{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T09:22:05Z","timestamp":1781169725714,"version":"3.54.1"},"reference-count":46,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T00:00:00Z","timestamp":1627430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The international nine-item Voice Handicap Index (VHI-9i) is a clinically established short-scale version of the original VHI, quantifying the patients\u2019 self-assessed vocal handicap. However, the current vocal impairment classification is based on percentiles. The main goals of this study were to establish test\u2013retest reliability and a sound statistical basis for VHI-9i severity levels. Between 2009 and 2021, 17,660 consecutive cases were documented. A total of 416 test\u2013retest pairs and 3661 unique cases with complete multidimensional voice diagnostics were statistically analyzed. Classification candidates were the overall self-assessed vocal impairment (VHIs) on a four-point Likert scale, the dysphonia severity index (DSI), the vocal extent measure (VEM), and the auditory\u2013perceptual evaluation (GRB scale). The test\u2013retest correlation of VHI-9i total scores was very high (r = 0.919, p &lt; 0.01). Reliability was excellent regardless of gender or professional voice use, with negligible dependency on age. The VHIs correlated best with the VHI-9i, whereas statistical calculations proved that DSI, VEM, and GRB are unsuitable classification criteria. Based on ROC analysis, we suggest modifying the former VHI-9i severity categories as follows: 0 (healthy): 0 \u2264 7; 1 (mild): 8 \u2264 16; 2 (moderate): 17 \u2264 26; and 3 (severe): 27 \u2264 36.<\/jats:p>","DOI":"10.3390\/jcm10153325","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T11:12:52Z","timestamp":1627470772000},"page":"3325","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Validation and Classification of the 9-Item Voice Handicap Index (VHI-9i)"],"prefix":"10.3390","volume":"10","author":[{"given":"Felix","family":"Caffier","sequence":"first","affiliation":[{"name":"Department of Audiology and Phoniatrics, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Charit\u00e9platz 1, D-10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadeus","family":"Nawka","sequence":"additional","affiliation":[{"name":"Department of Audiology and Phoniatrics, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Charit\u00e9platz 1, D-10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9482-0971","authenticated-orcid":false,"given":"Konrad","family":"Neumann","sequence":"additional","affiliation":[{"name":"Institute of Biometry and Clinical Epidemiology, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Campus Charit\u00e9 Mitte, Charit\u00e9platz 1, D-10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Seipelt","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Ernst von Bergmann Klinikum Potsdam, Charlottenstr. 72, D-14467 Potsdam, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8492-9586","authenticated-orcid":false,"given":"Philipp P.","family":"Caffier","sequence":"additional","affiliation":[{"name":"Department of Audiology and Phoniatrics, Charit\u00e9-Universit\u00e4tsmedizin Berlin, Charit\u00e9platz 1, D-10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s004050000299","article-title":"A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Committee on Phoniatrics of the European Laryngological Society (ELS)","volume":"258","author":"Dejonckere","year":"2001","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1017\/S0022215109005398","article-title":"Measuring voice outcomes: State of the science review","volume":"123","author":"Carding","year":"2009","journal-title":"J. Laryngol. Otol."},{"key":"ref_3","first-page":"633","article-title":"Professional voice users: The evaluation of voice disorders","volume":"16","author":"Sataloff","year":"2001","journal-title":"Occup. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1177\/0194599817726528","article-title":"Identifying Occupations at Risk for Laryngeal Disorders Requiring Specialty Voice Care","volume":"157","author":"Mori","year":"2017","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1044\/1058-0360.0603.66","article-title":"The Voice Handicap Index (VHI): Development and Validation","volume":"6","author":"Jacobson","year":"1997","journal-title":"Am. J. Speech Lang. Pathol."},{"key":"ref_6","unstructured":"Frajkova, Z., Krizekova, A., Missikova, V., and Tedla, M. (2020). Translation, Cross-Cultural Validation of the Voice Handicap Index (VHI-30) in Slovak Language. J. Voice."},{"key":"ref_7","unstructured":"Sakaguchi, Y., Kanazawa, T., Okui, A., Hirosaki, M., Konomi, U., Sotome, T., Tashiro, N., Kurihara, M., Omae, T., and Nakayama, Y. (2020). Assessment of Dysphonia Using the Japanese Version of the Voice Handicap Index and Determination of Cutoff Points for Screening. J. Voice."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"758.e1","DOI":"10.1016\/j.jvoice.2015.09.002","article-title":"Adaptation and Validation of the Voice Handicap Index (VHI)-30 into Serbian","volume":"30","author":"Erdoglija","year":"2016","journal-title":"J. Voice"},{"key":"ref_9","first-page":"1199","article-title":"Cross-Cultural Adaptation and Validation of the Voice Handicap Index into Thai","volume":"98","author":"Jaruchinda","year":"2015","journal-title":"J. Med. Assoc. Thail."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.jvoice.2014.01.008","article-title":"Adaptation and Validation of the Voice Handicap Index in Latvian","volume":"28","author":"Trinite","year":"2014","journal-title":"J. Voice"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00106-003-0909-8","article-title":"Validation of the German version of the Voice Handicap Index (VHI)","volume":"51","author":"Nawka","year":"2003","journal-title":"Hno"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1159\/000127836","article-title":"Validation of the Voice Handicap Index by Assessing Equivalence of European Translations","volume":"60","author":"Leeuw","year":"2008","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_13","first-page":"458","article-title":"Translated Versions of Voice Handicap Index (VHI)-30 across Languages: A Systematic Review","volume":"44","author":"Seifpanahi","year":"2015","journal-title":"Iran. J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1159\/000200767","article-title":"Item Reduction of the Voice Handicap Index Based on the Original Version and on European Translations","volume":"61","author":"Nawka","year":"2009","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1159\/000316140","article-title":"Comparison of Subjective Assessment of Voice Disorders and Objective Voice Measurement","volume":"63","author":"Hanschmann","year":"2011","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"250.e1","DOI":"10.1016\/j.jvoice.2016.07.016","article-title":"The VHI-10 and VHI Item Reduction Translations\u2014Are we all Speaking the Same Language?","volume":"31","author":"Gilbert","year":"2017","journal-title":"J. Voice"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1097\/00005537-200409000-00009","article-title":"Development and validation of the voice handicap index-10","volume":"114","author":"Rosen","year":"2004","journal-title":"Laryngoscope"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Song, W., Caffier, F., Nawka, T., Ermakova, T., Martin, A., M\u00fcrbe, D., and Caffier, P. (2021). T1a Glottic Cancer: Advances in Vocal Outcome Assessment after Transoral CO2-Laser Microsurgery Using the VEM. J. Clin. Med., 10.","DOI":"10.3390\/jcm10061250"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.jvoice.2018.10.013","article-title":"Cervical Spine Disability in Correlation with Subjective Voice Handicap in Patients with Voice Disorders: A Retrospective Analysis","volume":"34","author":"Langenfeld","year":"2020","journal-title":"J. Voice"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jvoice.2017.11.014","article-title":"Do Standard Instrumental Acoustic, Perceptual, and Subjective Voice Outcomes Indicate Therapy Success in Patients With Functional Dysphonia?","volume":"33","author":"Reetz","year":"2019","journal-title":"J. Voice"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"194","DOI":"10.14639\/0392-100X-1544","article-title":"Efficacy of microsurgery in Reinke\u2019s oedema evaluated by traditional voice assessment integrated with the Vocal Extent Measure (VEM)","volume":"38","author":"Salmen","year":"2018","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"187","DOI":"10.21091\/mppa.2017.4035","article-title":"Phonomicrosurgery in Vocal Fold Nodules: Quantification of Outcomes in Professional and Non-Professional Voice Users","volume":"32","author":"Caffier","year":"2017","journal-title":"Med Probl. Perform. Artist."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/S0030-6665(20)31062-8","article-title":"The spectrum of vocal dysfunction","volume":"24","author":"Koufman","year":"1991","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1044\/jshr.3606.1120","article-title":"Comparison of F o Extraction Methods for High-Precision Voice Perturbation Measurements","volume":"36","author":"Titze","year":"1993","journal-title":"J. Speech Lang. Heart Res."},{"key":"ref_25","first-page":"591","article-title":"How to render an expert opinion on dysphonia","volume":"93","author":"Nawka","year":"2014","journal-title":"Laryngorhinootologie"},{"key":"ref_26","first-page":"68","article-title":"Perceptual and acoustic evaluation of hoarseness","volume":"90","author":"Hanschmann","year":"2011","journal-title":"Laryngorhinootologie"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00106-005-1310-6","article-title":"On the auditory evaluation of voice quality","volume":"54","author":"Ptok","year":"2006","journal-title":"Hno"},{"key":"ref_28","first-page":"117","article-title":"Psychoacoustic scaling of acoustic voice parameters by multicenter voice ratings","volume":"80","author":"Hess","year":"2001","journal-title":"Laryngorhinootologie"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/S0095-4470(19)30694-1","article-title":"Classification of voice qualities","volume":"14","author":"Wendler","year":"1986","journal-title":"J. Phon."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1159\/000265889","article-title":"Perception of Hoarseness by Several Classes of Listeners","volume":"40","author":"Anders","year":"1988","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4208189","DOI":"10.1155\/2020\/4208189","article-title":"Monitoring the Outcome of Phonosurgery and Vocal Exercises with Established and New Diagnostic Tools","volume":"2020","author":"Seipelt","year":"2020","journal-title":"BioMed Res. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1159\/000265703","article-title":"Recommendation by the Union of European Phoniatricians (UEP): Standardizing Voice Area Measurement\/Phonetography","volume":"35","author":"Schutte","year":"1983","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"268","DOI":"10.3813\/AAA.918943","article-title":"The Voice Range Profile: Its Function, Applications, Pitfalls and Potential","volume":"102","author":"Pabon","year":"2016","journal-title":"Acta Acust. United Acust."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Printz, T., Godballe, C., and Gr\u00f8ntved, \u00c5.M. (2020). The Dual-Microphone Voice Range Profile Assessment\u2014Interrater Reliability. J. Voice.","DOI":"10.1016\/j.jvoice.2019.12.017"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3836714","DOI":"10.1155\/2018\/3836714","article-title":"The Vocal Extent Measure: Development of a Novel Parameter in Voice Diagnostics and Initial Clinical Experience","volume":"2018","author":"Caffier","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_36","first-page":"5309508","article-title":"Pathology-Related Influences on the VEM: Three Years\u2019 Experience since Implementation of a New Parameter in Phoniatric Voice Diagnostics","volume":"2020","author":"Caffier","year":"2020","journal-title":"BioMed Res. Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1044\/jslhr.4303.796","article-title":"The dysphonia severity index: An objective measure of vocal quality based on a multiparameter approach","volume":"43","author":"Wuyts","year":"2000","journal-title":"J. Speech Lang. Heart Res."},{"key":"ref_38","unstructured":"Gonnermann, U. (2007). Quantifizierbare Verfahren zur Bewertung von Dysphonien [Quantifiable Techniques for Evaluation of Dysphonia], Peter Lang."},{"key":"ref_39","unstructured":"M\u00f6ller, A. (2010). Vocal Extent Measure as a New Parameter in Instrumental Voice Diagnostics. Unpublished. [Bachelor Thesis, Fachhochschule Stralsund\u2014University of Applied Sciences]."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1055\/s-0042-112197","article-title":"Das Stimmumfangsma\u00df SUM als neuer Parameter in der objektiven Stimmdiagnostik","volume":"40","author":"Caffier","year":"2016","journal-title":"Sprache \u00b7 Stimme \u00b7 Geh\u00f6r"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"114.e7","DOI":"10.1016\/j.jvoice.2016.03.016","article-title":"The Value of Vocal Extent Measure (VEM) Assessing Phonomicrosurgical Outcomes in Vocal Fold Polyps","volume":"31","author":"Salmen","year":"2017","journal-title":"J. Voice"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.jvoice.2006.04.005","article-title":"The Voice Handicap Index: Correlation Between Subjective Patient Response and Quantitative Assessment of Voice","volume":"21","author":"Woisard","year":"2007","journal-title":"J. Voice"},{"key":"ref_44","unstructured":"Titze, I.R. (1995). Workshop on Acoustic Voice Analysis: Summary Statement, National Center for Voice and Speech."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jvoice.2004.07.003","article-title":"Adverse Effects of Environmental Noise on Acoustic Voice Quality Measurements","volume":"19","author":"Deliyski","year":"2005","journal-title":"J. Voice"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3710","DOI":"10.1121\/1.3397477","article-title":"Updating signal typing in voice: Addition of type 4 signals","volume":"127","author":"Sprecher","year":"2010","journal-title":"J. Acoust. Soc. Am."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/15\/3325\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:36:09Z","timestamp":1760164569000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/15\/3325"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,28]]},"references-count":46,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["jcm10153325"],"URL":"https:\/\/doi.org\/10.3390\/jcm10153325","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,28]]}}}