Is a voice‐specific instrument more indicative of stroboscopy results than common clinical queries?

• Published in: The Laryngoscope Vol. 130; no. 4; pp. 992 - 999
• Main Authors: DeVore, Elliana Kirsh, Carroll, Thomas L., Shin, Jennifer J.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-04-2020; Wiley Subscription Services, Inc
• Subjects: area under the curve; diagnostic test; Interpersonal communication; laryngeal stenosis; Laryngoscopy; laryngostenosis; Larynx; Quality of life; receiver operator characteristic curve; sensitivity; specificity; Stroboscopy; Throat surgery; vocal cord paralysis; voice disorders; Stroboscopy; laryngoscopy; specificity; laryngeal stenosis; area under the curve; sensitivity; quality of life; vocal cord paralysis; voice disorders; diagnostic test; receiver operator characteristic curve; laryngostenosis
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.28207

Objectives
To determine whether the Voice Handicap Index‐10 (VHI‐10) predicts diagnoses made via laryngoscopy/stroboscopy, as compared to common clinical inquiries about vocal characteristics.
Methods
We prospectively collected data from a cohort of 204 consecutive patients newly presenting for ambulatory laryngology evaluation. Each patient completed the VHI‐10 and 16 concurrent mainstream queries about vocal characteristics such as weakness, breathiness, fatiguability, or inability to shout. Using the objective diagnoses made by laryngoscopy/stroboscopy as a gold standard, the area under the receiver operating characteristic curves (AUC), sensitivity, and specificity were determined.
Results
For unilateral vocal fold paralysis, VHI‐10 scores had an AUC of 0.78 (95% CI, 0.68–0.88) and had better discrimination than 12 common clinical queries. At a threshold score of ≥11, VHI‐10 sensitivity was 0.94; at a threshold of ≥31, specificity was 0.91. For laryngeal stenosis, the VHI‐10 score demonstrated moderate discrimination, with an AUC of 0.79 (95% CI, 0.56–1.00) and higher discrimination than three common clinical queries. At a threshold score of ≥11, VHI‐10 sensitivity was 1.00; at a threshold of ≥31, specificity was 0.89. Both VHI‐10 scores and common clinical queries had low diagnostic ability for vocal fold paresis, laryngopharyngeal reflux (LPR), paradoxical vocal fold motion, and vocal fold scar or atrophy.
Conclusions
The VHI‐10 score is an effective diagnostic indicator of laryngoscopy/stroboscopy findings of vocal fold paralysis and laryngeal stenosis, performing better than multiple mainstream queries about vocal characteristics. VHI‐10 scores and common clinical queries are limited in their ability to indicate paresis, reflux, paradoxical motion, and vocal fold scar or atrophy.
Level of Evidence
2c Laryngoscope, 130:992–999, 2020