Audiology and Speech Center, Department of Research Programs, Otolaryngology, and Surgical Oncology at Walter Reed National Military Medical Center, Bethesda, MD, USA.
J Voice. 2013 May;27(3):348-54. doi: 10.1016/j.jvoice.2012.10.012. Epub 2013 Jan 5.
OBJECTIVES/HYPOTHESES: The Voice Handicap Index (VHI) is a simple, reliable, self-administered questionnaire that has been used to identify negative voice outcomes after thyroidectomy. This study provides an updated report of a multiyear study examining the predictive ability of the VHI to classify normal versus negative voice outcomes (VOs).
Prospective observational, longitudinal study of the patient reported impact of voice changes after thyroidectomy using the VHI. Since the preliminary report, the sample size doubled and methods for classifying voice outcomes (VOs) were refined.
Ninety-one adults provided voice assessment data preoperatively (baseline) and at approximately 2 weeks postthyroidectomy. VO was defined according to endoscopic laryngeal examination, acoustic, auditory perceptual, and patient report parameters. The VHI was tested for its sensitivity and specificity for identifying VO.
Twenty-two participants (24.2%) qualified as having adverse VOs during the early postoperative period. A change from baseline in VHI of 13-16 points had a diagnostic accuracy of 86% sensitivity and 88% specificity for classifying early VO and had 70% and 95% positive and negative predictive values, respectively. The Functional and Physical subscales of the VHI had higher predictive value than the Emotional subscale. Adjunctive analyses of a two-subscale version of the VHI and of the 10 items that comprises the VHI-10 also revealed high predictive value for differentiating groups by VO.
Balanced sensitivity and specificity are achieved at a change in the total VHI score of 13-16. These results are generally consistent with several other studies examining voice problems over time. The VHI, as well as its alternate versions, appear to be useful and should be incorporated into the diagnostic process for identifying patients with voice problems after thyroidectomy.
目的/假设：嗓音障碍指数（VHI）是一种简单、可靠、可自我管理的问卷，用于识别甲状腺切除术后的负面嗓音结果。本研究提供了一项多年研究的最新报告，该研究检查了 VHI 对正常与负面嗓音结果（VO）进行分类的预测能力。
使用 VHI 对甲状腺切除术后患者嗓音变化的影响进行前瞻性观察性、纵向研究。自初步报告以来，样本量增加了一倍，并且 VO 分类方法也得到了改进。
91 名成年人在术前（基线）和甲状腺切除术后约 2 周时提供了嗓音评估数据。VO 根据内镜喉镜检查、声学、听觉感知和患者报告参数进行定义。测试了 VHI 识别 VO 的敏感性和特异性。
22 名参与者（24.2%）在术后早期出现不良 VO。VHI 从基线的变化 13-16 分，对分类早期 VO 的诊断准确性为 86%的敏感性和 88%的特异性，阳性和阴性预测值分别为 70%和 95%。VHI 的功能和生理子量表比情绪子量表具有更高的预测价值。VHI 的两分量表版本和包含 10 个项目的 VHI-10 的辅助分析也表明，VO 可区分组的预测价值较高。
VHI 总分变化 13-16 时达到了平衡的敏感性和特异性。这些结果与其他几项随时间检查嗓音问题的研究基本一致。VHI 及其替代版本似乎很有用，应该纳入甲状腺切除术后识别嗓音问题患者的诊断过程。
