Voice Handicap Index: Cut-Off Points for Screening European Portuguese With Voice Disorders

Abstract

To determine cut-off values of the Voice Handicap Index (VHI) and the shortened version (VHI-10) for European Portuguese (EP) with voice disorders. In addition, to analyze the discriminatory power of individual items of the VHI-10 and the ability to detect differences in various Ear Nose and Throat (ENT) diagnoses. Cross-sectional cohort study. All participants completed the EP VHI and a 4-point self-assessment of voice disorder severity. The case group (subjects with voice disorders) underwent assessment through strobovideolaryngoscopy examinations by ENT surgeons and perceptual analyses by speech-language pathologists (SLPs). In contrast, the control group was evaluated solely by SLPs. Data were analyzed using a receiver-operating characteristic curve to determine the accuracy and cut-off values of the VHI and VHI-10. The study involved a sample of 350 adults (171 cases and 179 controls), predominantly women aged 18-88years. The area under curve (AUC) for VHI and VHI-10 was 0.997 [95% confidence interval (CI): 0.992-1] and 0.998 [95% CI: 0.995-0.999], respectively. Optimal cut-off values were identified as 13.5 for VHI (0.994 sensitivity and 0.989 specificity) and 5.5 for VHI-10 (0.977 sensitivity and 0.955 specificity). Each individual item within the VHI-10 significantly contributed to the overall assessment, exhibiting varying discriminatory power ranging from excellent (AUC=0.937) to poor (AUC=0.637). Significant differences were found in the case group between neurogenic disorders and healthy larynx (P=0.014), structural and physiologic minor laryngeal abnormalities (P=0.006), and inflammatory disorders (P=0.043). The VHI and the VHI-10 exhibited accurate screening properties for predicting EP speakers with voice disorders.