Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 18
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Dehqan, Ali Yadegari, Fariba Scherer, Ronald C. and Dabirmoghadam, Peyman 2016. Correlation of VHI-30 to Acoustic Measurements Across Three Common Voice Disorders. Journal of Voice,

    Montgomery, J. Hendry, J. Wilson, J.A. Deary, I.J. and MacKenzie, K. 2016. Pragmatic detection of anxiety and depression in a prospective cohort of voice outpatient clinic attenders. Clinical Otolaryngology, Vol. 41, Issue. 1, p. 2.

    Moore, Jaime Greenberg, Caprice and Thibeault, Susan L. 2016. Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population. Journal of Voice,

    Akın Şenkal, Özgül and Özer, Cem 2015. Hoarseness in School-Aged Children and Effectiveness of Voice Therapy in International Classification of Functioning Framework. Journal of Voice, Vol. 29, Issue. 5, p. 618.

    Ansari, S. and MacKenzie, K. 2015. Voice outcomes following endolaryngeal surgery; are we achieving our aims?. Clinical Otolaryngology, Vol. 40, Issue. 6, p. 580.

    Carding, Paul and Miller, Tracy 2015. Practical Laryngology.

    Gillespie, Amanda I. Gooding, William Rosen, Clark and Gartner-Schmidt, Jackie 2014. Correlation of VHI-10 to Voice Laboratory Measurements Across Five Common Voice Disorders. Journal of Voice, Vol. 28, Issue. 4, p. 440.

    Moreti, Felipe Zambon, Fabiana Oliveira, Gisele and Behlau, Mara 2014. Cross-Cultural Adaptation, Validation, and Cutoff Values of the Brazilian Version of the Voice Symptom Scale—VoiSS. Journal of Voice, Vol. 28, Issue. 4, p. 458.

    Albanese, Alberto Sorbo, Francesca Del Comella, Cynthia Jinnah, H. A. Mink, Jonathan W. Post, Bart Vidailhet, Marie Volkmann, Jens Warner, Thomas T. Leentjens, Albert F.G. Martinez-Martin, Pablo Stebbins, Glenn T. Goetz, Christopher G. and Schrag, Anette 2013. Dystonia rating scales: Critique and recommendations. Movement Disorders, Vol. 28, Issue. 7, p. 874.

    Moradi, Negin Pourshahbaz, Abbas Soltani, Majid and Javadipour, Shiva 2013. Cutoff Point at Voice Handicap Index Used to Screen Voice Disorders Among Persian Speakers. Journal of Voice, Vol. 27, Issue. 1, p. 130.e1.

    Paleri, Vinidh Carding, Paul Chatterjee, Sanjoy Kelly, Charles Wilson, Janet Ann Welch, Andrew and Drinnan, Michael 2012. Voice outcomes after concurrent chemoradiotherapy for advanced nonlaryngeal head and neck cancer: A prospective study. Head & Neck, Vol. 34, Issue. 12, p. 1747.

    Bassi, Iara Barreto Assunção, Ada Ávila de Medeiros, Adriane Mesquita de Menezes, Letícia Neiva Teixeira, Letícia Caldas and Côrtes Gama, Ana Cristina 2011. Quality of Life, Self-Perceived Dysphonia, and Diagnosed Dysphonia Through Clinical Tests in Teachers. Journal of Voice, Vol. 25, Issue. 2, p. 192.

    Verduyckt, Ingrid Remacle, Marc Jamart, Jacques Benderitter, Céline and Morsomme, Dominique 2011. Voice-Related Complaints in the Pediatric Population. Journal of Voice, Vol. 25, Issue. 3, p. 373.

    Deary, Ian J. Wilson, Janet A. Carding, Paul N. MacKenzie, Kenneth and Watson, Roger 2010. From dysphonia to dysphoria: Mokken scaling shows a strong, reliable hierarchy of voice symptoms in the Voice Symptom Scale questionnaire. Journal of Psychosomatic Research, Vol. 68, Issue. 1, p. 67.

    Nixon, I Kunanandam, T and MacKenzie, K 2010. Minimum dataset for endolaryngeal surgery: pilot study. The Journal of Laryngology & Otology, Vol. 124, Issue. 09, p. 980.

    Carding, P N Wilson, J A MacKenzie, K and Deary, I J 2009. Measuring voice outcomes: state of the science review. The Journal of Laryngology & Otology, Vol. 123, Issue. 08, p. 823.

    Smith, Richard V. 2009. Complications in Head and Neck Surgery.

    Syed, I. Daniels, E. and Bleach, N.R. 2009. Hoarse voice in adults: an evidence-based approach to the 12 minute consultation. Clinical Otolaryngology, Vol. 34, Issue. 1, p. 54.


Optimising outcome assessment of voice interventions, II: sensitivity to change of self-reported and observer-rated measures

  • I N Steen (a1), K MacKenzie (a2), P N Carding (a3), A Webb (a3), I J Deary (a4) and J A Wilson (a3)
  • DOI:
  • Published online: 01 May 2007

A wide range of well validated instruments is now available to assess voice quality and voice-related quality of life, but comparative studies of the responsiveness to change of these measures are lacking. The aim of this study was to assess the responsiveness to change of a range of different measures, following voice therapy and surgery.


Longitudinal, cohort comparison study.


Two UK voice clinics.


One hundred and forty-four patients referred for treatment of benign voice disorders, 90 undergoing voice therapy and 54 undergoing laryngeal microsurgery.

Main outcome measures:

Three measures of self-reported voice quality (the vocal performance questionnaire, the voice handicap index and the voice symptom scale), plus the short form 36 (SF 36) general health status measure and the hospital anxiety and depression score. Perceptual, observer-rated analysis of voice quality was performed using the grade–roughness–breathiness–asthenia–strain scale. We compared the effect sizes (i.e. responsiveness to change) of the principal subscales of all measures before and after voice therapy or phonosurgery.


All three self-reported voice measures had large effect sizes following either voice therapy or surgery. Outcomes were similar in both treatment groups. The effect sizes for the observer-rated grade–roughness–breathiness–asthenia–strain scale scores were smaller, although still moderate. The roughness subscale in particular showed little change after therapy or surgery. Only small effects were observed in general health and mood measures.


The results suggest that the use of a voice-specific questionnaire is essential for assessing the effectiveness of voice interventions. All three self-reported measures tested were capable of detecting change, and scores were highly correlated. On the basis of this evaluation of different measures' sensitivities to change, there is no strong evidence to favour either the vocal performance questionnaire, the voice handicap index or the voice symptom scale.

Corresponding author
Address for correspondence: Prof. Janet A Wilson, Dept of Otolaryngology Head Neck Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK. Fax: (44) 191 223 1246 E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1A Millar , IJ Deary , JA Wilson , K MacKenzie . Is an organic/functional distinction psychologically meaningful in patients with dysphonia? J Psychosom Res 1999;46:497505

3IJ Deary , A Webb , K MacKenzie , JA Wilson , PN Carding . Short self-report voice symptom scales: psychometric characteristics of the VHI-10 and the VPQ. Otolaryngol Head Neck Surg 2004;131:232–5

4BH Jacobson , A Johnson , C Grywalski , A Silbergleit , G Jacobson , MS Benninger . The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol 1997;6:6670

5MS Benniger , AS Ahuja , G Gardner , C Grywalski . Assessing outcomes for dysphonic patients. J Voice 1998;12:540–50

6IJ Deary , JA Wilson , PN Carding , K MacKenzie . VoiSS: a patient derived voice symptom scale. J Psychosom Res 2003;54:483–9

7JA Wilson , AL Webb , PN Carding , IN Steen , K MacKenzie , IJ Deary . Comparing the Voice Symptom Scale (VoiSS) and the Voice Handicap Index: structure and content. Clin Otolaryngol 2004;29:169–74

9PH Dejonckere , C Obbens , GM de Moor , GH Wieneke . Perceptual evaluation of dysphonia: reliability and relevance. Folia Phoniatrica 1993;45:7683

10M De Bodt , FL Wuyts , PH Van de Heyning , C Croux . Test-retest of the GRBAS scale: influence of experience and professional background on perceptual ratings of voice quality. J Voice 1997;11:7480

12C Jenkinson , A Coulter , L Wright . Short-form SF-36 health survey questionnaire: normative data for adults of working age. Br Med J 1993;306:1437–40

13JE Brazier , R Harper , NMB Jones , A O'Cathain , KJ Thomas , T Usherwood Validating the SF-36 health survey questionnaire: a new outcome measure for primary care. BMJ 1992;305:160–4

14JA Wilson , A Millar , IJ Deary , K MacKenzie . The quality of life impact of dysphonia. Clin Otolaryngol 2002;27:179–82

15AS Zigmond , RP Snaith . The hospital anxiety and depression scale. Acta Psychiatrica Scand 1983;67:361–70

16J Cohen . Statistical Power Analysis for the Behavioral Sciences, 2nd edn.Hillsdale, NJ: Erlbaum, 1988

17LE Kazis , JJ Anderson , RF Meenen . Effect sizes for interpreting changes in health status. Med Care 1989;27(3 Suppl):S178–89

18K MacKenzie , A Millar , C Sellars , JA Wilson , IJ Deary . Is voice therapy an effective treatment for dysphonia? A randomised controlled trial. BMJ 2001;323:658–61

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *