Determining Cutoff Point in Bahasa Malaysia Version of Voice Handicap Index-10 (mVHI-10).

OBJECTIVE: Determining the cutoff point on Bahasa Malaysia version of Voice Handicap Index (mVHI-10) questionnaire scores for distinguishing between dysphonic and normal voice samples. STUDY DESIGN: A cross-sectional study was conducted in the tertiary hospital, Otorhinolaryngology-Head and Neck clinic. METHODS: The study involved 205 subjects (105 in the dysphonia group; 100 in the normal group) with a complete database of flexible laryngoscopy/stroboscopy, voice recording, acoustic analysis, and mVHI-10 score. A sample with a discrepancy between subjective evaluation and acoustic analysis results was excluded from the study. Each classified dataset matched with the respective mVHI-10 questionnaire score. Finally, all the collected data were subjected to data analysis. RESULTS: The best cutoff point for mVHI-10 was 7.5 by the receiver operating characteristic curve, with an area under the curve value of 0.997. Its sensitivity, specificity, positive predictive value, and negative predictive value were 92.4%, 100.0%, 100.0%, and 93.0%, respectively. CONCLUSIONS: The best cutoff point for mVHI-10 is 7.5, as determined by stringent data evaluation and rigorous statistical analysis. With excellent diagnostic accuracy properties, it enhances the usage of the mVHI-10 questionnaire as an excellent screening tool. Nevertheless, we advocate multidimensional voice assessment for diagnostic purposes.

Challenging Removal of Embedded Fishbone in Tongue: Multimodal Technique, Surgical Approach and Consideration of Migration.

Fishbone ingestion is a common occurrence and patients present with various symptoms, posing challenges to the attending physicians. Here, we present two unique cases of patients with an unexpected rapidly migrating fishbone in the tongue. The first patient was operated transorally because of a foreign body embedded in the genioglossus muscle. In the second patient, CT scan located a fishbone embedded in the left hyoglossus muscle; however, the fishbone had to be relocated intraoperatively using bedside ultrasound guidance and was eventually found embedded within the mylohyoid muscle. The fishbone was successfully removed via transcervical approach following a failed transoral approach.