Although recognized as a valuable diagnostic tool for more than 60 years, many laryngologists do not routinely use laryngeal electromyography (LEMG). This may be due to a persisting lack of agreement on methodology, interpretation, validity, and clinical application of LEMG. To achieve consensus in these fields, a laryngeal electromyography working group of European neurolaryngologic experts was formed in order to (1) evaluate guidelines for LEMG performance and (2) identify issues requiring further clarification. To obtain an overview of existing knowledge and research, English-language literature about LEMG was identified using Medline. Additionally, cited works not detected in the initial search were screened. Evidence-based recommendations for the performance and interpretation of LEMG and also for electrostimulation for functional evaluation were considered, as well as published reports based on expert opinion and single-institution retrospective case series. To assess the data obtained by this literature evaluation, the working group met five times and performed LEMG together on more than 20 patients. Subsequently, the results were presented and discussed at the 8th Congress of the European Laryngological Society in Vienna, Austria, September 1-4, 2010, and consensus was achieved in the following areas: (1) minimum requirements for the technical equipment required to perform and record LEMG; (2) best practical implementation of LEMG; (3) criteria for interpreting LEMG. Based on this consensus, prospective trials are planned to improve the quality of evidence guiding the proceedings of practitioners.

Objective: We aimed to assess the equivalence of translations of the Voice Handicap Index (VHI). Patients and Methods: Confirmatory factor analysis was used to assess equivalence of the US version and several translations including (1) Dutch, (2) Flemish Dutch (Belgium), (3) UK English, (4) French, (5) German, (6) Italian, (7) Portuguese and (8) Swedish. VHI questionnaires were gathered from 1,281 subjects. Patients were classified into 11 voice lesion categories. Patients with incomplete response (4%) and patients within voice lesion categories with small numbers were excluded from further analyses, leaving a cohort of 1,052 patients from 8 countries. Results: The internal consistency of the VHI proved to be good. Confirmatory factor analysis across countries revealed that a 3-factor fixed measurement model best fitted the data; the 3 subscales appeared to highly intercorrelated, especially in the US data. The underlying structure of the VHI was also equivalent regarding various voice lesions, but distinct groups were recognized with respect to the height of the VHI scores, indicating that various voice lesions lead to a diversity of voice problems in daily life. Conclusion: The US VHI and the translations appeared to be equivalent, which means that the results from studies from the various included countries can be compared.

The voice handicap index (VHI) was developed in the United States for subjective evaluation of a voice disturbance by the patient. The translation into German has been applied for a German population of patients. It was validated by the examination of 316 adult patients, 221 female and 95 male. The reliability of the VHI rests on a high Cronbach's alpha (0.96). A factor analysis in order to structure the items yields four factors that can be interpreted as negative voice experience (factor 1-explaining 20.83% of the variance after rotation), lack of assertiveness (factor 2-18.82%), lack of vocal power (factor 3-12.84%), and negative emotionality (factor 4-11.01%). The mean VHI scores differ significantly from each other in different degrees of voice disturbance as estimated by the patients themselves. The voice handicap index is qualified as a diagnostic tool for German-speaking countries.

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