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Published on: August 9, 2024
Clinical Validation of the Hebrew Voice Symptom Scale (VoiSS-Heb)
Daniel Hilewitz1, Osnat Kandelshine-Waldman2, Ofer Amir2
1Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel; Department of Otolaryngology, Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel.
Objective:
To translate, culturally adapt, and validate the Voice Symptom Scale (VoiSS) into Hebrew (VoiSS-Heb) for use in the clinical assessment of Hebrew-speaking adults with dysphonia, and to evaluate its psychometric properties, including associations with perceptual voice quality (GRBAS [grade, roughness, breathiness, asthenia, strain]) and anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7]).
Methods:
A cross-sectional validation study was conducted at a tertiary multidisciplinary Voice Clinic between January 2020 and December 2021. Seventy-eight dysphonic patients and 140 vocally healthy controls completed the VoiSS-Heb, the Hebrew Voice Handicap Index (VHI-Heb), and the GAD-7. Clinicians provided GRBAS perceptual ratings. Internal consistency, convergent and construct validity, and discriminative ability (receiver operating characteristic [ROC] analysis) were examined.
Results:
The VoiSS-Heb demonstrated excellent internal consistency (Cronbach's α = 0.932) and effectively distinguished dysphonic from nondysphonic individuals (median: 58 vs. 7; P < 0.001). Strong correlations with the VHI-Heb (r = 0.946, P < 0.001) confirmed convergent validity. Moderate subscale-level correlations indicated that the Physical subscale captures symptom dimensions not fully represented in the VHI. VoiSS-Heb scores correlated with GRBAS ratings (P < 0.001) and GAD-7 scores (r = 0.347, P < 0.001), reflecting sensitivity to both perceptual and emotional aspects of dysphonia. ROC analysis identified a clinically useful cutoff of 32.5 points (sensitivity = 87.2%, specificity = 92.9%).
Conclusions:
The VoiSS-Heb is a valid, reliable, and clinically meaningful tool for evaluating the multidimensional impact of dysphonia among Hebrew-speaking adults. Its availability supports more precise assessment, more patient-centered treatment planning, and improved access to culturally appropriate voice care.
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