VoiSS: a patient-derived Voice Symptom Scale

Many voice-rating tools are either physician-derived, disease-specific measures or they merely combine general quality-of-life domains with vocal symptoms. The aim of this series of studies was to devise and validate a patient-derived inventory of voice symptoms for use as a sensitive assessment tool of (i) baseline pathology and (ii) response to change in adult dysphonia clinics.

Three stages in the development of the instrument are described. First, an initial exploratory, open-ended questionnaire study was used to compile a prototype list of voice complaints [Clin Otolaryngol 22 (1997) 37]. Second, the prototype list was administered to 168 subjects with dysphonia and underwent principal components analysis. Qualitatively, it was also assessed at this stage for its ability to capture voice-related impairment, disability and handicap. Third, a modified 44-item scale was administered to 180 new subjects.

The symptoms were highly endorsed. Principal components analysis with oblique rotation yielded a Voice Symptom Scale (VoiSS); 43 of the items comprise a 'general voice pathology' scale. More specifically, five oblique components provided assessments of: 'communication problems,' 'throat infections,' 'psychosocial distress,' 'voice sound and variability' and 'phlegm.'

The VoiSS is simple for patients to complete and easy to score. It is sensitive enough to reflect the wide range of communication, physical symptoms and emotional responses implicit in adult dysphonia.