Measurement and validation of the voice handicap index in voice-disordered patients in Taiwan

Abstract

Voice disorders can cause problems for patients emotionally, physically, economically and functionally. Neither subjective nor objective voice examinations are able to evaluate such factors adequately. For this study, a retrospective analysis of 79 dysphonic cases was conducted using the voice handicap index (VHI) to gather comprehensive data across a variety of voice disorders. Of the 79 cases, 41 involved glottic insufficiency, 26 involved vocal polyps or mass, and 12 involved functional voice disorders. Cases were assessed with the VHI using physical (P), functional (F), emotional (E) parameters and a total (T) of the three. P, F, E and T variables were entered into a statistical programme and analysed using one-way analysis of variance (ANOVA). Mean ±SE values for P, F, E and T, respectively, in glottic insufficiency cases were 31.61 ± 1.10, 26.49 ± 1.43, 26.06 ± 1.54, and 84.20 ± 4.21. Mean ±SE values for P, F, E and T, respectively, in vocal mass cases were 30.69 ± 1.73, 25.23 ± 1.90, 23.96 ± 1.82, and 79.88 ± 5.08. The mean ±SE values of P, F, E and T,respectively, in functional voice disorders were 20.92 ± 2.06, 18.33 ± 1.82, 16.83 ± 1.86, and 56.08 ± 5.23. We found the mean glottic insufficiency was significantly greater than functional voice disorders for each measure. There were significant differences between vocal mass and functional voice disorders means for P and T. Glottic insufficiency and vocal mass means were not significantly different for any measure. Problems in the physical realm were identified as the most severe amongst all patients. Glottic insufficiency patients were found to suffer the most in every VHI value. Although VHI is a relatively new method by which to measure discomfort in voice-disordered patients, it provides a mechanism for patients to define their discomfort and for therapists to better target recovery programmes to patient’s needs.