Comparison of the Pediatric Voice Handicap Index With Perceptual Voice Analysis in Pediatric Patients With Vocal Fold Lesions

Objective: To compare a subjective patient/family-derived voice handicap survey with an expert observer-derived method of evaluating voice disturbance in pediatric patients with vocal fold lesions (VFLs). Design: Retrospective review. Setting: Tertiary care referral center. Patients: Thirty-eight children with VFLs referred for voice evaluation. Main Outcome Measures: Pediatric Voice Handicap Index (pVHI) scores and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores. Percentages for CAPE-V (100-point scale) and pVHI (92-point scale) were calculated for direct comparisons. Relationships between pVHI scores and CAPE-V scores were investigated using the Spearman rank correlation. Results: Thirty-eight patients with VFLs (median age, 8.3 years; age range, 4.2-17.2 years; 63% males) were included from a database of more than 600 children and evaluated between November 15, 2005, and June 15, 2010. The median CAPE-V overall score was 30.3 (range, 1-67), and the normalized total pVHI score was 29.3 (range, 0-73) (P=.90). The Spearman rank correlation showed significant fair correlations between CAPE-V overall and functional pVHI and between CAPE-V strain and breathiness, and the pVHI total, functional, but none higher than rho=0.44 (P <=.03). The correlation was higher in males for CAPE-V loudness to total pVHI (rho=0.40, P=.04) and in females for CAPE-V breathiness (rho=0.58, P=.03) and strain (rho=0.55, P=.04) to total pVHI. Conclusions: The CAPE-V and the pVHI are useful tools in the measurement of voice outcomes in children with VFLs. There are fair correlations between the CAPE-V and the pVHI, and they likely evaluate important yet different aspects of voice disturbance. Significant gender differences in these correlations should be further evaluated in future studies.