A Meta-Analysis of the Association Between the Voice Handicap Index and Objective Voice Analysis

Purpose: Dysphonia can be evaluated by both patient-reported quality of life instruments and objective acoustic and aerodynamic analyses. However, less is known about the association between the two metrics. The goal of this study was to perform a meta-analysis of the correlation of the Voice Handicap Index (VHI-30) with the following objective parameters: fundamental frequency, jitter, shimmer, harmonics to noise ratio, noise to harmonic ratio, maximum phonation time, and the Dysphonia Severity Index. Method: A literature search was performed in the PubMed, Scopus, and Cumulative Index of Nursing and Allied Health Literature databases. Inclusion criteria were subjects age 18 years and older with voice complaints and assessed by both VHI-30 and objective voice analysis. Results: A literature search resulted in 1,297 unique articles, of which 310 underwent full-text review and 17 studies were included in quantitative analysis. Significant pooled correlation was observed for VHI-30 total with jitter (.301 [.177;.416]), shimmer (.255 [.162;.344]), noise to harmonic ratio (.200 [.111;.285]), maximum phonation time (-.227 [-.352; -.094]), and Dysphonia Severity Index (-.254[-. 455; -. 0286]). Significant correlations were observed in 4/7 objective parameters with the Physical subscale, 3/7 with the Functional subscale, and 2/7 with the Emotional subscale. All significant correlations were negligible (0-.3) or low (.3-.5). Conclusions: Results from meta-analysis showed that correlations between objective voice parameters and the VHI-30 were negligible or low. Further study is needed to determine if correlations vary by patient demographics or specific pathology.