|Year : 2012 | Volume
| Issue : 2 | Page : 89-92
Clinical application of the validated Hindi VHI in assessing subjective improvement following microlaryngeal surgeries for benign vocal fold lesions: A preliminary report
Ashwani Sethi, Rakesh Datta, Awadhesh K Mishra, Satwinder P Singh, Purnima Sangwan
Department of ENT, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, Delhi, India
|Date of Web Publication||5-Feb-2013|
E-80, NarainaVihar, New Delhi - 110028
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: To assess the clinical utility of a validated Hindi VHI in the assessment of patients treated microsurgically for benign vocal fold lesions. Design: Prospective study. Setting: Tertiary health care centre. Materials and Methods: The study population comprised 46 patients of either sex with benign vocal fold lesions, who underwent microlaryngeal surgery in our hospital between January, 2011 and May, 2012. An acoustic analysis of all the patients was done using Dr. Speech voice analysis software (Tiger electronics, USA) preoperatively and 6 weeks postoperatively. The parameters analyzed were in terms of perturbation (Jitter and shimmer), normalized noise energy (NNE), and fundamental frequency (F0). A validated Hindi version of VHI was filled by all the patients preoperatively and 6 weeks postoperatively. The results obtained were statistically correlated using SPSS 17 software. Results: There was a significant correlation between the parameters analyzed on Dr. Speech voice analysis software and VHI parameters obtained preoperatively and postoperatively as assessed using Pearson's correlation coefficient. There was a statistically significant improvement in objective voice parameters and VHI scores postoperatively as assessed using Pearson's correlation coefficient. Conclusion: The validated Hindi version of VHI correlates well with the widely used acoustic analysis software (Dr. Speech, Tiger electronics, USA). It also correlates well with voice improvement after surgeries for benign vocal fold lesions. It merits inclusion in the standard evaluation protocol both in the preoperative assessment and postoperative evaluation following surgical treatment for benign vocal fold lesions in Hindi speaking population.
Keywords: Microlaryngeal surgery, true vocal cord, VHI, voice analysis
|How to cite this article:|
Sethi A, Datta R, Mishra AK, Singh SP, Sangwan P. Clinical application of the validated Hindi VHI in assessing subjective improvement following microlaryngeal surgeries for benign vocal fold lesions: A preliminary report. J Laryngol Voice 2012;2:89-92
|How to cite this URL:|
Sethi A, Datta R, Mishra AK, Singh SP, Sangwan P. Clinical application of the validated Hindi VHI in assessing subjective improvement following microlaryngeal surgeries for benign vocal fold lesions: A preliminary report. J Laryngol Voice [serial online] 2012 [cited 2022 May 17];2:89-92. Available from: https://www.laryngologyandvoice.org/text.asp?2012/2/2/89/106986
| Introduction|| |
Lesions of the vocal folds, besides causing an impairment in voice generation, also cause a significant disability to an individual in performing routine and important activities with a resultant handicap. A number of objective and subjective methods of analysis of voice are used for the pre- and post-treatment analysis of such patients. These methods include:voice analysis using Dr. Speech voice analysis software,  GRBAS scale,  videolaryngoscopy,  high speed endoscopy,  videostroboscopy,  phonetogram,  etc. However, none of these modalities assess the degree of handicap that the patient is suffering from because of the vocal fold pathology. To assess this handicap in our population, a validated Hindi version of Voice Handicap Index (VHI) was developed in 2011.  The present study was done to assess the correlation between the validated Hindi VHI and Dr. Speech voice analysis software that is being used for voice analysis in our institution for dysphonic patients.
| Materials and Methods|| |
The subjects were 46 consecutive patients of benign true vocal cord lesions who underwent microlaryngeal surgery in the ENT Department who could read and understand Hindi. There were 26 men and 20 women with the mean age of 41.7 years [age range = 14-61 years; SD = 12.55; [Figure 1]]. They were included in the study after obtaining a prior consent.
The patients underwent an acoustic analysis using Dr. Speech voice analysis software preoperatively and 12 weeks postoperatively. In addition, they were also asked to fill the Hindi version of VHI preoperatively and 12 weeks postoperatively. A microlaryngeal surgery under general anesthesia with endotracheal intubation was performed on all the patients by the same team of surgeons.
The following parameters were statistically analyzed:
The average scores of the three domains of VHI (i.e., physical, functional, and emotional) were analyzed.
Voice analyses were done in terms of shimmer, jitter, normalized noise energy (NNE), and fundamental frequency (F0) and Voice Quality Estimate (VQE) score was calculated for all the patients using Dr. Speech voice analysis software.
Pre- and post-operative correlation
The VHI scores and VQE scores were correlated pre- and post-operatively using Pearson's correlation coefficient.
Correlation between VHI and acoustic analysis
The VHI scores were correlated with VQE scores both pre- and post-operatively.
| Results|| |
The most common pathology identified was true vocal fold polyp (n = 23). The other lesions included cysts, nodules, granulomas, and Rienke's edema [Figure 2].
The mean total VHI scores for the patients pre- and post-operatively were 61.69 (SD = 26.78) and 10.04 (SD= 10.35), respectively [Table 1] and [Table 2]. The mean of the physical domain was slightly higher as compared with the means of the functional and emotional domains.
The mean VQE scores for the patients pre- and post-operatively were 2.21 (SD = 0.80) and 0.47 (SD = 0.58), respectively.
Pre- and post-operative VHI correlation
There was a significant reduction in the total and individual domain VHI scores in the patients 12 weeks postoperatively as compared to preoperative scores as assessed by Pearson's correlation coefficient [Table 3].
|Table 3: Pre- and post-operative VHI score correlation using Pearson's correlation coefficient|
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Pre- and postoperative VQE score correlation
There was a significant reduction in VQE score in the patients 12 weeks postoperatively as compared to preoperative scores as assessed by Pearson's correlation coefficient (r = 0.38; P< 0.0001).
Correlation between VHI and VQE scores
There was significant correlation between the total VHI score and VQE score both in the pre- and postoperative assessments [Table 4].
|Table 4: Correlation between VHI and VQE scores using Pearson's correlation coefficient|
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| Discussion|| |
Analysis of voice disorders is an ever-evolving field. It involves techniques that evaluate physical/structural parameters (i.e., laryngoscopy, stroboscopy, and high speed endoscopy), ,, mechanical parameters of voice (i.e., shimmer, jitter, fundamental frequency, and maximum phonation time), , electrical parameters (i.e., EMG),  and imaging (i.e., optical coherence tomography, videokymography, CT scan, and color Doppler imaging). ,, Lately, there has been a realization that these parameters may not be a true reflection of the amount of suffering/handicap of the patient as a result of dysphonia.  As a result, in order to assess the level of handicap in dysphonic patients quite a few instruments have been developed in the past, such as the Voice-Related Quality of Life,  the Vocal Performance Questionnaire,  the Voice Participation Profile,  the Voice Symptom Scale,  Dysphonia Severity Index,  the Voice Handicap Index (VHI),  and Vocal Tract Discomfort (VTD) Scale. 
The VHI is considered to be the most relevant, patient-friendly, and versatile tool.  As a result, a Hindi version of VHI was developed and validated in 2011 for the assessment of Hindi speaking population. The present study was carried out to assess the amount of correlation between VHI scores and parameters assessed using Dr. Speech voice analysis software in patients undergoing surgery for benign vocal cord lesions.
All the patients included in our study were asked to fill the Hindi version of VHI. This version contains 30 questions divided into three domains, i.e. functional, physical, and emotional. The other VHI versions that are currently being used in different languages include VHI-10, VHI-12, and VHI- 13. ,, These versions have lesser number of questions and have been found to be highly related to the original VHI.  In our study, the average scores for the physical domain of VHI was found to be higher than the other two domains. This is due to a higher familiarity and association of the patients with the physical symptoms of voice disorders as compared with the functional and emotional symptoms.  There was a statistically significant reduction in the VHI scores postoperatively in the patients included in our study.
The parameters assessed on voice analysis using Dr. Speech voice analysis software in our study were shimmer, jitter, fundamental frequency, and NNE. These are the most commonly assessed parameters in dysphonic patients across the globe. ,,, The other vocal parameters that are commonly assessed include: grade, roughness, breathiness, asthenia, strain, harmonic-to-noise ratio (HNR), signal-to-noise ratio (SNR), and maximum phonation time (MPT). ,, There was a statistically significant improvement in the acoustic parameters assessed in our patients postoperatively.
In order to assess its clinical utility, the VHIs developed in different languages across the world have been evaluated statistically to compare their correlation with various established modalities of voice assessment. Studies in the past have shown a statistically significant correlation of VHI with voice analysis parameters using Dr. Speech voice analysis software, GRBAS scale, laryngoscopic assessment, voice self-assessment, VTD scale, videostroboscopy, voice symptom scale (VoiSS), and Gottingen Hoarseness Diagram (GHD). ,,,,,, These studies have advocated using VHI along with the objective voice analysis parameters in the comprehensive assessment of dysphonic patients. Since the validated version of Hindi VHI was developed only recently,  no such comparative analyses have been performed till date. This study was aimed at comparing the Hindi VHI with the currently assessed voice analysis parameters in our institution (Dr. Speech Voice analysis software) in order to assess its clinical utility and a possible inclusion in our voice evaluation protocols for dysphonic patients. Similar to the studies in the past, we found a significant correlation between the two.
| Conclusion|| |
Hindi VHI correlates well with the commonly used objective voice assessment parameters. It should be included in the standard voice evaluation protocols in dysphonic patients for a comprehensive assessment.
| References|| |
|1.||Yu Z, Pang Z. Study on self-assessment, acoustic analysis, laryngoscopy for patients with voice surgery. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2010;24:980-2, 986. |
|2.||Yu P, Wang G, Han B, Yang W, Han D. Objective multi-parameters analysis of the voice dysphonia. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2004;18:751-4. |
|3.||Döllinger M, Kunduk M, Kaltenbacher M, Vondenhoff S, Ziethe A, Eysholdt U, et al. Analysis of vocal fold function from acoustic data simultaneously recorded with high-speed endoscopy. J Voice 2012;26:726-33. |
|4.||Kazi R, Rhys-Evans P, Nutting CM, Harrington KJ. The great debate: Stroboscopyvs high- speed imaging for assessment of alaryngeal phonation. J Cancer Res Ther 2009;5:121-3. |
|5.||Uloza V, Kaseta M, Pribuisiene R, Saferis V, Jokûzis V, Gelzinis A, et al . Quantitative microlaryngoscopic measurements of vocal fold polyps, glottal gapand their relation to vocal function. Medicina (Kaunas) 2008;44:266-72. |
|6.||Datta R, Sethi A, Singh S, Nilakantan A, Venkatesh MD. Translation and validation of the voice handicap index in Hindi. J Laryngol and Voice 2011;1:12-7. |
|7.||García-López I, Santiago-Pérez S, Peñarrocha-Teres J, Del Palacio AJ, Gavilan J. Laryngeal electromyography in diagnosis and treatment of voice disorders. Acta Otorrinolaringol Esp 2012;63:458-64. |
|8.||Burns JA. Optical coherence tomography: Imaging the larynx. Curr Opin Otolaryngol Head Neck Surg 2012;20:477-81. |
|9.||Popolo PS, Titze IR. Qualification of a quantitative laryngeal imaging system using videostroboscopy and videokymography.Ann Otol Rhinol Laryngol 2008;117:404-12. |
|10.||Tsai CG, Shau YW, Liu HM, Hsiao TY. Laryngeal mechanisms during human 4-kHz vocalization studied with CT, videostroboscopy, and color Doppler imaging. J Voice 2008;22:275-82. |
|11.||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. |
|12.||Hogikyan ND, Sethuraman G. Validation of an instrument tomeasure voice-related quality of life (V-RQOL). J Voice 1999;13:557-69. |
|13.||Carding P, Horsley IA, Docherty GJ. A study of the effectiveness of voice therapy in the treatment of 45 patients with non-organicdysphonia. J Voice 1999;1:72:104. |
|14.||Ma EP, Yiu EM. Voice activity and participation profile: Assessingthe impact of voice disorders on daily activities. J Speech Lang Hear Res 2001;44:511-24. |
|15.||Deary Ĳ, Wilson JA, Carding PN, Mac Kenzie K. VoiSS: A patient derived Voice Symptom Scale. J Psychosom Res 2003;54:483-9. |
|16.||Wuyts FL, De Bodt MS, Molenberghs G, Remacle M, Heylen L, Millet B, et al. The dysphonia severity index: An objective measureof vocal quality based on a multiparameter approach. J Speech Lang Hear Res 2000;43:796-809. |
|17.||Jacobson BH, Jonson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS, etal. The Voice Handicap Index (VHI): Development and validation. Am J Speech Lang Pathol 1997;6:66-70. |
|18.||WoŸnicka E, Niebudek-Bogusz E, Kwiecieñ J, Wiktorowicz J, Sliwiñska-Kowalska M. Applicability of the vocal tract discomfort (VTD) scale in evaluating the effects of voice therapy of occupational voice disorders. Med Pr 2012;63:141-52. |
|19.||Franic DM, Bramlett RE, Bothe AC. Psychometric evaluation of disease specific quality of life instruments in voice disorders. J Voice 2005;19:300-15. |
|20.||Rosen CA, Lee AS, Osborne J, Zullo T, Murry T. Development and validation of the voice handicap index-10. Laryngoscope 2004;114:1549-56. |
|21.||Hanschmann H, Lohmann A, Berger R. Comparison of subjective assessment of voice disorders and objective voice measurement. Folia Phoniatr Logop 2011;63:83-7. |
|22.||Li H, Huang Z, Hu R, Zhang L, Xu W. Study on the simplified Chinese version of the voice handicap index. J Voice 2012;26:365-71. |
|23.||Cho SW, Yin CS, Park YB, Park YJ. Differences in self-rated, perceived, and acoustic voice qualities between high- and low-fatigue groups. J Voice 2011;25:544-52. |
|24.||Lau DP, Zhang EZ, Wong SM, Lee G, Chan YH. Correlating voice handicap index and quantitative videostroboscopy following injection laryngoplasty for unilateral vocal paralysis. Otolaryngol Head Neck Surg 2010;143:190-7. |
|25.||Kiagiadaki DE, Chimona TS, Chlouverakis GI, Stylianou Y, Proimos EK, Papadakis CE, et al. Evaluating the outcome of phonosurgery: Comparing the role of VHI and VoiSS questionnaires in the Greek language. J Voice 2012;26:372-7. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]