in older adults. Therefore, it is important to intervene promptly when hearing impairment is detected in the elderly; pay attention to patient guidance and comfort for the elderly with hearing impairment, give them positive psychological support, encourage them to get out of the house and participate in more social activities to avoid depressive symptoms. The study's results may inform the development of targeted interventions to address the mental health needs of older adults with hearing impairment.

Validation of the Czech Version of the Voice Handicap Index

OBJECTIVE(S)

The present study aims to evaluate the reliability and construct validity of the Czech version of the Voice Handicap Index (VHI-CZ) and determine the cut-off value to distinguish dysphonic patients from nondysphonic individuals.

STUDY DESIGN

Prospective study, Parallel group design.

METHODS

The study investigated 100 adult patients with dysphonia, divided into three groups based on the etiology of the voice problem (neurogenic, functional, and structural). Out of these, 25 patients were used for test-retest analysis, and 45 patients to determine the responsiveness to change. The control group consisted of 51 healthy subjects. All 151 individuals completed the VHI-CZ and were examined with the videolaryngostroboscopy. The internal consistency (Cronbach's alpha), the test-retest reliability (Intra-class Correlation Coefficient, ICC), and the construct validity were analyzed and the normative cut-off value was determined.

RESULTS

The internal consistency of the VHI-CZ was excellent (Cronbach α = 0.984), and test-retest reliability was also excellent (ICC = 0.95, P < 0.001). The correlation between the self-assessed severity of the voice disorder and the VHI-CZ score was strong (Spearman's ρ = 0.877, P < 0.001). The VHI scores differences between dysphonic and nondysphonic patients were statistically significant (Mann-Whitney U test, P < 0.001). The differences among the three etiological subgroups (neurogenic, functional, and structural) were also statistically significant (Kruskal-Wallis test, P < 0.001). Moreover, the differences in the VHI-CZ total scores between pretreatment and posttreatment were statistically significant (Wilcoxon test, P < 0.001). The cut-off score of 13 points was found, by the analysis of the Receiver Operating Characteristic (ROC, Youden Index), to be most suitable for preselecting dysphonic individuals.

CONCLUSION

The existing VHI-CZ showed excellent reliability and construct validity. The Czech VHI is a useful and valid monitoring tool for clinicians.

Reliability of Vocal Self-assessment Tools in Individuals With Vocal Complaints Applied Using a Digital Platform and In-person

OBJECTIVE

To verify the reliability of vocal self-assessment tools in individuals with vocal complaints using a digital platform and in-person.

METHODS

Data from 50 Brazilian adults with vocal complaints were collected. The participants answered the Voice Symptoms Scale (VoiSS), the Voice Handicap Index - 10 (VHI-10), and questions regarding personal information and their general health. The data collection occurred in two moments, within a period of 2-14 days, with time variation between participants, and always in the same collection order: 1. using a digital platform (Google Forms); 2. In-person. The data were analyzed descriptively and inferentially using the SPSS 25.0 software and the Wilcoxon Test.

RESULTS

The self-perception of vocal symptoms in the Emotional factors for women presented a statistical difference between the digital platform and the in-person response (P = 0.029); higher scores were observed when answers were given in-person compared to using a digital platform.

CONCLUSION

Overall, the participants perceived their voice symptoms and voice handicap similarly when answers were given using a digital platform and in-person. The Emotion voice symptoms in women were the only exception, although remaining deviated; however, the perception of the symptoms may have been attenuated during the in-person care.

Validation of the Polish Version of Voice Handicap Index-10

PURPOSE

The aim of this study was to adapt and evaluate the psychometric properties of the Polish version of the VHI-10.

METHODS

We enrolled 183 subjects-118 patients with voice disorders and 65 without voice disorders.

RESULTS

All items were correlated with each other and were strongly correlated with the total score (rho ≥ 0.70), the only exception being item five (rho = 0.56). Internal consistency was very high, with Cronbach's alpha = 0.92. There was a statistically significant difference between patients with voice disorders and healthy controls in terms of VHI-10 global score (U = 251.0; P < 0.001). There was a statistically significant negative correlation between mean phonation time (MPT) and VHI-10 (rho = -0.30; P < 0.01). Only the amplitude perturbation quotient (APQ) was correlated positively with the global score (rho = 0.22; P = 0.020). There were statistically significant and positive correlations between VHI-10 scores and GRBAS evaluation. Correlations between global scores of VHI-30 and VHI-10, and between VHI-30 subscales and the corresponding items from VHI-10, were very strong (respectively 0.97 and 0.89-0.94). In the patient group, there was high test-retest reproducibility (intraclass correlation = 0.91). A cut-off value of 8.5 points was estimated.

CONCLUSION

The Polish version of VHI-10 showed excellent internal consistency, good test-retest reproducibility, and had clinical validity. It is a useful brief tool for self-reported evaluation and reliable assessment of patients with voice disorders.

Comparison of Outcome Measures (Subjective, Objective, and Patient-Based) in Laryngeal Dystonia Treatment With Botulinum Toxin A Injection

BACKGROUND

Outcome assessment in laryngeal dystonia is hindered by lack of consensus on a core set of outcome measures to quantify treatment effect and disease severity on quality of life. Potential outcome measure domains include objective voice, clinician reported, and patient reported outcome measures (PROMs) for determining treatment success and longitudinal disease tracking. We aim to determine correlations between a selections of outcome measure tools following Botulinum toxin injection.

METHODS

A selection of instruments were administered to assess adductor laryngeal dystonia patient outcomes before and after Botulinum toxin injection. Voice samples recorded using a cellular telephone application were used for objective acoustic measures (CPPS, acoustic voice quality index) and speech language pathologist perceptual analysis (CAPE-V). Additionally, patients completed a PROMs battery consisting of the Voice Handicap Index-10, Communicative Participation Item Bank-10, OMNI-Vocal Effort Scale, 3 visual analog scale (VAS) questions. Changes in these outcome measures pre-post treatment were compared between each other and with a global rating of change questionnaire (GRCQ) using Spearman's rank correlation coefficients.

RESULTS

Twenty six patients (20 female, mean age 57.7 years) participated. Using an anchor based GRCQ, patients reported Botox efficacy was the only outcome measure found to have significant correlation (r = 0.54, P = 0.022); all other outcome measures did not meet statistically significant correlation. Amongst the selected outcome tools, several moderate-strong correlations were identified, largely for outcome measures within the same domain. Most notable were correlations between the patient reported OMNI-VES and VAS questions (r > 0.68, P < 0.05), clinician CAPE-V strain and overall severity (r = 0.900, P < 0.001), and acoustic voice quality index with sustained vowel CPPs (r = -0.797, P = 0.002).

CONCLUSION

Correlation between outcome measures instruments used for patients with adductor laryngeal dystonia requires further attention. Weak correlations with an anchor based GRCQ were found for this study's selected outcome instruments. A select number of correlations were found between outcome instruments within each of the individual outcome measure domains (patient perception, clinical perception, objective acoustics), but there was largely a lack of correlation found for instruments between these three separate domains.

Comparison of efficiency of different self-assessment instruments for screening dysphonia

PURPOSE

To compare the efficiency of different vocal self-assessment instruments for dysphonia screening.

METHODS

262 dysphonic and non-dysphonic individuals participated in the research. The mean age was 41.3 (±14.5) years. The diagnosis of dysphonia was based on the auditory-perceptual analysis of the sustained vowel "é" and on laryngological diagnosis. The responses of the instruments were collected: Voice-Related Quality of Life (V-RQOL), Voice Handicap Index (VHI), VHI-10, Voice Symptoms Scale (VoiSS), and the Brazilian Dysphonia Screening Tool, (Br-DST) called in Brazilian Portuguese Instrumento de Rastreio da Disfonia (IRDBR). To analyze assertiveness in relation to the presence of dysphonia, the cutoff points of each instrument and the decision rule recommended by the IRDBR were used. An exploratory analysis was performed to compare mean scores of instruments and verify associations between variables.

RESULTS

The instruments evaluated were sensitive to capture the impact of dysphonia in a similar way regardless of professional voice use and type of dysphonia. There was a difference only in VoiSS scores for the variable gender, with a higher score for females. Regarding global assertiveness, the instruments showed high rates of success in classification, with emphasis on the VoiSS, which had the highest rate (86.3%), followed by the IRDBR (84.0%), VQL (80.9%), VHI (78.2%), and VHI-10 (75.2%).

CONCLUSION

The VoiSS has the highest assertiveness index in the identification of dysphonia, followed by the IRDBR. The IRDBR is a short, simple, and easy-to-apply tool for screening procedures.

Methods of Measuring Laryngeal Muscle Tension in Patients with Muscle Tension Dysphonia: A Scoping Review

BACKGROUND

In clinical practice and research relating to Muscle Tension Dysphonia (MTD), several laryngeal muscle tension measurement methods are used to diagnose, to identify specific muscle strengths and deficits, and to measure therapeutic outcomes. The variety and reliability of available measurement methods presents challenges within diagnosis and treatment. The lack of methodical standardization presents a barrier to homogeneous practice in this area. There is a need for a comprehensive scoping review of laryngeal muscle tension measurement methods.

STUDY DESIGN

Scoping review.

OBJECTIVES

(1) To identify current methods of laryngeal muscle measurement which have been developed or tested with people with MTD; and (2) To identify the construct/s measured, reliability, validity, ability to detect change, efficiency and accessibility of identified methods.

METHOD

This scoping review was conducted using the Arksey and O'Malley framework. Studies were identified through searches of 4 major databases. The reviewer independently assessed titles, abstracts, and full-text articles.

RESULTS

Twenty seven papers published from 2000 to 2022 that satisfied the inclusion criteria were selected from 194 studies. The papers showed a variety of approaches with regards to the measurement of laryngeal activity and tension in subjects with MTD. Just over a quarter (25.9%) were reviews of the validity of assessment methods of MTD, including surface electromyography (sEMG), while 22.2% discussed surface electromyography as a measurement of muscle activity in subjects with MTD. 96.3% used a published methodological framework.

CONCLUSIONS

Assessment methods for Primary MTD are multifaceted, including patient history, laryngoscopic examination, and voice-related musculoskeletal features. Potential use of objective measurement methods, including sEMG, Real Time Elastosonography, Magnetic Resonance Imaging was noted. Due to variability in assessment methods and results, there is a need for greater objective practical methodological standardization to ensure accurate diagnosis, appropriate care, and chart patient progress.

Validation of the Brazilian Scale of Perceived Control Over Voice in the Present using Item Response Theory

OBJECTIVE

this study aims to verify the stages of evidence of validity of the voice-adapted present perceived control scale (V-APPCS) in its translated and cross-culturally adapted version for the Brazilian Portuguese "Voice-Adapted Present Perceived Control Scale" and to estimate the psychometric measurements of the properties of its items based on the item response theory (IRT).

METHODS

the instrument underwent a process of translation and cross-cultural adaptation for the Brazilian Portuguese, the process was carried out by two qualified translators, native in the destination language, and fluent in the language and culture of origin. The first translated version of the protocol was forwarded to a back-translation, performed by a third bilingual Brazilian translator. The translations were analyzed and compared by a committee composed of five speech therapists who are specialists in voice and with proficiency in the English language. The empirical study used data from 168 individuals, 127 had voice problems and 41 vocally healthy ones. For the stages of validity evidence, the following analyses were performed: Cronbach's alpha, exploratory factor analysis, confirmatory factor analysis and IRT.

RESULTS

The stages of translation and cross-cultural adaptation allowed linguistic adjustments to be made so that the items were understandable and suitable for use in Brazil. The adequacy, structure, and application of the items were confirmed through the application of the final version of the scale in twenty individuals in a real context. The instrument in its Brazilian version presented good internal consistency, with bifactorial structure the exploratory factor analysis, besides presenting satisfactory values in the adjustment indexes of the model, confirming the structure of the confirmatory factor Analysis. The IT was applied to evaluate the parameters discrimination (a) and difficulty (b) of the items of the instrument; item 5 "I have control over my day-to-day reactions to the voice problem." Presented itself as a more discriminative item and item 8 "My reaction to the voice problem is not under my control." As an item of greater difficulty.

CONCLUSION

The V-APPCS, translated, cross-culturally adapted, and validated, is robust and adequate to represent the construct in the Brazilian versions.

Brazilian Dysphonia Screening Tool (Br-DST): An Instrument Based on Voice Self-Assessment Items

OBJECTIVE

To propose a short instrument for the screening of dysphonia in the Brazilian population through the investigation of traditional voice self-assessment instrument items.

METHODS

We analyzed the medical records of 139 individuals with an average age of 37.4 years and a minimum and maximum age of 18 and 77 years, respectively. The participants were classified as dysphonic (D) or non-dysphonic (ND) according to an analysis of the combination of vocal complaints and laryngological reports. Responses to the items of the following self-assessment instruments were collected: the Questionário de Qualidade de Vida em Voz - QVV (Voice-Related Quality of Life - V-RQOL), the Índice de Desvantagem Vocal - IDV (Voice Handicap Index - VHI) and the Escala de Sintomas Vocais - ESV (Voice Symptom Scale - VoiSS). These items were analyzed regarding their predictive capacities for dysphonia through logistic regression models.

RESULTS

The model containing items of the QVV was not observed to be valid. The model for the IDV produced a set of three items (10, 13, and 14), and the ESV model showed two items (4 and 20) to be significant. A Global model combining the previous models shows that items I feel as though I have to strain to produce voice from the IDV and "Is your voice hoarse?" from the ESV are the most significant in the classification of the presence of dysphonia. This decision-making model was considered the most efficient to identify the dysphonia, with the highest level of accuracy compared to the other models investigated (83.4%).

CONCLUSION

Dysphonia screening can be performed using a simple, rapid protocol with a high-efficiency index that includes two items taken from traditional voice self-assessment instruments.

Most-Cited Patient-Reported Outcome Measures Within Otolaryngology-Revisiting the Minimal Clinically Important Difference: A Review

Importance

Patient-reported outcome measures (PROMs) allow clinicians and researchers to assess health-related information from a patient's perspective. These measures have been used more frequently over the last several decades, but an associated minimal clinically important difference (MCID) is needed to optimize their utility. This narrative review identified the top 100 most-cited otolaryngology-related PROM development and validation publications and assessed the presence and characteristics of the PROMs' associated MCID.

Observations

In this narrative review, a literature search in Scopus and Web of Science was conducted on June 29, 2022, using keywords related to PROM development and validation studies in otolaryngology and reference lists. Studies that met the definition of a PROM and assessed an otolaryngologic disorder or study population were included for full-text review. After full-text review of 188 articles, the top 100 most-cited PROM development and validation publications, resulting in 106 total PROMs, were chosen for review. A total of 39 (37%) of the identified PROMs had an associated MCID. Of those reporting an MCID, 14 (35.9%) used an anchor-based method, 12 (30.8%) used a distribution-based method, 10 (25.6%) used both, and 3 (7.7%) did not specify or used neither method. Rhinology had the greatest number of PROMs with an associated MCID (16 of 24, 66%), and pediatrics had the fewest (1 of 13, 7.7%). The median number of citations of PROMs with an MCID was higher than those without an MCID.

Conclusions and Relevance

The majority of the most-cited PROMs in otolaryngology lack an associated MCID. These data indicated that there are a multitude of PROMs that have been cited hundreds of times and used for decades without the ability to identify whether a particular change in score on the instrument is clinically meaningful. There is a need to determine and validate MCIDs for commonly used PROMs to aid clinical research and trial interpretation.

Variability in Voice Characteristics of Female Speakers With Phonotraumatic Vocal Fold Lesions

OBJECTIVE

To examine the variability of lesion characteristics and vocal function in female speakers with phonotraumatic vocal fold lesions (PVFLs).

STUDY DESIGN

Prospective Cohort Study METHODS: Thirty adult female speakers with PVFL who were participating in voice therapy were recruited to complete a multidimensional voice analysis at four time points across 1 month. Analysis comprised self-ratings of effort and vocal function, expert ratings of videostroboscopy and audio recordings, and instrumental evaluation by selected aerodynamic and acoustic parameters. The degree of variability across time for each individual was assessed against a minimal clinically important difference threshold.

RESULTS

A high degree of variability across time was observed for participant self-ratings of perceived effort and vocal function, and for instrumental parameters. The greatest degree of variability was observed in aerodynamic measures of airflow and pressure, and the acoustic parameter semitone range. Comparatively less variability was observed in perceptual evaluation of speech, and lesion characteristics via stroboscopy still images. Findings suggest that individuals with all PVFL types and sizes present with variability in function across time, with the greatest degree of variability in function observed in participants with large lesions and vocal fold polyps.

CONCLUSION

Variability is observed in voice characteristics of female speakers with PVFLs across 1 month despite general stability in lesion presentation, suggesting vocal function can change despite the presence of laryngeal pathology. This study highlights the need to explore individual functional and lesion responses across time to determine potential for change and improvement in both aspects when selecting treatment options.

Common Mental Disorders and Self-Perceived Interpersonal Communication and Vocal Symptoms in University Professors

OBJECTIVE

To determine the prevalence of common mental disorders in university professors and to analyze the same with sociodemographic and occupational data, self-perceived interpersonal communication, and vocal symptoms.

METHODS

A Cross-sectional analytical observational quantitative study with 322 university professors. Four assessment instruments: the Sociodemographic and Work Information Questionnaire, the Self-Report Questionnaire, the Brazilian Dysphonia Screening Tool, the Interpersonal Communication Competence Scale, and the Voice Symptom Scale. The study performed descriptive and association analyses. The measure of association was the prevalence ratio, estimated with Poisson regression with robust invariance, considering common mental disorders as a dependent variable.

RESULTS

The prevalence of common mental disorders in university professors was 27.6%. There was a significant association between such disorders and self-perceived vocal complaints, the suspicion of dysphonia, and self-perceived difficulties in regards to being heard with a mask (sometimes/always). The higher the score in the self-disclosure domain of the Interpersonal Communication Competence Scale the higher the prevalence of common mental disorders in university professors.

CONCLUSION

The prevalence of common mental disorders in university professors is high and influences their self-perception of vocal symptoms and interpersonal relationships. Hence, it reinforces the need for measures to maintain university professors' vocal and mental health.

Prevention of occupational dysphonia in scientific university personnel: A cross-sectional study

Aim

The aim of the study was to identify occupational and individual factors that influence the occurrence of voice problems in university staff and to investigate whether there is a link between voice problems and physical, psychological or functional changes?

Subject and methods

The voices of university teachers are exposed to increased stress. As members of the group of professional speakers, they have an increased prevalence of developing a voice disorder, so-called dysphonia. In the worst case, chronic, occupational dysphonia can occur. In an empirical-quantitative study in form of a cross-sectional study in Germany, an online questionnaire was used to determine whether university teaching staff is more frequently affected by voice problems than their colleagues in the administrative sector.

Results

The results show that dry room climate, background noise, poor spatial acoustics, lack of breaks, and increasing age influence the occurrence of voice problems in university teachers. Teaching staff is therefore more frequently affected by impaired vocal function due to frequent throat clearing/coughing and a raspy, hoarse and scratchy voice than their administrative colleagues. In addition, there is a need for regular training and counselling.

Conclusion

In order to prevent the development of occupational dysphonia among university teachers, diagnostic, practical and theoretical interventions for the target group are needed. To this end, the appropriate structural and personnel conditions must be created in the university environment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01805-0.

The usefulness of multi voice evaluation: Development of a model for predicting a degree of dysphonia

OBJECTIVES

The purposes of this study were (1) to analyze the usefulness of self-report questionnaires, acoustic analysis, and auditory perceptual assessment for screening voice problems; and (2) to develop a new model for predicting a comprehensive voice severity using multi-assessment.

METHODS

A total of 306 voice samples were analyzed in this study (typical group, n = 72; dysphonia group, n = 234). We performed a receiver operating characteristic analysis to determine the cutoff values of auditory perceptual assessments (visual analog scale), acoustic parameters (spectral- and cepstral-based analyses), and self-report questionnaires for screening voice disorders. We also performed a stepwise multiple regression analysis to verify which combination of parameters (acoustic parameters, and self-report questionnaires) could best predict perceived voice severity.

RESULTS

We verified that most of the variables analyzed were useful for voice evaluation, and found to be useful for screening voice problems. Of these, a five-variable model was a useful to predict perceived voice severity (mean R² = .807). The five-variable model consisted of acoustic parameters based on cepstral analysis (cepstral peak prominences in connected speech and sustained vowel task, and low versus high-frequency spectral energy ratio in connected speech task) and self-report questionnaires (total score of the Voice Handicap Index, and rumination score of the Voice Catastrophization Index).

CONCLUSION

We verified that most of the variables were useful for screening dysphonia and five-variable model was a useful to predict perceived voice severity. The five-variable model could be used as an objective criterion for predicting voice severity.

Comparison of efficiency of different self-assessment instruments for screening dysphonia

PURPOSE

To compare the efficiency of different vocal self-assessment instruments for dysphonia screening.

METHODS

262 dysphonic and non-dysphonic individuals participated in the research. The mean age was 41.3 (±14.5) years. The diagnosis of dysphonia was based on the auditory-perceptual analysis of the sustained vowel "é" and on laryngological diagnosis. The responses of the instruments were collected: Voice-Related Quality of Life (V-RQOL), Voice Handicap Index (VHI), VHI-10, Voice Symptoms Scale (VoiSS), and the Brazilian Dysphonia Screening Tool, (Br-DST) called in Brazilian Portuguese Instrumento de Rastreio da Disfonia (IRDBR). To analyze assertiveness in relation to the presence of dysphonia, the cutoff points of each instrument and the decision rule recommended by the IRDBR were used. An exploratory analysis was performed to compare mean scores of instruments and verify associations between variables.

RESULTS

The instruments evaluated were sensitive to capture the impact of dysphonia in a similar way regardless of professional voice use and type of dysphonia. There was a difference only in VoiSS scores for the variable gender, with a higher score for females. Regarding global assertiveness, the instruments showed high rates of success in classification, with emphasis on the VoiSS, which had the highest rate (86.3%), followed by the IRDBR (84.0%), VQL (80.9%), VHI (78.2%), and VHI-10 (75.2%).

CONCLUSION

The VoiSS has the highest assertiveness index in the identification of dysphonia, followed by the IRDBR. The IRDBR is a short, simple, and easy-to-apply tool for screening procedures.

Glottal Function Index: Validity and Reliability of the Persian Language Version in Patients With Voice Disorders

OBJECTIVE

To translate and cross-culturally adapt the Glottal Function Index into the Persian language (GFIp) and validate it in patients with voice disorders.

STUDY DESIGN

A cross-sectional and prospective validation design was adopted.

METHOD

The GFI was translated and culturally adapted into Persian language according to the methodology of standard forward-backward translations to obtain semantic, idiomatic, and conceptual equivalence. One hundred patients with voice disorders (53 men; mean age: 41.4 ± 13.6 years) and 40 healthy volunteers (21 women; mean age: 36.7 ± 10.0 years) completed the GFIp. Patients with voice disorders also completed the Persian Voice Handicap Index (VHIp) to assess the construct validity.

RESULTS

There were no floor and ceiling effects. Evidence for construct validity was found with a significant very good correlation between the GFIp and the VHIp total scores (r = 0.70; P < 0.001). Differences of GFIp scores between the patients and healthy participants were statistically significant (P < 0.001) confirming discriminant validity. The internal consistency reliability was acceptable for GFIp (Cronbach's α = 0.74). Absolute reliability measures of Standard Error of Measurement and the Smallest Detectable Change for GFIp were 2.5 (confidence interval 95% = ±4.9) and 6.93, respectively. Factor analysis revealed the GFIp as a single factor instrument.

CONCLUSION

The GFIp is a valid and reliable self-administered instrument for use in Persian-speaking patients with voice disorders.

Investigation of Validity and Reliability of Voice Activity and Participation Profile-Turkish Version (VAPP-TR)

A voice activity and participation profile (VAPP) is a self-assessment tool used to measure activity and participation limitations resulting from voice disorders. This study aims to demonstrate the adaptation, validity, and reliability of the Turkish version of the VAPP scale. A total of 231 individuals, 155 with voice disorders (patient group) and 76 without voice disorders (normal group), were included in this study. With reliability, internal consistency, and test-retest methods; validity was evaluated with criterion and convergent validity methods. The Cronbach α coefficient calculated for internal consistency was found to be 0.985 for the VAPP total and between 0.914 and 0.978 for the subsections. Intraclass Correlation Coefficient was found to be 0.974 for the VAPP total and between 0.800 and 0.981 for the subsections. Total and subsection scores of the VAPP scale had correlation coefficients ranged between 0.725 and 0.903 with VHIT and V-RQOLT in the whole sample (all P<0.001). The cut-off point was determined as ≥ 8 by ROC curve analysis for criterion validity. VAPP-TR is a valid and reliable tool that can be used to evaluate the quality of life of Turkish patients with voice disorders, particularly those with activity limitations and participation restrictions.

Correlations among the Mandarin Voice Handicap Index, its shortened version, and the Voice-Related Quality of Life Measure for laryngectomees

BACKGROUND

The Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL) are seldom administered to alaryngeal patients who use pneumatic artificial larynx (PAL) and esophageal speech (ES). As such, the specificity of VHI and 10-item VHI (VHI-10) for assessing voice-related changes in such patients is unclear. Accordingly, this study investigated the correlation between scores on the VHI, its shortened version (VHI-10), and the V-RQOL for Mandarin-speaking laryngectomees using PAL and ES, with the aim of establishing which of these instruments is suited to such patients.

METHODS

The participants comprised 126 PAL and 26 ES patients from Taiwan who completed the Mandarin VHI and V-RQOL. Fifty-two of these alaryngeal participants then completed both those instruments a second time, between 8 and 64 days later.

RESULTS

One item appearing in both the Mandarin long-form VHI and the VHI-10 was excluded because more than half the participants left it unanswered. The correlation of scores on the remaining 29 items on the former with the nine on the latter was high ( r = 0.968), while that between the former and V-RQOL scores was moderate ( r = -0.569), as was the correlation between short-form VHI and Mandarin V-RQOL scores ( r = -0.582). Structural equation modeling was then used as the basis for simplifying the Mandarin long-form VHI into a new 10-item VHI specifically for alaryngeal Mandarin speakers (MA-VHI-10), to eliminate the scoring effect of the original VHI's and VHI-10's work-related item. MA-VHI-10 scores were highly correlated with those on the Mandarin long-form VHI ( r = 0.983).

CONCLUSION

The Mandarin versions of long-form VHI, short-form VHI, and MA-VHI-10 are interchangeable for a Mandarin-speaking alaryngeal population. However, neither of the former two instruments should be substituted for the V-RQOL.

Polish Translation and Validation of the Voice Handicap Index (VHI-30)

Traditional voice evaluations, including imaging techniques, auditory-perceptual ratings, and acoustic and aerodynamic analyses, fail to assess the global handicap that a patient experiences as a result of a voice disorder. The Voice Handicap Index (VHI) is currently one of the most widely used and psychometrically robust instruments for measuring voice disability. The aim of the study is to translate and validate a Polish version of the VHI. The original English-language version of VHI-30 was translated into Polish. We enrolled 188 subjects-123 patients (91 women and 32 men) with voice disorders and 65 controls (53 women and 12 men) without voice disorders. Results obtained by the patients were significantly higher than those obtained by the controls on the Emotional subscale (U = 519.0; p < 0.001), Functional (U = 829.0; p < 0.001), Physical (U = 331.0; p < 0.001), and the global score (U = 390.0; p < 0.001). There were statistically significant negative correlations between maximum phonation time and global score (rho = -0.31; p < 0.01) as well as all three subscales. Shimmer and Smoothed Amplitude Perturbation Quotient were correlated positively with the global score (rho = 0.22; p < 0.05; rho = 0.25; p < 0.01, respectively) and with all three subscales. There were also statistically significant correlations between VHI scores and auditory perceptual evaluation. In the patient group, there was excellent internal consistency (α = 0.97) and strong test-retest reliability (intraclass correlation = 0.94). The cut-off value equal to 17 points was estimated. The Polish VHI showed excellent internal consistency, good test-retest reproducibility, and clinical validity. It is a useful tool for evaluating the voice disability perceived by a patient.

Validity, internal consistency, and test-retest reliability of the Montenegrin 10-item Voice Handicap Index

The purpose of the this cross-sectional study was to assess clinical validity, internal consistency, and test-retest reliability of the adapted Montenegrin translation of the Voice Handicap Index 10 (VHI-10). It included 50 patients with voice disorders, divided into three subgroups according disease aetiology: structural, neurological, and functional and a control group of 50 vocally healthy participants. Mean patient VHI-10 score of 21.1±7.6 was significantly higher than the 2.3±2.5 score of controls (p<0.001). Each of the three patient subgroups also scored significantly higher than control (p<0.001). Spearman’s rank correlation coefficient of 0.90 (p<0.001) indicated a very strong correlation between the Montenegrin VHI-10 score and self-reported perception of the severity of voice disorder. Excellent internal consistency was found in the patient group, with a Cronbach’s alpha of 0.94. Test-retest reliability was also excellent, with intra class correlation coefficient of 0.98. The translated Montenegrin version of VHI-10 is a valid, reliable, and clinically useful tool for self-assessment of the severity of voice disorders in individuals with voice problems in daily practice and in research projects.

Terapia de voz en el contexto de la pandemia covid-19; recomendaciones para la práctica clínica

INTRODUCTION

Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment.

OBJECTIVE

To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists.

METHODS

A group of 11 experts in voice and swallowing disorders from 5 different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context.

RESULTS

The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics.

CONCLUSION

This guideline should be taken only as recommendations; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.

Terapia Vocal No Contexto Da Pandemia Do Covid-19; Orientações Para A Prática Clínica

INTRODUCTION

Since the beginning of the new pandemic, Corona Virus Disease 2019 (COVID-19) health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment.

OBJECTIVE

To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists.

METHODS

A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context.

RESULT

The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics.

CONCLUSION

This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.

Voice Therapy in the Context of the COVID-19 Pandemic: Guidelines for Clinical Practice

INTRODUCTION

Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment.

OBJECTIVE

To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists.

METHODS

A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context.

RESULTS

The clinical guide provides 65 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics.

CONCLUSION

This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.