Voice Handicap Index: Cut-Off Points for Screening European Portuguese With Voice Disorders

Isabel Guimarães; Gabriela Torrejano; Raquel Aires; Mariana Caetano; António Fernandes; Paulo Martins; Leonel Luís

doi:10.1016/j.jvoice.2023.08.018

Voice Handicap Index: Cut-Off Points for Screening European Portuguese With Voice Disorders

J Voice. 2023 Oct 5:S0892-1997(23)00265-5. doi: 10.1016/j.jvoice.2023.08.018. Online ahead of print.

Authors

Isabel Guimarães¹, Gabriela Torrejano², Raquel Aires³, Mariana Caetano³, António Fernandes³, Paulo Martins³, Leonel Luís³

Affiliations

¹ Clinical and Therapeutics Pharmacological Unit, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal; Speech Therapy Department, Alcoitão Health School of Sciences, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.
² ENT Department, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal. Electronic address: gabriela.torrejano@chln.min-saude.pt.
³ ENT Department, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal.

PMID: 37805301
DOI: 10.1016/j.jvoice.2023.08.018

Abstract

Objectives: To determine cut-off values of the Voice Handicap Index (VHI) and the shortened version (VHI-10) for European Portuguese (EP) with voice disorders. In addition, to analyze the discriminatory power of individual items of the VHI-10 and the ability to detect differences in various Ear Nose and Throat (ENT) diagnoses.

Study design: Cross-sectional cohort study.

Methods: All participants completed the EP VHI and a 4-point self-assessment of voice disorder severity. The case group (subjects with voice disorders) underwent assessment through strobovideolaryngoscopy examinations by ENT surgeons and perceptual analyses by speech-language pathologists (SLPs). In contrast, the control group was evaluated solely by SLPs. Data were analyzed using a receiver-operating characteristic curve to determine the accuracy and cut-off values of the VHI and VHI-10.

Results: The study involved a sample of 350 adults (171 cases and 179 controls), predominantly women aged 18-88 years. The area under curve (AUC) for VHI and VHI-10 was 0.997 [95% confidence interval (CI): 0.992-1] and 0.998 [95% CI: 0.995-0.999], respectively. Optimal cut-off values were identified as 13.5 for VHI (0.994 sensitivity and 0.989 specificity) and 5.5 for VHI-10 (0.977 sensitivity and 0.955 specificity). Each individual item within the VHI-10 significantly contributed to the overall assessment, exhibiting varying discriminatory power ranging from excellent (AUC = 0.937) to poor (AUC = 0.637). Significant differences were found in the case group between neurogenic disorders and healthy larynx (P = 0.014), structural and physiologic minor laryngeal abnormalities (P = 0.006), and inflammatory disorders (P = 0.043).

Conclusions: The VHI and the VHI-10 exhibited accurate screening properties for predicting EP speakers with voice disorders.

Keywords: Dysphonia; ROC analysis; Self-reported questionnaires; Voice Handicap Index; Voice Handicap Index-10.