Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population

Abstract

Objective To evaluate predictors of longitudinal change in patient-perceived voice impact as determined by the Voice Handicap Index (VHI). Study Design Prospective, survey study. Methods Patients consented to the UW Voice and Swallow Clinics Outcomes Database with voice, breathing and/or cough concerns with a baseline clinic visit from November 2012 to January 2014 were eligible for the study. VHI was sent to patients six months post-clinic visit to determine change in voice handicap from baseline. General health was screened using the SF-12v2 survey, using physical component (PCS) and mental component summary (MCS) scores. Predictor variables included – treatment (medical and/or behavioral), dysphonia sub-diagnosis, GRBAS rating, age, sex, socioeconomic factors, smoking history, and comorbidity score. Results Two-hundred thirty-seven patients met study criteria and were followed longitudinally. Eighty-two patients returned six month surveys. VHI was significantly correlated with MCS scores. Patients with a higher grade in baseline GRBAS score were more likely to receive voice intervention (p = .04). Six-month improvement in VHI score was associated with both higher initial VHI score and higher education level in both univariate (p < .01, p = .04) and multivariate analyses (p < .01, p = .02). Voice treatment (medical and/or behavioral) was not a significant factor for improvement in VHI. Conclusions Our results suggest it is important to consider baseline self-perceived voice impact measures and education level in setting expectations for voice treatment. Future studies examining the relationship between treatment patterns and voice-related patient outcomes are warranted.

Healthcare Disparities in Laryngology: A Scoping Review

“…Following laryngeal cancer, voice disorders, deglutitive disorders, and airway disorders represent the remainder of pathologies examined across the U.S. disparity literature in laryngology. Granularity was present in the voice literature, with outcomes of patients with specific benign vocal fold lesions (such as polyps, nodules, and sulcus vocalis) being distinguished and studied within larger voice pathology cohorts 56,60–62,64,80 . All but one study 72 on disparities in the care of deglutitive disorders examined swallowing dysfunction and PEG placement following stroke.…”

“…Granularity was present in the voice literature, with outcomes of patients with specific benign vocal fold lesions (such as polyps, nodules, and sulcus vocalis) being distinguished and studied within larger voice pathology cohorts. 56,[60][61][62]64,80 All but one study 72 on disparities in the care of deglutitive disorders examined swallowing dysfunction and PEG placement following stroke. Though deliberately sought in our search strategy, only one paper examined airway pathologies.…”

“…Higher education level associated with improvement in voice symptoms. 55,56 Geography Midwesterners more likely to report voice disorders. 57,58 For patients undergoing procedures on same day as dysphonia diagnosis, higher expenditures in South (coefficient,$ 22, 95% CI 12 to 32, P < .001) and Northeast (reference) vs. West (coefficient,$ -17, 95% CI -29 to −6, P < .003) and North-Central (coefficient,$ -16, 95% CI -26 to −5, P = .005) regions.…”

The effectiveness of voice therapy on voice‐related handicap: A network meta‐analysis

“…Further studies of the VHI‐30 evaluated the potential reduction of questions, 11‐13 its application to various populations with voice disorders, 14‐22 the relationship to objective measurements, 17,23‐25 test‐retest differences 10,26‐28 and its applicability as screening tool 28 . The VHI has been used by numerous studies to measure the effect of voice therapy; its sensitivity treatment‐associated voice changes have established it as a useful voice assessment tool 29‐32 …”

“…28 The VHI has been used by numerous studies to measure the effect of voice therapy; its sensitivity treatment-associated voice changes have established it as a useful voice assessment tool. [29][30][31][32] Dysphonia has different aetiologies 33,34 that determine the primary approach to treatment. Treatment options can include voice therapy, [35][36][37][38][39][40][41][42][43][44][45] phonosurgery 46,47 or pharmacological 48 treatment.…”