Validation and Classification of the 9-Item Voice Handicap Index (VHI-9i)

Abstract

The international nine-item Voice Handicap Index (VHI-9i) is a clinically established short-scale version of the original VHI, quantifying the patients’ self-assessed vocal handicap. However, the current vocal impairment classification is based on percentiles. The main goals of this study were to establish test–retest reliability and a sound statistical basis for VHI-9i severity levels. Between 2009 and 2021, 17,660 consecutive cases were documented. A total of 416 test–retest pairs and 3661 unique cases with complete multidimensional voice diagnostics were statistically analyzed. Classification candidates were the overall self-assessed vocal impairment (VHIs) on a four-point Likert scale, the dysphonia severity index (DSI), the vocal extent measure (VEM), and the auditory–perceptual evaluation (GRB scale). The test–retest correlation of VHI-9i total scores was very high (r = 0.919, p < 0.01). Reliability was excellent regardless of gender or professional voice use, with negligible dependency on age. The VHIs correlated best with the VHI-9i, whereas statistical calculations proved that DSI, VEM, and GRB are unsuitable classification criteria. Based on ROC analysis, we suggest modifying the former VHI-9i severity categories as follows: 0 (healthy): 0 ≤ 7; 1 (mild): 8 ≤ 16; 2 (moderate): 17 ≤ 26; and 3 (severe): 27 ≤ 36.

A follow-up study of surgically managed benign vocal cord lesions using vocal handicap index – 10 score

“…They can easily, through this questionnaire, assess the severity of the disease and can refer to an ENT surgeon for further management. [ 27 ]…”

Assessment of speech function in an axiographic examination in patients with voice handicap – preliminary report

“…Na każde pytanie badany udziela odpowiedzi, określającej częstotliwość występowania danego odczucia. 13 Z kolei badaniem, które pozwala ocenić zmianę położenia wyrostków kłykciowych podczas ruchu żuchwy poprzez zobrazowanie zakresu oraz toru osi kinematycznej podczas różnych czynności URNŻ, w tym mowy jest aksjografia. 14,15 Bazując na powyższym, postanowiono ocenić ruchy żuchwy u osób z subiektywną niepełnosprawnością głosową.…”

Vocal Fatigue als Indikator für komplexe Stimmstörungen – eine diagnostische und therapeutische Herausforderung

“…Im Voice Handicap Index 9 international (VHi9i) [8] wurde ein Gesamtscore von ∑ = 17 (von insgesamt 40) erreicht, wobei physische Symptome die meisten Punkt erhielten (Unterscores: "funktional": ∑ = 4 von 16; "physisch": ∑ = 10 von 12; "emo-…”

“…Im Voice Handicap Index 9 international (VHi9i) [ 8 ] wurde ein Gesamtscore von ∑ = 17 (von insgesamt 40) erreicht, wobei physische Symptome die meisten Punkt erhielten (Unterscores: „funktional“: ∑ = 4 von 16; „physisch“: ∑ = 10 von 12; „emotional“: ∑ = 1 von 8). In der Vocal Tract Discomfort Scale (VTD) [ 19 ] wurden die Empfindungen „Trockenheit, Schmerzen, Reizung und/oder Kloß im Hals“ in Häufigkeit und Schweregrad als sehr oft bis immer (Skala 4–6 von 6) angegeben.…”