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Is There a Relationship Between Vocal Effort and VHI?

Brienne Ruel, Susan Thibeault
Journal of Voice: Official Journal of the Voice Foundation 2019 April 8

OBJECTIVES: Vocal effort is often a symptom reported when a patient experiences a voice disorder. The aim of this investigation was to compare Voice Handicap Index (VHI) scores among patients with primary complaints of vocal effort (VE) versus vocal quality (VQ) and both vocal effort and quality (VQ+VE). A secondary aim was to compare Glottal Function Index (GFI), and glottic closure pattern between patients with the aforementioned primary presenting complaints and laryngeal pathology diagnosis.

STUDY DESIGN: Prospective outcomes database design METHODS: Patients were identified with presenting complaints of VQ, VE, or VQ+VE who completed the VHI. Seven hundred and thirteen subjects who met criteria were categorized across three complaint groups and five laryngeal pathologies. Variables selected included age, gender, diagnosis, VHI, GFI, and 12-Item Short Form Health Survey. VHI and GFI scores were compared between the three presenting complaints. Relationships between the categorical variables and glottic closure were also assessed.

RESULTS: Significant differences in total VHI were measured among all three presenting-complaint categories (P < 0.0001). Patients with VE only complaints had significantly greater VHI scores than those patients who report VQ only complaints. VHI scores were significantly higher for patients with combined complaints of VQ+VE as compared to VQ only or VE only. Significant differences in GFI were measured across all three complaints, and GFI was significantly higher in VE only as compared to VQ only (P < 0.001). Glottic closure pattern was not statistically significant in the variables examined. VHI scores were significantly different within pathology subgroups (P < 0.03).

CONCLUSION: VE only complaints affect quality of life with and without concomitant VQ complaints. Patients with VE complaints perceive a higher level of glottic dysfunction. An underlying mechanism for increased VE could be altered glottic function, however, we were unable to suggest a correlation between glottic closure and GFI.


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