Voice Handicap Index check pre and post vocal intervention in patients with dysphonia

Lemos, Isadora de Oliveira; Marchand, Daniel Lucas Picanço; Cassol, Mauriceia

doi:10.1590/2317-6431-2015-1580

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Audiology - Communication Research

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Original Articles • Audiol., Commun. Res. 20 (4) • Oct-Dec 2015 • https://doi.org/10.1590/2317-6431-2015-1580 copy

Voice Handicap Index check pre and post vocal intervention in patients with dysphonia

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

Characterize and measure the voice self-perception of patients pre and post speech therapy treatment using the Índice de Desvantagem Vocal (IDV) protocol, adapted from the Voice Handicap Index (VHI) protocol.

Methods:

This is a cross-sectional study using a database of patients seen in a speech therapy service.

Results:

The sample comprised 23 patients, 16 (69.6%) of whom female and seven (30.4%) male. The mean age was 58 years and the mean therapy duration was three months with 11 sessions. Among the types of dysphonia found, organic was the most frequent (47.8%) followed by functional (30.7%) and organic-functional (21.7%). The protocol's total score median decreased prior to intervention compared to the post-intervention period, which means a lower voice handicap. Moreover, 80% of the protocol's questions significantly differed when compared pre and post speech therapy.

Conclusion:

A difference was found in voice perception after speech therapy intervention, indicated by lower scores in the IDV items. The findings show the importance of using the IDV protocol in clinical practice to help the speech therapist target the treatment and understand the voice behavior of dysphonic patients. Further research is suggested given the instrument's efficacy.

Keywords:
Voice; Dysphonia; Protocols; Voice disorders; Speech therapy

Variables		n=23
Sex – n (%)
	Female	16 (69.6)
	Male	7 (30.4)
Age (years) - mean±SD		58.7±8.6
No. of therapy sessions – mean±SD		11.4±4.1
Time of therapy (months) – mean±SD		3.3±1.1
Type of dysphonia – n (%)
	Organic	11 (47.8)
	Functional	7 (30.4)
	Organic-functional	5 (21.7)

Questions	Sub-scale	Before	After	p-value
Questions	Sub-scale	Mean (P25-P75)	Mean (P25-P75)	p-value
1. My voice makes it difficult for people to hear me.	Physical	2 (1 – 3)	2 (0 – 2)	0.156
2. I run out of air when I talk.	Organic	2 (0 – 2)	1 (0 – 2)	0.233
3. People have difficulty understanding me in a (…)	Physical	3 (2 – 4)	2 (0 – 2)	0.005^* * Significant values (p≤0.05) – Wilcoxon test
4. The sound of my voice varies throughout the day.	Organic	2 (2 – 4)	2 (1 – 2)	0.013^* * Significant values (p≤0.05) – Wilcoxon test
5. My family has difficulty hearing me when I call (…)	Physical	2 (2 – 3)	0 (0 – 2)	0.003^* * Significant values (p≤0.05) – Wilcoxon test
6. I use the phone less often than I would like.	Physical	2 (0 – 3)	0 (0 – 2)	0.010^* * Significant values (p≤0.05) – Wilcoxon test
7. I'm tense when talking with others because of (…)	Emotional	2 (0 – 4)	1 (0 – 2)	0.011^* * Significant values (p≤0.05) – Wilcoxon test
8. I tend to avoid groups of people because of my (…)	Physical	2 (0 – 4)	0 (0 – 1)	0.005^* * Significant values (p≤0.05) – Wilcoxon test
9. People seem irritated with my voice.	Emotional	0 (0 – 2)	0 (0 – 2)	0.680
10. People ask, “What's wrong with your voice?”	Organic	3 (2 – 4)	1 (0 – 2)	0.001^* * Significant values (p≤0.05) – Wilcoxon test
11. I speak with friends, neighbors, or relatives (…)	Physical	1 (0 – 3)	0 (0 – 1)	0.013^* * Significant values (p≤0.05) – Wilcoxon test
12. People ask me to repeat myself when (…)	Physical	2 (0 – 3)	2 (0 – 2)	0.029^* * Significant values (p≤0.05) – Wilcoxon test
13. My voice sounds creaky and dry.	Organic	4 (2 – 4)	2 (2 – 3)	0.007^* * Significant values (p≤0.05) – Wilcoxon test
14. I feel as though I have to strain to produce voice.	Organic	3 (1 – 4)	2 (0 – 2)	0.006^* * Significant values (p≤0.05) – Wilcoxon test
15. I find other people don't understand my voice (…)	Emotional	2 (1 – 4)	0 (0 – 2)	<0.001^* * Significant values (p≤0.05) – Wilcoxon test
16. My voice difficulties restrict my personal and (…)	Physical	2 (0 – 4)	0 (0 – 0)	0.001^* * Significant values (p≤0.05) – Wilcoxon test
17. The clarity of my voice is unpredictable.	Organic	4 (2 – 4)	2 (0 – 3)	0.011^* * Significant values (p≤0.05) – Wilcoxon test
18. I try to change my voice to sound different.	Organic	3 (0 – 4)	2 (0 – 2)	0.050^* * Significant values (p≤0.05) – Wilcoxon test
19. I feel left out of conversations because of my (…)	Physical	0 (0 – 2)	0 (0 – 0)	0.037^* * Significant values (p≤0.05) – Wilcoxon test
20. I use a great deal of effort to speak.	Organic	2 (1 – 3)	0 (0 – 2)	0.005^* * Significant values (p≤0.05) – Wilcoxon test
21. My voice is worse in the evening.	Organic	0,5 (0 – 4)	0 (0 – 2)	0.040^* * Significant values (p≤0.05) – Wilcoxon test
22. My voice problem causes me to lose income.	Physical	0 (0 – 3)	0 (0 – 0)	0.067
23. My voice problem upsets me.	Emotional	3 (2 – 4)	0 (0 – 2)	0.002^* * Significant values (p≤0.05) – Wilcoxon test
24. I am less outgoing because of my voice problem.	Emotional	2 (0 – 4)	0 (0 – 2)	0.086
25. My voice makes me feel handicapped.	Emotional	2 (0 – 4)	0 (0 – 2)	0.014^* * Significant values (p≤0.05) – Wilcoxon test
26. My voice “gives out” on me in the middle of (…)	Organic	3 (2 – 4)	2 (0 – 2)	0.001^* * Significant values (p≤0.05) – Wilcoxon test
27. I feel annoyed when people ask me to repeat.	Emotional	2 (0 – 2)	0 (0 – 1)	0.010^* * Significant values (p≤0.05) – Wilcoxon test
28. I feel embarrassed when people ask me to repeat.	Emotional	1 (0 – 2)	0 (0 – 2)	0.176
29. My voice makes me feel incompetent.	Emotional	2 (0 – 3)	0 (0 – 0)	0.018^* * Significant values (p≤0.05) – Wilcoxon test
30. I'm ashamed of my voice problem.	Emotional	0 (0 – 1)	0 (0 – 0)	0.026^* * Significant values (p≤0.05) – Wilcoxon test

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[1] Correspondence address: Isadora de Oliveira Lemos. R. Roque Calage 590/403, Passo da Areia, Porto Alegre (RS), Brazil, CEP: 91350-090. E-mail: isadoradelemos@gmail.com