Throat related symptoms and voice: development of an instrument for self assessment of throat-problems

<p>Abstract</p> <p>Background</p> <p>Symptoms from throat (sensation of globus; frequent throat clearing; irritated throat) are common in patients referred to voice clinics and to ENT specialists. The relation to symptoms of voice discomfort is unclear and in some cases patients do not have voice problems at all. Instruments for patients' self-reporting of symptoms, and assessment of handicap, such as the Voice Handicap Index (VHI), are in common use in voice clinics. Symptoms from throat are however only marginally covered. Purpose: To develop and evaluate an instrument that could make the patients' estimation of symptoms from the throat possible. Further to facilitate the consideration of the relation between throat- and voice problems with the Throat subscale together with a Swedish translation of the Voice Handicap Index. Finally to try the VHI with the Throat subscale: the VHI-T, for test-retest reliability and validity.</p> <p>Methods</p> <p>A subscale with 10 throat related items was developed for appliance with the VHI. The VHI was translated to Swedish and retranslated to English. The questionnaire was tried in two phases on a total of 23+144 patients and 12+58 voice healthy controls. The reliability was calculated with Cronbach's alpha, ICC and Pearson's correlation coefficient. The validity was estimated by independent T-test.</p> <p>Results</p> <p>The difference in VHI-T scores between the patients and the voice-healthy controls was significant (<it>p </it>= < 0,01) and there was a good correlation of the test- retest occasions. The reliability testing of the entire questionnaire showed an alpha value of <it>r </it>= 0,90 and that for the Throat subscale separately a value of <it>r </it>= 0,87 which shows a high degree of reliability.</p> <p>Conclusions</p> <p>For the estimation of self-perceived throat and voice problems the scale on throat related problems together with the present Swedish translation of the Voice Handicap Index, (VHI) the VHI-Throat, proves to be a valid and reliable instrument. The throat subscale seems to help revealing a category of symptoms that are common in our patients. These are symptoms that have not earlier been possible to cover with the questionnaires designed for use in the voice clinic.</p

Wie der Einfluss von Geschlecht und Lautstärke in der klinischen akustischen Stimmuntersuchung minimiert werden kann

Various reports have shown marked gender and habitual voice intensity effects on jitter and shimmer measurements in clinical practice. The aim of this cross-sectional single cohort study was to compare voice intensity and gender effects in healthy adults under a range of assessment protocols, and to derive guidelines to control for these effects in practice. Forty healthy adults (1:1 f:m) aged 20-40 years were recorded. All phonated a prolonged /a/ under eleven protocols: a) at subjective soft, normal and loud intensity to model routine clinical assessment b) at prescribed intensities: 65, 75, 85 and 95 dB, maintained by visual feedback; c) at prescribed intensities and with fixed fundamental frequency (auditory feedback). Recordings were analysed with Praat software. Gender effects were assessed with inferential (ANOVA) statistics. Lowest jitter and shimmer were found at highest SPL. The difference between male and female measurements was smallest with control for SPL but not for pitch. When asked for soft, medium or loud phonations without SPL control, men were always louder. But at prescribed voice intensities women and men phonated comparably loud; 75 dB and 85 dB were matched best. Inter-individual SPL differences, and therefore also jitter and shimmer differences were considerably lower in controlled phonations. Gender and habitual voice intensity effects in voice measurements can be efficiently minimised by asking the patients to control for voice intensity by visual feedback. In acoustic assessments patients should maintain their voice intensity at 85 dB. Future work should investigate which patients groups are able to fulfil these requirements