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Predicting the Outcome of Unilateral Vocal Fold Paralysis: A Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10.
Ann Otol Rhinol Laryngol. 2019 May; 128(5):447-452.AO

Abstract

OBJECTIVES

The aim of this study was to investigate if any clinical and phoniatric characteristics or quality-of-life measures could predict the outcome of unilateral vocal fold paralysis (UVFP) initially managed with speech therapy.

METHODS

Forty-six patients with UVFP were evaluated using laryngostroboscopy, the GIRBAS (grade, instability, roughness, breathiness, asthenia, and strain) scale, acoustic analysis, and the Voice Handicap Index-10 (VHI-10) questionnaire. Treatment was speech therapy according to a 3-phase protocol. The main outcome measure was incomplete vocal fold mobility 12 months after symptom onset. Univariate and multivariate modeling (k-nearest neighbors model) were applied.

RESULTS

Fifteen patients had incomplete motion recovery 12 months after the onset of UVFP. On univariate analysis, time to diagnosis (0.01), global grade of dysphonia (0.018), jitter (0.01), shimmer (0.012), and VHI-10 score (0.006) were associated with the outcome of vocal fold paralysis. Using a k-nearest neighbors multivariate discriminating model, the best discrimination of UVFP outcome was achieved with 4 parameters: global grade of dysphonia 2 or 3, jitter > 2.46%, shimmer > 6.97%, and VHI-10 score > 13. The model's misclassification rate for incomplete motion recovery was only 6%. The model showed sensitivity of 93% and specificity of 74%.

CONCLUSIONS

Delayed diagnosis and speech therapy was associated with negative outcomes. Higher grade of dysphonia, jitter, shimmer, and VHI-10 score on initial phoniatric assessment may help clinicians in predicting the outcomes of UVFP patients.

Authors+Show Affiliations

1 Department of Neurosciences, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy.2 Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy.3 Department of Medicine DIMED, University of Padova, Padova, Italy.1 Department of Neurosciences, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy.1 Department of Neurosciences, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30693800

Citation

Lovato, Andrea, et al. "Predicting the Outcome of Unilateral Vocal Fold Paralysis: a Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10." The Annals of Otology, Rhinology, and Laryngology, vol. 128, no. 5, 2019, pp. 447-452.
Lovato A, Barillari MR, Giacomelli L, et al. Predicting the Outcome of Unilateral Vocal Fold Paralysis: A Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10. Ann Otol Rhinol Laryngol. 2019;128(5):447-452.
Lovato, A., Barillari, M. R., Giacomelli, L., Gamberini, L., & de Filippis, C. (2019). Predicting the Outcome of Unilateral Vocal Fold Paralysis: A Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10. The Annals of Otology, Rhinology, and Laryngology, 128(5), 447-452. https://doi.org/10.1177/0003489419826597
Lovato A, et al. Predicting the Outcome of Unilateral Vocal Fold Paralysis: a Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10. Ann Otol Rhinol Laryngol. 2019;128(5):447-452. PubMed PMID: 30693800.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting the Outcome of Unilateral Vocal Fold Paralysis: A Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10. AU - Lovato,Andrea, AU - Barillari,Maria Rosaria, AU - Giacomelli,Luciano, AU - Gamberini,Lisa, AU - de Filippis,Cosimo, Y1 - 2019/01/29/ PY - 2019/1/30/pubmed PY - 2019/4/26/medline PY - 2019/1/30/entrez KW - -nearest neighbors KW - Multi-Dimensional Voice Program KW - Voice Handicap Index-10 KW - multidimensional phoniatric evaluation KW - speech therapy KW - unilateral vocal fold paralysis SP - 447 EP - 452 JF - The Annals of otology, rhinology, and laryngology JO - Ann. Otol. Rhinol. Laryngol. VL - 128 IS - 5 N2 - OBJECTIVES: The aim of this study was to investigate if any clinical and phoniatric characteristics or quality-of-life measures could predict the outcome of unilateral vocal fold paralysis (UVFP) initially managed with speech therapy. METHODS: Forty-six patients with UVFP were evaluated using laryngostroboscopy, the GIRBAS (grade, instability, roughness, breathiness, asthenia, and strain) scale, acoustic analysis, and the Voice Handicap Index-10 (VHI-10) questionnaire. Treatment was speech therapy according to a 3-phase protocol. The main outcome measure was incomplete vocal fold mobility 12 months after symptom onset. Univariate and multivariate modeling (k-nearest neighbors model) were applied. RESULTS: Fifteen patients had incomplete motion recovery 12 months after the onset of UVFP. On univariate analysis, time to diagnosis (0.01), global grade of dysphonia (0.018), jitter (0.01), shimmer (0.012), and VHI-10 score (0.006) were associated with the outcome of vocal fold paralysis. Using a k-nearest neighbors multivariate discriminating model, the best discrimination of UVFP outcome was achieved with 4 parameters: global grade of dysphonia 2 or 3, jitter > 2.46%, shimmer > 6.97%, and VHI-10 score > 13. The model's misclassification rate for incomplete motion recovery was only 6%. The model showed sensitivity of 93% and specificity of 74%. CONCLUSIONS: Delayed diagnosis and speech therapy was associated with negative outcomes. Higher grade of dysphonia, jitter, shimmer, and VHI-10 score on initial phoniatric assessment may help clinicians in predicting the outcomes of UVFP patients. SN - 1943-572X UR - https://www.unboundmedicine.com/medline/citation/30693800/Predicting_the_Outcome_of_Unilateral_Vocal_Fold_Paralysis:_A_Multivariate_Discriminating_Model_Including_Grade_of_Dysphonia_Jitter_Shimmer_and_Voice_Handicap_Index_10_ L2 - http://journals.sagepub.com/doi/full/10.1177/0003489419826597?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -