Use of Voice Handicap Index (VHI) as Predictor of Outcome of Non-surgical Treatment in Vocal Nodules

Abstract

Introduction Vocal Nodule is commonest benign vocal cord lesion which causes varying degree of dysphonia having serious impact on personal and professional well being. Voice Handicap Index (VHI) is a psychometrically validated tool for measuring pshycosocial handicapping effect of voice disorder. Materials and Methods From data available since last 18 months, patients who had undergone treatment for vocal nodule were selected as study population. In Group A, 50 patients were selected who required surgery and Group B, 50 patients who responded to medical treatment. Patients filled in VHI-30 form at time of diagnosis and subjected to voice therapy and adjunctive medical treatment for 1 month and reassessed using VHI-30. Successful treatment consisted of absence of pathology by laryngoscopy and decrease of VHI total score ≥18. Results The cut-off score was calculated using Receiver Operating Characteristics (ROC). VHI cut-off of total score was 45 (Sensitivity 94%, Specificity76%). The cut-off score for functional, physical and emotional domains are 14(Sensitivity 94%, Specificity 64%) , 15(Sensitivity 92%, Specificity 60%) and 15(Sensitivity 90%, Specificity 66%) respectively. Discussion Hard consistency of nodules can explain refractoriness to speech therapy and higher VHI score. The physical subscale of VHI was higher among both groups indicating patients’ perceptions of laryngeal discomfort and voice output affected them more. According to our study patients with higher VHI score should be counselled for MLS at earliest instead of speech therapy for one month which would not have given good outcome. Conclusion These scores give a good idea about categories of patients who will not benefit by non-surgical treatment and hence early surgical intervention will obviate the duration of handicap and delay in appropriate treatment.

Keywords

• vocal nodule
• dysphonia
• roc curve
• speech therapy