The value of the Voice Handicap Index-questionnaire and acoustic analyses to the laryngological examination.

Abstract

Voice-related diseases may influence on individual’s daily life. Quantifying the extent of laryngeal pathology, voice symptoms and evaluating treatment responses for patients are challenging. The European Laryngological Society (ELS) has proposed a basis protocol for assessment of voice-related disease. Aims of this protocol include comparison of treatments of voice related diseases across cultures as well as assessing the impact of voice disorders on the health of the patient. ELS suggests to include both patient related outcome measures (PROM) and physical studies of the voice as part of assessment of voice related disease. Voice Handicap Index (VHI) questionnaire, a validated instrument on self-reported speech challenges, was translated to Norwegian and tested psychometrically and clincially. In the first study, we aimed to study 126 voice-related disease patients and 126 controls answering the VHI-30N questionnaire. The VHI was translated to Norwegian following a formal forward-backward translation of the questionnaire from English to Norwegian. Our main finding, was that the VHI was psychometrically well functioning, and discriminated well between healthy and patients with voice disease. In the second study, we aimed to study the ability to discriminate between voice diagnoses dependent on disease origin, based on the VHI questionnaire. We also wanted to study the psychometrics of the VHI based on specific laryngeal diseases. The impact of different diagnoses on the VHI score, and on the cut-off values was also studied. The study was designed as a multi-center-study, including Haukeland University Hospital and Statped in both Bergen and Oslo. A total of 126 healthy subjects and 355 patients answered the VHI-30(N). We concluded that the Norwegian version of the VHI questionnaire was psychometrically well functioning, also when studied among different laryngeal disease patients specifically. When deploying large groups of patients, the VHI-30(N) had the capability to discriminate between voice diagnoses dependent on disease origin. The third study aimed to investigate the importance of including general Health related quality of life (HRQoL) measures to clinical investigations. The participants (N= 80 larynx cancer, N=32 recurrent palsy, N=23 dysfunctional, N=75 degenerative/inflammation, N=19 various) were included consecutively at the laryngology clinic at Haukeland University Hospital. In addition, HRQoL data were included from one national group with laryngectomies (N=105), one group with various former HNSCC patients (N=96) and one population-based reference group (N=1956). EORTC QLQ, voice handicap index (VHI) and the Eysenck Personality Inventory (EPI) neuroticism scores were obtained in the presently recruited patient group. A total score for global QoL/health index was calculated, in addition to scores based on function and symptoms. In particular, patients with recurrent palsy and laryngeal cancer reported decreased HRQoL. At the index levels, in particular dyspnea scores were scored dependent on larynx disease group. The VHI score correlated with the EORTC H&N35 “speech” index with a common variance about 50 %. VHI scores correlated with level of neuroticism with eight percent and EORTC scores with 22 %. The fourth study aimed to study acoustic voice analyses, maximum phonation time (MPT) and Voice Handicap Index (VHI) in clinical investigations. The participants (N= 80 larynx cancer, N=32 recurrent palsy, N=23 dysfunctional, N=75 degenerative/inflammation, N=19 various) were included consecutively at the outpatient laryngology clinic at Haukeland University Hospital. In addition, a control group of 98 healthy subjects were included. Voice samples, maximum phonation times (MPT) and VHI score and data on clinical examination were obtained for all participants. Based on acoustic analyses, we determined the level of jitter, shimmer and noise to harmonic ratio (NHR) as well as analyzing frequency of a prolonged vowel. The maximum phonation time was also measured. Among larynx disease patients, acoustic and MPT analyses segregated with all determined analyses between patients and control conditions, except the dysfunctional group. But also to some extent between various patient groups. VHI scores correlated to jitter, shimmer and NHR scores among cancer and degenerative/inflammatory disease patients. In conclusion, a thorough examination of laryngeal patients, as suggested by ELS, leads to essential information on the disease. It also forms a comprehensive basis when treatment results are evaluated.