Is a voice‐specific instrument more indicative of stroboscopy results than common clinical queries?

Abstract

Objectives To determine whether the Voice Handicap Index‐10 (VHI‐10) predicts diagnoses made via laryngoscopy/stroboscopy, as compared to common clinical inquiries about vocal characteristics. Methods We prospectively collected data from a cohort of 204 consecutive patients newly presenting for ambulatory laryngology evaluation. Each patient completed the VHI‐10 and 16 concurrent mainstream queries about vocal characteristics such as weakness, breathiness, fatiguability, or inability to shout. Using the objective diagnoses made by laryngoscopy/stroboscopy as a gold standard, the area under the receiver operating characteristic curves (AUC), sensitivity, and specificity were determined. Results For unilateral vocal fold paralysis, VHI‐10 scores had an AUC of 0.78 (95% CI, 0.68–0.88) and had better discrimination than 12 common clinical queries. At a threshold score of ≥11, VHI‐10 sensitivity was 0.94; at a threshold of ≥31, specificity was 0.91. For laryngeal stenosis, the VHI‐10 score demonstrated moderate discrimination, with an AUC of 0.79 (95% CI, 0.56–1.00) and higher discrimination than three common clinical queries. At a threshold score of ≥11, VHI‐10 sensitivity was 1.00; at a threshold of ≥31, specificity was 0.89. Both VHI‐10 scores and common clinical queries had low diagnostic ability for vocal fold paresis, laryngopharyngeal reflux (LPR), paradoxical vocal fold motion, and vocal fold scar or atrophy. Conclusions The VHI‐10 score is an effective diagnostic indicator of laryngoscopy/stroboscopy findings of vocal fold paralysis and laryngeal stenosis, performing better than multiple mainstream queries about vocal characteristics. VHI‐10 scores and common clinical queries are limited in their ability to indicate paresis, reflux, paradoxical motion, and vocal fold scar or atrophy. Level of Evidence 2c Laryngoscope, 130:992–999, 2020

Clinical and Anatomical Variation During Assessment of Maximum Glottic Angle

“…While patient self‐report of symptoms and patient‐reported outcomes measures have generally been shown to correlate with stroboscopic changes, normative data on many quantitative laryngeal function measures—and any intra‐patient variability across time—remain sparse 5,6 . Given the conflicting reports on the strength of the correlation between patient outcomes and quantitative measures, a thorough understanding of expected normal variance is paramount 7,8 .…”