Correlations among the Mandarin Voice Handicap Index, its shortened version, and the Voice-Related Quality of Life Measure for laryngectomees

Sep 29, 2026

Background: The Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL) are rarely used in alaryngeal patients who rely on pneumatic artificial larynx (PAL) and esophageal speech (ES), leaving the specificity of the VHI and VHI-10 unclear for these populations. Methods: The study examined score correlations among Mandarin VHI, VHI-10, and V-RQOL in Mandarin-speaking laryngectomees using PAL or ES, including a subset retest. Results: Remaining VHI items correlated strongly with VHI-10, and VHI measures showed high intercorrelation with a newly derived MA-VHI-10. Conclusion: Mandarin long-form VHI, VHI-10, and MA-VHI-10 are interchangeable, but should not be substituted for the V-RQOL.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

1. INTRODUCTION

Self-report instruments and voice-related measures

Rationale for comparing VHI, VHI-10, and V-RQOL in alaryngeal speakers

Methods and Participants

Results

Structural equation modeling and MA-VHI-10

Conclusion

Keywords

J Chin MedAssoc Original article Correlations among the Mandarin Voice Handicap Index, its shortened version, and the Voice-Related Quality of Life Measure for laryngectomees Chen-Chi Wanga,b,c, Jia-Shiou Liaod,e,* aDepartment of Otolaryngology–Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; bSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cDepartment of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan, ROC; dDepartment of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan, ROC; eSpeech and Language Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC Abstract Background: The Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL) are seldom administered to alaryngeal patients who use pneumatic artificial larynx (PAL) and esophageal speech (ES) . As such, the specificity of VHI and 10-item VHI (VHI-10) for assessing voice-related changes in such patients is unclear. Accordingly, this study investigated the correlation between scores on the VHI, its shortened version (VHI-10), and the V-RQOL for Mandarin-speaking laryngectomees using PAL and ES, with the aim of establishing which of these instruments is suited to such patients. Methods: The participants comprised 126 PAL and 26 ES patients from Taiwan who completed the Mandarin VHI and V-RQOL. Fifty-two of these alaryngeal participants then completed both those instruments a second time, between 8 and 64 days later. Results: One item appearing in both the Mandarin long-form VHI and the VHI-10 was excluded because more than half the participants left it unanswered. The correlation of scores on the remaining 29 items on the former with the nine on the latter was high (r = 0.968), while that between the former and V-RQOL scores was moderate (r = −0 .569), as was the correlation between short-form VHI and Mandarin V-RQOL scores (r = −0 .582) . Structural equation modeling was then used as the basis for simplifying the Mandarin longform VHI into a new 10-item VHI specifically for alaryngeal Mandarin speakers (MA-VHI-10), to eliminate the scoring effect of the original VHI’s and VHI-10’s work-related item. MA-VHI-10 scores were highly correlated with those on the Mandarin long-form VHI (r = 0 .983) . Conclusion: The Mandarin versions of long-form VHI, short-form VHI, and MA-VHI-10 are interchangeable for a Mandarinspeaking alaryngeal population. However, neither of the former two instruments should be substituted for the V-RQOL. Keywords: Esophageal speech; Pneumatic artificial laryngeal speech; Total laryngectomy; Voice handicap index; Voice-related quality of life 1. INTRODUCTION Self-report instruments are useful means of learning the magnitude of patients’ problems.1 Several such instruments have been developed to measure voice-related quality of life, including the Voice Handicap Index (VHI),1 the 10-item VHI (VHI- 10),2 the Voice-Related Quality of Life Measure (V-RQOL),3 the Voice Outcome Survey,4 the Voice Activity and Participation Profile,5 the Voice Symptom Scale,6 and the Self-Evaluation of Communication Experiences After Laryngectomy (SECEL) .7 Among them, three of the most commonly used are the VHI, * Address correspondence. Dr. Jia-Shiou Liao, Department of Speech Language Pathology and Audiology, Chung Shan Medical University, 110, Section 1, Jianguo North Road, Taichung 402, Taiwan, ROC.E-mail address: jsliao@csmu. [edu.tw](edu.tw) (J.-S. Liao). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2022) 85: 944-951. Received December 13, 2021; accepted May 5, 2022. doi: 10. 1097/JCMA.0000000000000752. Copyright © 2022, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://

FAQs

Why was this study conducted?

To clarify how VHI, VHI-10, and V-RQOL relate for Mandarin-speaking alaryngeal patients using PAL or ES, and to determine which instrument is appropriate for this group.

How were correlations between instruments assessed?

Participants completed the Mandarin VHI and V-RQOL, and a subset repeated both instruments 8 to 64 days later; correlations were then calculated between score sets.

What instrument relationship was found as the main outcome?

Mandarin long-form VHI, VHI-10, and a newly derived MA-VHI-10 were highly correlated and interchangeable for a Mandarin-speaking alaryngeal population.

Can VHI-based measures replace V-RQOL?

No. The study concludes that neither the long-form nor short-form VHI should be substituted for the V-RQOL.

Sep 29, 2026

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