Francesco Mozzanica

Cross-cultural Adaptation and Validation of the Voice Handicap Index Into Italian

OBJECTIVES To evaluate the internal consistency, reliability, and clinical validity of the Italian version of the Voice Handicap Index (VHI). STUDY DESIGN Cross-sectional survey study was carried out. METHODS One hundred and seventy-five patients with voice disorders, divided in four groups according to the etiology of the disease (neurogenic, structural, functional, and inflammatory), and 84 asymptomatic subjects were included in the study. Internal consistency was analyzed through Cronbach α coefficient. For the VHI test-retest reliability analysis, the Italian VHI was filled twice by 56 patients and 56 control subjects. The test-retest reliability was assessed through the Pearson correlation test. For the clinical validity assessment, the scores obtained in the pathological group were compared with those found in asymptomatic individuals through the Kruskal-Wallis test. Also, the correlation between VHI and the grade of voice disorder was assessed. Finally, the effect of age and gender on overall VHI and its three subscales was analyzed. RESULTS Optimal internal consistency was found (α=0.93); the test-retest reliability in both groups was high (r>0.86). Nonparametric Kruskal-Wallis analysis of variance for the overall VHI score and its three domains revealed a significant main effect for group (P=0.000). The control group scored significantly lower than the four groups of voice-disordered patients. The overall VHI score positively correlated with the grade of voice disorder (r=0.43). In the voice-disorder group, age and gender were not correlated to the overall VHI score and to their three domains. CONCLUSION The Italian VHI is highly reproducible, and exhibits excellent clinical validity.

Correlation between the Voice Handicap Index and voice measurements in four groups of patients with dysphonia

OBJECTIVES: To evaluate the correlation between the Voice Handicap Index (VHI) and objective voice measurements in patients with dysphonia of different origin. STUDY DESIGN: Cross-sectional survey. SETTING: Otolaryngology department in a university hospital. SUBJECTS AND METHODS: One hundred fifteen patients consulting for voice disorders were enrolled in the study: 32 presented with functional dysphonia (Group 1), 24 with unilateral vocal fold paralysis (Group 2), 30 with structural dysphonia (Group 3), and 29 with nodules (Group 4). From each patient, the maximum phonation time (MPT) and a voice spectrogram were obtained: patients with type 1 signal underwent perturbation analysis. Each patient completed the VHI. RESULTS: No significant difference across the four groups, in the VHI scores and voice measurements, was found. The correlation between the different voice measurements was good, while those between the VHI domains were very good. Considering the patients with type 1 signal (n = 80) all together, the correlations between VHI and voice laboratory measurements ranged between poor and good. Analyzing each patient group separately, good correlations were found between MPT and functional and physical VHI domain in Group 1 (r = 0.58 and 0.68), jitter and functional VHI domain in Group 2 (r = 0.61), MPT and functional VHI domain in Group 3 (r = 0.52), and physical VHI domain and jitter, shimmer, and noise-to-harmonic ratio in Group 4 (r = 0.58, 0.77, 0.76). CONCLUSION: The VHI and the voice laboratory measurements give independent information. However, the correlation between VHI and some laboratory measurements increases in populations with voice disorder of the same origin.

Reliability and validity of the Italian Eating Assessment Tool.

Objectives: We sought to evaluate the reliability and validity of the Italian EAT-10 (Italian Eating Assessment Tool; I-EAT-10). Methods: The study consisted of 4 phases: Item generation, internal consistency and reliability analysis, normative data generation, and validity analysis. Discussion of the EAT-10 with 30 patients and its back-translation were accomplished. The recruited population included 172 patients (40 with dysphonia and 132 with dysphagia) and 269 asymptomatic subjects for testing of internal consistency, and 94 patients with dysphagia and 158 asymptomatic subjects for test-retest reliability analysis. Normative data were gathered from the 269 subjects. The scores of patients and asymptomatic subjects were compared. The I-EAT-10 and flexible endoscopic evaluation of swallowing (FEES) scores in 94 patients were correlated. The I-EAT-10 scores made before and after successful swallowing rehabilitation in 38 patients were compared. Results: Excellent internal consistency (Cronbachs alpha values of 0.90 and 0.93) and strong test-retest reliability (intraclass correlation coefficients of 0.95 and 0.98) were found in patients and asymptomatic subjects. The I-EAT-10 mean (±SD) score of the normal cohort was 0.6 ± 1.1. The asymptomatic subjects and dysphonic patients scored lower than the dysphagic patients on the Kruskal-Wallis test (p = 0.001). The I-EAT-10 and FEES scores were mildly correlated. The mean I-EAT-10 score improved from 9.8 ± 10.3 to 5.8 ± 6.7 after swallowing rehabilitation (p = 0.04). Conclusions: The I-EAT-10 is a reliable, valid, symptom-specific outcome tool.

Voice-related quality of life in patients after total and partial laryngectomy

OBJECTIVE To assess the voice-related quality of life (V-RQOL) in patients after total and partial laryngectomy. MATERIALS AND METHODS 96 patients treated for laryngeal cancer were enrolled in the study. The cohort of patients was divided into three groups depending on the surgical procedure carried out: total laryngectomy (TL), supracricoid partial laryngectomy (SCL) and/or horizontal glottectomy (HG). The maximum phonation time (MPT) and syllable diadochokinesis, were used for the aerodynamic assessment; Yanagihara score was used for acoustic analysis of the sustained /a/ and the GRBAS scale was used for perceptual assessment. Each of the patients completed the VHI. The Kruskal-Wallis and Mann-Whitney tests were used to analyse the mean difference among the three groups of patients. RESULTS A comparison with the values found between groups noted that the TL group showed significantly higher scores of G, R and Yanagihara score, while the HG group showed a significantly higher score of B. No differences were found in the aerodynamic and acoustic measures among the 3 groups. The mean±standard deviations of VHI total score were 35.3±24.5 for TL group, 30.1±21.6 for SCL group, 35.8±9.6 for HG group. No significant difference was found across the three groups. CONCLUSIONS V-RQOL seems to be similar in patients who underwent significantly different surgical procedures even if the voice characteristics were different. These findings need to be considered in patients counselling together with other data on general quality of life after total and partial laryngectomy.

Multidimensional assessment of vocal changes in benign vocal fold lesions after voice therapy

OBJECTIVE To evaluate through a multidimensional protocol voice changes after voice therapy in patients with benign vocal fold lesions. METHODS 65 consecutive patients affected by benign vocal fold lesions were enrolled. Depending on videolaryngostroboscopy the patients were divided into 3 groups: 23 patients with Reinkes oedema, 22 patients with vocal fold cysts and 20 patients with gelatinous polyp. Each subject received 10 voice therapy sessions and was evaluated, before and after voice therapy, through a multidimensional protocol including videolaryngostroboscopy, perception, acoustics, aerodynamics and self-rating by the patient. Data were compared using Wilcoxon signed-rank test. Kruskal-Wallis test was used to analyse the mean variation difference between the three groups of patients. Mann-Whitney test was used for post hoc analysis. RESULTS Only in 11 cases videolaryngostroboscopy revealed an improvement of the initial pathology. However a significant improvement was observed in perceptual, acoustic and self-assessment ratings in the 3 groups of patients. In particular the parameters of G, R and A of the GIRBAS scale, and the noise to harmonic ratio, Jitter and shimmer scores improved after rehabilitation. A significant improvement of all the parameters of Voice Handicap Index after rehabilitation treatment was found. No significant difference among the three groups of patients was visible, except for self-assessment ratings. CONCLUSION Voice therapy may provide a significant improvement in perceptual, acoustic and self-assessed voice quality in patients with benign glottal lesions. Utilization of voice therapy may allow some patients to avoid surgical intervention.

Reliability and Clinical Validity of the Italian Reflux Symptom Index

Currently, there is no Italian version of the Reflux Symptom Index (RSI). The aim of this study was to develop an Italian RSI and to evaluate its internal consistency, reliability, and clinical validity. The study design used was a cross-sectional survey study. Eighty patients with a Reflux Finding Score (RFS) >7, and 193 asymptomatic subjects were included in the study. For the RSI reliability analysis, the appositely developed Italian RSI was filled twice, with a week interval, by the 80 patients and 80 control subjects. The test-retest reliability was assessed through the Pearson correlation test, whereas the Cronbachs alpha coefficient was used for internal consistency analysis. For the clinical validity assessment, the scores obtained in the pathological group were compared with the data from the asymptomatic individuals through the Students t test. Finally, the correlation between RSI and RFS in the 80 patients was assessed. All of the patients filled in the entire questionnaire autonomously. The test-retest reliability in the patients, as well as in the control group, was very high (r>0.90); the internal consistency also showed very high values (alpha=0.99). The mean RSI score in the patients was 21.1+/-6.6, whereas in the control group it was 6.3+/-5.6; the difference was statistically significant (P=0.0001). The mean RFS score in the 80 patients was 9.2+/-2.7 and the correlation between RFS score and RSI score was rather high (r=0.89). The Italian RSI is easily administered, highly reproducible, and exhibits excellent clinical validity.

Upper esophageal sphincter dysfunction: diverticula–globus pharyngeus

The following discussion of upper esophageal sphincter dysfunction includes commentaries on the role of the cricopharyngeus muscle in reflux disease; the etiology and treatment of Zenker diverticulum; the use of videofluoroscopy in patients with dysphagia, suspicion of aspiration, or globus; the role of pH–impedance monitoring in globus evaluation; and treatment for reflux‐associated globus.

Prevalence and Voice Characteristics of Laryngeal Pathology in an Italian Voice Therapy-seeking Population.

OBJECTIVES The aim of this study was to determine the prevalence and clinical characteristics of voice disorders in a large group of patients seeking voice therapy. STUDY DESIGN This is a prospective prevalence study. METHODS A total of 821 patients were enrolled. Each patient was evaluated following a multidimensional protocol including videolaryngostroboscopy, perception, acoustics, aerodynamics, and self-rating by the patient. Data regarding age, gender, tobacco use, gastroesophageal reflux disease (GERD), and professional voice use were collected and analyzed. RESULTS Based on videolaryngoscopic findings, the sample group was divided into patients with functional dysphonia (n = 155), patients with organic dysphonia (n = 359), and patients with dysphonia due to movement disorders (n = 307). The most frequently detected pathologies were vocal fold paralysis, muscle tension dysphonia, and vocal fold edema. Children (n = 41) and adolescents (n = 43) represented a minority of the sample group. Dysphonia was significantly more common in women. Organic dysphonia was more common in children and adolescents. GERD was suspected in 382 patients and confirmed in 83 of them; 164 patients were smokers. Professional voice users composed the large majority of the working population and were more frequently affected by organic dysphonia. Patients with dysphonia due to movement disorders presented a worse voice quality and voice-related quality of life. CONCLUSIONS In patients seeking voice therapy, there are more females than males, children and adolescents represent a minority of the sample, professional voice users more commonly present organic dysphonia, and patients with dysphonia due to movement disorders show significantly worse voice quality.

Swallowing, voice, and quality of life after supratracheal laryngectomy: Preliminary long-term results

The purpose of this study was to report preliminary long‐term outcomes after supratracheal laryngectomy (STL).

Reliability and validity of the Italian self-evaluation of communication experiences after laryngeal cancer questionnaire

The Self‐Evaluation of Communication Experiences after Laryngeal Cancer (SECEL) questionnaire assesses the impact of total laryngectomy on communication‐related quality of life (QOL). This study evaluates the Italian version of the SECEL (I‐SECEL), including reliability, concurrent validity, and differences in scores between patients who undergo either total laryngectomy or partial laryngectomy.