Correlation between the Arabic pediatric voice handicap index and both the auditory perceptual assessment and acoustic analysis of voice in patients with hyperfunctional childhood dysphonia
Authors: Ghandour Hassan H. , Kaddah Fatma-Alzahraa A. 
Published: September 2023

EnAbstract
Background
Pediatric voice disorders have typically been blamed on vocal abuse. Changes in the pitch, loudness, and overall vocal quality tend to interfere with communicative abilities. Recently, research has focused on pediatric voice disorders and the effects of a voice disorder on a child’s life. It has been reported that children felt that their voice disorders resulted in negative attention and limited their participation in activities.

Aim
The aim of this study was to examine the relationship between the pediatric voice handicap index (p-VHI) and both the auditory perceptual assessment (APA) and acoustic analysis of voice in patients with hyperfunctional childhood dysphonia.

Participants and methods
This study included 32 children diagnosed with hyperfunctional childhood dysphonia within the age range of 4.7–11.8 years, with a mean of age of 8.4 years; 22 (68.75%) were boys and 10 (31.25%) were girls. All patients were subjected to an APA of their voice after a modified GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and the domains were graded on a scale of 0–3, in which 0 is normal and 3 is severe. Acoustic voice analysis was carried out using Kay Elemetrics’ Computerized Speech Laboratory to obtain the following perturbation measures: jitter (%), shimmer (%), and harmonic to noise ratio. All patients were examined by videolaryngoscopy using fiberoptic nasofibrolaryngoscopes. Parents of all patients were given an Arabic p-VHI form that consists of 23 items divided among three subscales: functional, physical, and emotional. Scoring of the Arabic p-VHI is on the basis of an ordinal scale: the parents rate each statement between ‘0’ and ‘4’, in which ‘0’ represents a response of ‘never’, ‘1’ represents ‘almost never’, ‘2’ represents ‘sometimes’, ‘3’ represents ‘almost always’, and ‘4’ represents ‘always’. From these responses, a total score was obtained by adding the values of all responses ranging from 0 to 92.

Results
The mean scores on the different domains of the Arabic p-VHI among the study groups were 18.6±3.75 in the functional domain (range 4–31), 20.91±8.36 in the physical domain (range 6–34), 13.11±4.86 in the emotional domain (range 3–28), and 52.77±18.15 (range 13–80) in the total score. Correlation between the domains of the APA and those of the Arabic p-VHI showed a significant correlation between both the functional and physical domains of the Arabic p-VHI, namely roughness, breathiness, and strain quality, and pitch, and overall severity, whereas the emotional domain was not correlated with any of the APA domains. The p-VHI total score showed a significant correlation with the overall severity of dysphonia and breathiness. Correlation between the Arabic p-VHI domains and perturbation measures showed a significant correlation between all the domains and all acoustic perturbation measures, namely jitter (r=0.83; P=0.42), shimmer (r=0.81; P=0.39), and harmonic to noise ratio (r=0.76; P=0.36).

Conclusion and recommendations
The Arabic p-VHI seems to be a useful tool in children with dysphonia. Although it could help in assessment of the degree of disability that a voice disorder is causing, it should not be used as a sole clinical tool. Other clinical evaluation procedures such as APA and acoustic analysis of voice are strongly recommended in the evaluation of voice disorders and defining the amount of voice handicap.