Patient reported voice outcome in recurrent respiratory papillomatosis

Objectives/Hypothesis:
To assess the impact of patient reported voice outcome on quality of life and emotional functioning in patients treated for recurrent respiratory papillomatosis (RRP).

Study Design:
Cross-sectional.

Methods:
All adult patients treated for RRP between 1984 and 2008 were asked to participate. Outcome measures were obtained from questionnaires including VHI (Voice Handicap Index), HADS (Hospital Anxiety and Depression Scale), 36-Item Short Form Health Survey (SF-36), and Utrechtse Coping List.

Results:
Out of 45 included patients, 34 (22 males,12 females) participated (76%). Mean age was 52 years (range, 25-85 years). RRP was located only in the larynx in 90% of the cases. Adult onset RRP was diagnosed in 29 cases, juvenile onset RRP in 5. Median number of surgical procedures was five (range, 1-17). In this study cohort, 68% scored above the VHI cutoff point, and 18% had an increased risk for depression or anxiety disorders (HADS). VHI scores were related to age, time between consecutive surgeries, time since last surgery, and passive coping. They were not related to gender, onset of RRP, or location. VHI scores were related to the SF-36 subscales social functioning (r = -0.43) and mental health (r = -0.43).

Conclusions:
Patients with RRP often report voice problems in daily life, and this is related to (a passive) coping style, social functioning, and mental health. Psychosocial intervention targeting an adaptive coping style may be beneficial in selected cases. Laryngoscope, 2009

from The Laryngoscope

Development and validation of the singing voice handicap-10

Methods:
Patients presenting to two tertiary care voice clinics prospectively completed the SVHI. Principal component analysis was performed. Individual item to total correlations were calculated, and individual items were also evaluated for bipolar response patterns. A clinical consensus conference prioritized each individual item. Items were then eliminated, and the internal consistency was evaluated. A second cohort of patients with singing voice problems completed the Voice Handicap Index-10 (VHI-10) and SVHI-10 at two time points. Singers without voice problems also completed the SVHI-10. SVHI-10 scores were compared between the groups, correlations between the SVHI-10 and VHI-10 were performed, and test-retest reliability of the SVHI-10 assessed.

Results:
Singers with voice problems had worse SVHI-10 scores than normal singers (P < .0001, t test). Test-retest reliability was high (Spearman correlation = 0.86, P < .001). Internal consistency of the SVHI-10 demonstrated a Cronbach of .94, and the correlation between the SVHI-10 and VHI-10 was 0.7 (P < .001, Spearman correlation).

Conclusions:
The SVHI-10 is a valuable instrument to assess self-perceived handicap associated with singing voice problems with reduced patient burden. Laryngoscope, 2009

from The Laryngoscope

Coprevalence and impact of dysphonia and hearing loss in the elderly

Methods:
Main outcome measures include prevalence of dysphonia and hearing loss, Voice Related Quality of Life (VRQOL), Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), and the Center for Epidemiologic Studies Depression (CES-D) scale. Relationships between continuous variables were analyzed with Spearman correlation, between categorical variables with chi-square, and between categorical and continuous variable with analysis of variance (ANOVA) on ranks.

Results:
A total of 248 residents responded with a mean age of 82.4 years. Of those, 19.8% had dysphonia, 50.0% had hearing loss, and 10.5% had both. Respondents with hearing loss were more likely to have dysphonia than those without hearing loss (odds ratio = 2.31, 95% confidence interval, 1.19-4.47). Worse VRQOL scores were associated with more impairment on the HHIE-S (Spearman correlation = -0.36, P < .001). Respondents with both dysphonia and hearing loss had greater depression scores than those with neither symptom (median CES-D score 13 vs. 8, P = .03, ANOVA on ranks, Dunn's method, P < .05).

Conclusions:
Voice problems and hearing loss are common in the elderly, adversely impact quality of life, and require simultaneous management. Laryngoscope, 2009

from The Laryngoscope

The impact of stuttering on the quality of life in adults who stutter

Stuttering is an involuntary fluency disorder that is not uncommon in society. However, the impact of stuttering on a composite measure such as quality of life has rarely been estimated. Quality of life (QOL) assesses the well-being of a person from a multidimensional perspective, and valid and reliable general QOL measures are available that can be used to estimate the impact of stuttering on QOL. This study involved the use of a general measure of QOL called the Medical Outcomes Study Short Form-36 (SF-36) in order to assess the impact of stuttering in 200 adults who stutter (AWS). Comparisons to 200 adults of similar age and sex ratio who do not stutter were made so that the unique contribution of stuttering on QOL could be estimated. Findings indicated that stuttering does negatively impact QOL in the vitality, social functioning, emotional functioning and mental health status domains. Results also tentatively suggest that people who stutter with increased levels of severity may have a higher risk of poor emotional functioning. These findings have implications for treatment such as the necessity to address the emotional and psychological aspects of QOL in AWS and the need for additional clinical resources to be invested in stuttering treatment.

from Journal of Fluency Disorders

The relationship between quality of life and swallowing in Parkinson’s disease

Few studies exist in the literature investigating the impact of idiopathic Parkinson’s Disease (IPD) on swallow-related quality of life. We therefore aimed in this project to: (1) evaluate swallow-specific quality of life in IPD; (2) delineate potential relationships between IPD duration and severity with swallow-specific quality of life; (3) investigate relationships between swallow-specific quality of life and general health-related quality of life; and (4) investigate relationships between swallow-specific quality of life and depression. Thirty-six patients diagnosed with IPD with and without dysphagia filled out self-report assessments of the SWAL-QOL, Parkinson’s Disease Questionnaire-39 (PDQ-39), and Beck Depression Inventory (BDI). A series of Mann Whitney U tests were performed between non-dysphagic and dysphagic groups for the total SWAL-QOL score and the 10 SWAL-QOL domains. Spearman’s Rho correlation analyses were performed between the SWAL-QOL and (1) PDQ-39; (2) Hoehn and Yahr stage; (3) PD disease duration; (4) UPDRS on score; and (5) the BDI. The dysphagia swallowing group reported significant reductions compared to the non-dysphagic group for the total SWAL-QOL score (P = 0.02), mental health domain score (P = 0.002) and social domain score (P = 0.002). No relationships existed between swallow-specific quality of life and disease duration or severity. Significant relationships existed between swallow-specific quality of life and general health-related quality of life (rs =-0.56, P = 0.000) and depression (rs = -0.48, P = 0.003). These exploratory data highlight the psychosocial sequelae that swallowing impairment can have in those with IPD and suggest a possible association between swallowing, social function, and depression. © 2009 Movement Disorder Society

from Movement Disorders

Measuring quality of life in aphasia: Results from two scales

Conclusions: Measuring QoL using the SAQOL and the QCL captures different but equally important aspects of experiences of living with aphasia. When interpreted together, they provide a holistic picture of functioning in aphasia that includes broad overviews of QoL from the SAQOL and a finer-grained analysis of communication impairments on QoL from the QCL.

from Aphasiology

Supracricoid laryngectomy: Age influence on long-term functional results

Conclusions:
Age by itself does not have a significant impact on long-term functional results following SCL. Meticulous selection of the candidate to SCL allows the application of this surgical technique with adequate long-term functional results. Laryngoscope, 2009

from Laryngoscope

Dysphagia Following a Total Laryngectomy: The Effect on Quality of Life, Functioning, and Psychological Well-Being

Abstract The aim of this study was to investigate the effect that dysphagia has on quality of life (QoL), functioning, and psychological well-being of people who have undergone a total laryngectomy. A questionnaire battery was sent to all members (N = 197) of the Laryngectomee Association of NSW, Australia. QoL and functioning were assessed using the World Health Organisation Quality of Life-Bref (WHOQoL-Bref) and the University of Washington QoL (UW-QoL) measures. Psychological well-being was measured using the Depression Anxiety and Stress Scale (DASS). One hundred ten questionnaires (56%) were completed and returned. There were no significant differences in QoL, as measured by the WHOQoL-Bref, between those laryngectomees with and without dysphagia. Laryngectomees with dysphagia, however, had significantly impaired functioning and markedly reduced social participation as measured by the UW-QoL. Significantly higher levels of depression and anxiety were also documented in those laryngectomees who had dysphagia. Dysphagia may not necessarily determine QoL following a total laryngectomy. However, it may have a negative impact on functioning and on psychological well-being.

from Dysphagia

Conceptualising quality of life for older people with aphasia

Conclusions: Quality of life for older people with predominantly mild to moderate chronic aphasia who are living in the community is multifactorial in nature. Some factors lie within the remit of speech and language therapy, some lie beyond the professional role, but all are relevant for consideration in rehabilitation and community practice. Further qualitative research is implicated to better understand QoL with aphasia, using in-depth interviewing with a broader range of people with aphasia.

from Aphasiology

Voice Handicap and Health-Related Quality of Life in Laryngectomees: Assessments with the Use of VHI and EORTC Questionnaires

Aims: To investigate the Voice Handicap Index (VHI), the health-related quality of life (HRQL), and the correlations between VHI and HRQL in laryngectomees. Methods: Forty-three laryngectomized persons participated (mean age 68;6 years, time since laryngectomy between 0;6 and 12 years). Evaluation of voice handicap was done with the VHI. HRQL was evaluated with questionnaires from the European Organization for Research and Treatment of Cancer, EORTC QLQ-C30 and EORTC QLQ-H&N35. Results: VHI for the whole group demonstrated a moderate voice handicap, with a mean score of 48/120. The functional scales of EORTC QLQ-C30 resulted in scores on the same level as the normal population with the exception of a lower global quality of life scale (Global QOL). EORTC QLQ-H&N35 revealed problems with smell and taste, speech, coughing, xerostomia, and sexuality. VHI correlated significantly with the Global QOL, the functional scales, dyspnea, pain, nausea and financial difficulties (EORTC QLQ-C30). Significant correlations were also found between VHI and speech problems, social contact, pain from the head and neck area, sense problems, sexuality and social eating (EORTC QLQ-H&N35). Conclusion: The EORTC questionnaires in combination with the VHI questionnaire seem to capture most of the problems following laryngectomy, including voice problems.

from Folia Phoniatrica et Logopaedica

Measuring Quality of Life in Dysphonic Patients: A Systematic Review of Content Development in Patient-Reported Outcomes Measures

To review existing patient reported outcomes measures (PROMs) used in dysphonic populations to assess the procedures used in their development and the extent to which these meet current development standards for content generation and psychometric evaluation. The study is a systematic review. A systematic review of Medline, Cumulative Index to Nursing & Allied Health, and Health and Psychosocial Instruments databases was completed using voice, quality of life, and PROMs as keywords. We identified all patient or parent-reported questionnaires measuring quality of life associated with voice disorders from the review findings. Questionnaires were appraised for adherence to international guidelines for the development and evaluation of PROMs as outlined by the Scientific Advisory Committee of the Medical Outcome Trust. Nine PROMs fulfilled the inclusion criteria. The quality of these questionnaires was variable with regard to instrument development and none met all of the current, recommended criteria. Of the nine questionnaires, the Voice Symptom Scale underwent the most rigorous development process. Furthermore, many instruments have been augmented to allow for proxy administration, failing to address quality of life-related issues specific to the target population. Instrument development is often overlooked when attempting to quantify patient reported outcomes in dysphonic patients. Careful instrument development procedures are required to ensure that PROMs are valid, reliable, and responsive. Our review suggests that the deficits in psychometric properties of the current voice-related PROMs may be, at least in part, due to deficits in the development process. Furthermore, these data suggest the potential utility of a novel PROM adhering to rigorous international standards to better ensure that clinicians appreciate the variables most relevant to patients with voice disorders and address some of the psychometric shortcomings of the currently used questionnaires.

from the Journal of Voice

Relationships Between Hearing Disability, Quality of Life and Wellbeing in Older Community-Based Australians

The aims of this study were to: (1) investigate the relationships between measured hearing impairment and self-reported hearing and communication difficulties (i.e., activity limitations, participation restrictions), health-related quality of life and wellbeing in community-based older Australians; and (2) investigate the influence of age, gender, living situation and hearing aid use on these relationships. Data were collected from 178 older people with hearing impairment. Pure-tone audiometry was used to assess hearing impairment and self-report questionnaires were used to assess activity limitations, participation restrictions, health-related quality of life and wellbeing. Results showed a relationship between hearing impairment and activity limitations, participation restrictions and wellbeing. No relationship was found between measured hearing impairment and health-related quality of life. However, significant relationships were evident between hearing difficulties in everyday life (activity limitations and participation restrictions) and health-related quality of life. Gender, living situation and hearing aid use influenced these relationships. The results highlight the far-reaching effects of hearing impairment on the lives of older people and the importance of using self-report measures to understand this.

from the Australian and New Zealand Journal of Audiology

Self-reported disability and handicap after hearing-aid fitting and benefit of hearing aids: comparison of fitting procedures, degree of hearing loss, experience with hearing aids and uni- and bilateral fittings

Abstract Self-reported outcome on hearing disability and handicap as well as overall health-related quality of life were measured after hearing-aid fitting in a large-scale clinical population. Fitting was performed according to two different procedures in a double-blind study design. We used a comparative procedure based on optimizing speech intelligibility scores and a strictly implemented fitting formula. Hearing disability and handicap were assessed with the hearing handicap and disability inventory and benefit of hearing aids with the abbreviated profile of hearing aid benefit. Effects on health-related quality of life and depression were assessed with the EuroQol-5D questionnaire and the geriatric depression scale. We found that hearing-aid fitting according to either procedure had a significantly positive effect on disability and handicap associated with hearing loss. This effect lasted for several months. Only the effect on disability persisted after 1-year of follow-up. Self-reported benefit from hearing aids was comparable for both fitting procedures. Unaided hearing disability was more pronounced in groups of participants with greater hearing loss, while the benefit of hearing aids was independent from the degree of hearing impairment. First-time hearing aid users reported greater benefit from their hearing aids. The added value from a bilateral hearing-aid fitting was not significant. Overall health-related quality of life and incidence of depression did not alter after hearing-aid fitting.

from the European Archives of Oto-Rhino-Laryngology

Validation and assessment of voice-related quality of life in Indian patients undergoing total laryngectomy and primary tracheoesophageal puncture

from Head and Neck

Background.
Voice-related quality of life (V-RQOL) has never been studied in Indian patients. This study was planned to validate and assess V-RQOL in patients using tracheoesophageal puncture (TEP).

Methods.
A cross-sectional study was undertaken to validate V-RQOL questionnaire by testing reliability, validity, and responsiveness. V-RQOL was assessed in patients undergoing total laryngectomy with primary TEP.

Results.
One hundred thirty-two patients filled 188 questionnaires. Analysis was carried out on 122 patients. Reliability and validity of questionnaire were tested by Cronbach’s alpha (.84-.91) and item-scale correlation (.67-.86). Median V-RQOL-Total score was 76.2 indicating excellent V-RQOL. Higher scores were observed in patients less than 50 years (82.5 vs 72.5, p = .08). There was no effect of time interval between laryngectomy and assessment of questionnaire on the V-RQOL scores.

Conclusion.
V-RQOL questionnaire can be used reliably to assess V-RQOL, which is found to be excellent in Indian patients undergoing TEP. © 2008 Wiley Periodicals, Inc. Head Neck, 2008

Adolescents with cerebral palsy: stability in measurement of quality of life and health-related quality of life over 1 year

from Developmental Medicine and Child Neurology

This study assessed stability of measurement of quality of life (QOL) and health-related quality of life (HRQOL) over the course of 1 year among 185 adolescents (mean age 16y, SD 1y 9mo) with cerebral palsy (CP). Participants were classified on the Gross Motor Function Classification System as level I (n=55), II (n=30), III (n=27), IV (n=46), or V (n=27). QOL was assessed by self- (n=125) or proxy-report (n=60) with the Short Version of the Quality of Life Instrument for People with Developmental Disabilities (QOL Instrument), which describes domains of Being, Belonging, and Becoming. HRQOL was captured through parent proxy-reports with the Health Utilities Index Mark 3 (HUI3). Generalizability coefficients (G) for domain and Overall QOL scores on the QOL Instrument ranged from 0.50 to 0.73, indicating that between 50 and 73% of the variance was stable over 1 year. Stability on the HUI3 was excellent (G>0.90) for ambulation and overall utility scores; moderate (G=0.70–0.90) for speech, vision, dexterity, cognition, and hearing; and low for pain (G=0.48) and emotion (G=0.24). Correlations between scores on the two instruments were moderate even when adjustments were made for the lack of perfect stability over 1 year. This supports the notion that QOL and HRQOL are different aspects of life experience among adolescents with CP.