In evaluations of the severity of voice problems and in order for treatment for dysphonic patients to be effective, clinicians should conduct not only examiner’s subjective and objective evaluations, but also a subjective evaluation with the patient. Voice-related psychometric evaluations have been used in recent years for patient’s subjective evaluations, but the reliability and validity of this technique, when conducted in the Korean language, have yet to be evaluated.The VHI(Voice Handicap Index) is one of the most psychometrically robust and well-studied instruments among the various instruments for measuring quality of life in patients suffering from voice disorders. However, the VHI has yet to be established as a gold standard for such testing. The primary objectives of this study were 1) to validate the Korean-translated versions of the VHI-30 and the VHI-10, and 2) to develop a new VHI version considering the cross-cultural differences. One hundred fifty-six Korean adult patients, all of whom had symptoms of dysphonia without laryngeal cancer, as well as 66 normal Korean adults participated in this study. The survey was conducted using the VHI-30, three ‘singing’ items, the IPVI(Iowa Patient’s Voice Index)-(1) and the SF(Short Form)-36. Acoustic analysis with the MDVP (Multi-Dimensional Voice Program) was conducted only in the patient group. The results were as follows.1. With regard to the reliability of the VHI-30, Pearson correlations in test-retest were very high(r=0.971, p<0.01). Cronbach’s α in internal consistency was 0.969. The control group received significantly lower scores than did the patient group. For the concurrent validity of the VHI-30, with regard to the total score of the patient group, Spearman correlations between the VHI-30 and the IPVI(1) were high(r=0.664, p<0.01), and the correlations between the VHI-30 and the SF-36 were low(r=0.372, p<0.01). With regard to the construct validity, the VHI-30 was divided into three components via factor analysis.2. Patients with neurogenic voice disorders evidenced worse VHI-30 scores than those suffering from any other voice disorders(functional, structural, and inflammatory disorders) and the controls. Those with neurogenic laryngeal disease evidenced the most severe impairments, supporting the conclusions of previous studies. This result suggests that a group study of laryngeal diseases could be achieved using the VHI-30.3. Correlations between the VHI-30 scores and the results of MDVP parameters were in relatively weak agreement. The VHI-30 and acoustic measurements provided independent information supporting the results of previous studies.4. Also for the VHI-10, statistical analyses revealed high reliability and validity values. The correlations of total scores between the VHI-30 and the VHI-10 were high(r=0.968, p<0.01). The mean ratio of total scores between the VHI-10 and the VHI-30 were 0.368. The items on the VHI-10 were more sensitive than those of the VHI-30, supporting the results of previous studies. VHI-10 had a single component according to the results of factor analysis.5. Ten questionnaire items as a‘new VHI-10’(nVHI-10) items were selected from the VHI-30. Five items from the original VHI-10 were remained in the nVHI-10. The mean ratio of the nVHI-10 to the VHI-30 was 0.408. The items on the nVHI-10 were more sensitive than those of the VHI-10.6. In order to reflect the cross-cultural differences, ‘singing VHI-10’ (sVHI-10) was developed by including eight items of the VHI-30 and 2 singing items (S31 as a physical factor: ‘My voice problem makes it difficult for me to sing’, and S32 as a functional factor: ‘My singing difficulties restrict social life’). The mean ratio of the sVHI-10 to the VHI-30 was 0.456. The sVHI-10 were more sensitive than those of the VHI-10 and the nVHI-10. These results confirmed that cross-cultural differences exist with regard to the selection of survey items.The validity and reliability of VHI-30 and VHI-10 questionnaires are maintained even after translating into Korean. In order to conduct the voice-related psychometric evaluation questionnaire or to decipher its results, cross-linguistic and cross-cultural differences should be considered.
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