Use of Voice Handicap Index (VHI) as Predictor of Outcome of Non-surgical Treatment in Vocal Nodules
Article Sidebar
Main Article Content
Abstract
Introduction
Vocal Nodule is commonest benign vocal cord lesion which causes varying degree of dysphonia having serious impact on personal and professional well being. Voice Handicap Index (VHI) is a psychometrically validated tool for measuring pshycosocial handicapping effect of voice disorder.
Materials and Methods
From data available since last 18 months, patients who had undergone treatment for vocal nodule were selected as study population. In Group A, 50 patients were selected who required surgery and Group B, 50 patients who responded to medical treatment. Patients filled in VHI-30 form at time of diagnosis and subjected to voice therapy and adjunctive medical treatment for 1 month and reassessed using VHI-30. Successful treatment consisted of absence of pathology by laryngoscopy and decrease of VHI total score ≥18.
Results
The cut-off score was calculated using Receiver Operating Characteristics (ROC). VHI cut-off of total score was 45 (Sensitivity 94%, Specificity76%). The cut-off score for functional, physical and emotional domains are 14(Sensitivity 94%, Specificity 64%) , 15(Sensitivity 92%, Specificity 60%) and 15(Sensitivity 90%, Specificity 66%) respectively.
Discussion
Hard consistency of nodules can explain refractoriness to speech therapy and higher VHI score. The physical subscale of VHI was higher among both groups indicating patients’ perceptions of laryngeal discomfort and voice output affected them more. According to our study patients with higher VHI score should be counselled for MLS at earliest instead of speech therapy for one month which would not have given good outcome.
Conclusion
These scores give a good idea about categories of patients who will not benefit by non-surgical treatment and hence early surgical intervention will obviate the duration of handicap and delay in appropriate treatment.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Jiang JJ, Titze IR. Measurement of vocal fold intraglottal pressure and impact stress. Journal of Voice 1994; 8:132-44
McMurray JS. Medical and surgical treatment of pediatric dysphonia. Otolaryngol Clin North Am. 2000; 33: 1111-26
Carr MM, Nguyen A, Poje C, Pizzuto M, Nagy M, Brodsky L. Correlation of findings on direct laryngoscopy and bronchoscopy with presence of extraesophageal reflux Laryngoscope 2000; 110: 1560-2
Kalach N, Gumpert L, Contencin P, Dupont C. Dual-probe pH monitoring for the assessment of gastroesophageal reflux in the course of chronic hoarseness in children. Turkish Journal of Pediatrics 2000; 42: 186-91
Pedersen M, McGlashan J. Surgical versus non-surgical interventions for vocal cord nodules. Cochrane Database Systemic Reviews 2001; CD001934. DOI: 10.1002/ 14651858
Yamaguchi H, Yotsukura Y, Hirose H. Non-surgical therapy for vocal nodules. Paper presented at the 20th Congress of the International Association of Logopedics and Phoniatrics. Logopedics and Phoniatrics Issues for Future Research, Tokyo, 1986; 458-9
Dejonckere PH, Bradley P, Clemente P, et al. A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Committee on Phoniatrics of the European Laryngological Society (ELS). Eur Arch Otorhinolaryngol. 2001; 258:77-82
Karnell MP, Melton SD, Childes JM, Coleman TC, Dailey AS, Hoffman HT. Reliability of clinician-based (GRBAS and CAPE-V) and patient-based (V-RQOL and IPVI) documentation of voice disorders. J Voice 2007;21:576-90
Ugulino AC, Oliveira G, Behlau M. Perceived dysphonia by the clinician’s and patient’s viewpoint. J Soc Bras Fonoaudiol. 2012;24:113-8
Hsiung MW, Pai L, Wang HW. Correlation between voice handicap index and voice laboratory measurements in dysphonic patients. Eur Arch Otorhinolaryngol. 2002; 259:97-9
Woisard V, Bodin S, Yardeni E, Puech M. The voice handicap index: correlation
between subjective patient response and quantitative assessment of voice. J Voice 2007; 21:623-31
Sataloff RT, Abaza MM. Impairment, disability, and other medical-legal aspects of dysphonia. Otolaryngol Clin North Am. 2000; 33(5):1143-52
Ballenger JJ, Show JB, editors. Disease of the nose, throat and ear, head and neck. 16th ed. Hamilton: B.C. Decker; 2003. pp. 1090-109
Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS. The Voice Handicap Index (VHI): develop- ment and validation. Am J Speech Language Pathol. 1997; 6:66-70
Hartnick CJ, Volk M, Cunningham M. Establishing normative voice related quality of life scores within the pediatric otolar- yngology population. Arch Otolaryngol Head Neck Surg. 2003; 129(10):1090-3.
Khanna R, Taneja V, Singh SK, Kumar N, Sreenivas V, Puliyel JM. The clinical risk index of babies (CRIB) score in India. Indian J Pediatr. 2002; 69:957-60
Hosmer DW, Lemeshow S. Applied Logistic Regression 2nd ed. New York, NY: John Wiley & Sons, Inc.; 2000 doi:10.1002/9780470258019
Scott-Brown’s Otorhinolaryngology Head and Neck Surgery, John C Watkinson, Raymond W Clarke; Volume 3, 8th Edition, CRC Press; p 951
Joshi A, Dhave VJ, Bradoo R, Sapkale D. Evaluation of validity of Voice Handicap Index among Indian population. 10.5005/jp-journals-10023-1145,IJOPL
Bhakat B, Gupta A, Roy A,Roychoudhury A, Raychaudhuri BK. Does Voice Therapy Cure all vocal Nodule? 10.5005/jp-journals-10023-1083, IJOPL
Williams N.R. Occupational Groups at risk of voice disorders: a review of literature. Occupational Medicine 2003; 53:456-460, DOI: 10.1093/occmed/kqg 113
Rosen CA, Murry T. Voice Handicap Index in Singers. Journal of Voice 2000; 14(3):370-7
Malki KH, Mesallam TA, Farahat M, et al. Validation and cultural modification of Arabic voice handicap index. Eur Arch Otorhinolaryngol. 2010; 267:1743-51. doi:10.1007/s00405-010-1296-x.