title: Comparison of pediatric voice handicap index scores with perceptual voice analysis in patients following airway reconstruction.
abstract: OBJECTIVE
  We performed a retrospective review to compare a subjective parental proxy-derived voice handicap survey to an observer-derived method of measuring voice perturbation in children who have undergone airway reconstruction. The main outcome measures were the Pediatric Voice Handicap Index (pVHI) total score and the Overall Severity score on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).
  
  
  METHODS
  The percent Overall Severity CAPE-V score (score divided by 100) and the percent pVHI score (score divided by 92) were calculated. A Wilcoxon signed rank test was used to compare CAPE-V scores with the pVHI total scores. The relationship between the pVHI scores and the CAPE-V scores was investigated with a Spearman correlation. Subgroup analysis was performed to determine the relationship of surgery type to CAPE-V and pVHI scores.
  
  
  RESULTS
  Fifty subjects with a history of airway surgery who were evaluated between 2005 and 2008 were identified. Forty-two of the 50 subjects had complete data for review. Their median age was 7.1 years (range, 3.3 to 17.9 years). Their pVHI total scores had a median of 30 (range, 1 to 80). Their Overall Severity CAPE-V scores had a median of 50.5 (range, 0 to 98). Their median CAPE-V percent was higher than their median pVHI percent (50.5% versus 32.6%; p = 0.0003). A weak correlation was found between the Overall Severity CAPE-V score and the pVHI total score (rho = 0.41; p = 0.0003). There was a trend toward higher Overall Severity CAPE-V scores in patients who underwent cricotracheal resection. The total number of airway surgeries was significantly correlated with the Overall Severity CAPE-V score (rho = 0.6; p <0.0001) but not with the pVHI score.
  
  
  CONCLUSIONS
  Children who undergo airway reconstruction often have a resulting voice disturbance that can affect their lives in multiple dimensions. The results of this study revealed a weak-to-fair correlation between the parent-reported pVHI total score and expert ratings of voice quality using the CAPE-V. In this patient population, both of these tools provided important information regarding the relationship of the severity of voice disturbance to its handicapping effects.
authors.affiliation: Center for Pediatric Voice Disorders, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: de Alarcon
authors.forename: Susan Baker
authors.initials: SB
authors.lastname: Brehm
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Kelchner
authors.forename: Jareen
authors.initials: J
authors.lastname: Meinzen-Derr
authors.forename: Janet
authors.initials: J
authors.lastname: Middendorf
authors.forename: Barbara
authors.initials: B
authors.lastname: Weinrich
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004185:Disability Evaluation; D006801:Humans; D015588:Observer Variation; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects; D010290:Parents / Q000523:psychology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013065:Speech Intelligibility; D013067:Speech Perception; D014832:Voice Disorders / Q000175:diagnosis* / Q000209:etiology; D014833:Voice Quality