Pediatric Voice Handicap Index (pVHI): Validation in European Portuguese Children.

OBJECTIVES: To determine reliability and validity of the European Portuguese pVHI version (pVHI-EP). STUDY DESIGN: Cross-sectional design. METHODS: The pVHI-EP and the talkative and global voice assessment scales were administered to the caregivers of children aged from 3 to 16 years old with and without dysphonia. Reliability (internal consistency and test-retest) was analyzed. The validity analyses performed were: (1) content validity by analyzing the percentage of missing data; (2) construct validity with intraclass correlation coefficients among pVHI-EP domains and overall score; (3) concurrent validity was conducted between pVHI-EP, the caregivers' judgment of the child's voice severity on a visual analog scale and the Speech-Language Pathologist perceptual voice assessment; (4) known-groups validity between children with and without dysphonia, and (5) predictive validity by calculating receiver operating characteristics, sensitivity and specificity and determining cut-off points. RESULTS: A total of 283 children (61.5% boys, mean age 8.3 years) participated in the study. The pVHI-EP showed an excellent internal consistency for the pVHI-EP total data. Strong to moderate test-retest reliability confirms pVHI-EP reproducibility. Excellent to good intraclass correlation coefficients between the pVHI-EP overall and the domains confirms its construct validity. Weak to moderate concurrent validity with visual analog scale and Speech-Language Pathologist perceptual voice assessment was confirmed. The pVHI-EP significantly distinguished two groups of different voice conditions. A cut-off point of 10.5 with 95.9% sensitivity and 92.5% specificity was determined for the overall score of the pVHI-EP. CONCLUSIONS: The pVHI-EP is a reliable and valid caregiver voice outcome tool for EP children with dysphonia.

Preoperative Voice Characteristics in Thyroid Patients.

INTRODUCTION: Thyroid surgery outcomes have evolved from mortality control strategies to morbidity control measures. Most vocal outcomes research in thyroid surgery are focused on recurrent nerve anatomic and functional preservation. However, there are likely multiple causes of vocal dysfunction in thyroid patients. We prospectively analyzed preoperative patients with thyroid disease to define preoperative vocal characteristics of this population. OBJECTIVE: Quantify vocal and laryngeal baseline conditions in thyroid surgical patients. METHODS: Prospective study of preoperative stroboscopy findings and vocal function assessing the correlation between thyroid disease, compressive symptoms, baseline vocal conditions and laryngoscopy results. RESULTS: Vocal quantitative scores were positive for dysphonia in 36% of patients and the Vocal Handicap Index confirmed either slight or Moderate impairment in most patients. Stroboscopy results were abnormal in 60% of cases with no diagnoses of immobility. Correlation was established for diagnosis of cancer and the absence of symptoms. CONCLUSIONS: These results point to a multifactorial cause for vocal impairment in thyroid surgery patients. Research on vocal impairment in thyroid surgery should not be centered exclusively on recurrent nerve neuromonitoring and functional preservation, but also on other variables that may contribute to vocal change in thyroid disease and surgery.

The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) Psychometric Characteristics: II European Portuguese Version (II EP CAPE-V).

OBJECTIVE: The purpose of this study was to assure a reliable and valid European Portuguese (EP) version of Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). This resulted in the second EP version of CAPE-V (II EP CAPE-V), with permission granted by American Speech-Language-Hearing Association. STUDY DESIGN: This is a transversal, observational, descriptive, and comparative study. METHODS: Retranslation of CAPE-V into EP was reviewed by an EP linguistic expert for content validity. A total of 20 subjects: 10 male individuals (mean age = 45) and 10 female individuals (mean age = 43) formed a control group (n = 10) and a dysphonic group (n = 10) were matched by age and gender. All subjects' CAPE-V phonatory tasks were captured with PEYLE PMENI (China) microphone and recorded with TASCAM DR-05 (Tokyo, Japan). Fourteen speech-language pathologists voice experts (>5 years of clinical practice) rated 26 voice samples with 6 repeated samples added for intrarater reliability. All voice samples were heard using AKG K101 (Europe) headphones and were rated in two sessions with a 1-week interval: one with the II EP CAPE-V; and the second with the GRBAS scale to establish for inter-rater reliability and construct and concurrent validity. Statistical analysis for inter-rater reliability was obtained with the intraclass correlation coefficient. Intrarater reliability was obtained with Pearson correlation. Construct and concurrent validity were performed with Student t test and multiserial correlation coefficient, respectively. SPSS 22.0 (IBM Corp, Armonk, NY) and LISREL 8.8 (Scientific Software International, Inc, Chicago, IL) were used with significance level cut-off points: r > 0.70 and α = 0.05. RESULTS: High inter-rater reliability was obtained for all vocal parameters (intraclass correlation coefficient > 0.84) revealing good equivalence. Intrarater reliability was high (r > 0.87) for overall severity, breathiness, and pitch; good (r = 0.73) for strain; and moderate (r > 0.61) for roughness and loudness. These results revealed good reproducibility and stability of the II EP CAPE-V over time. Content validity was assured by an EP linguistic expert. Construct validity was obtained for all vocal parameters (P < 0.05), except for strain (P = 0.52), revealing these were the salient parameters for rating normal and dysphonic voices samples. Concurrent validity between the II EP CAPE-V and the GRBAS scales had strong correlations (r > 0.89) for overall severity/grade, roughness, and breathiness parameters, suggesting both instruments measure the same construct. CONCLUSIONS: The II EP CAPE-V is a reliable and valid instrument for auditory-perceptual evaluation of the EP population, with all psychometric measures assured.