Voice Handicap Index-10 for Distinguishing Vocal Fold Mobility Status After Cardiovascular Surgery

OBJECTIVE(S): 1) Determine the prevalence of vocal fold mobility impairment (VFMI) in adults following invasive cardiovascular surgery, 2) Evaluate the relationship between patient-perceived voice quality and VFMI status, and 3) To examine the discriminant ability (sensitivity, specificity) of the Voice Handicap Index-10 (VHI-10) to correctly classify VFMI status. METHODS: A prospective, single-center cohort study of adults undergoing invasive cardiovascular surgery was conducted. All patients underwent a flexible fiberoptic laryngoscopy exam and completed the VHI-10 questionnaire. Blinded VFMI ratings were performed. RESULTS: A total of 541 patients were enrolled (66% male, mean age: 61.5 ± 13.2) of whom 75.7% demonstrated no VFMI, 17.3% had a partial VFMI, and 6.8% had a confirmed complete VFMI. A main effect was observed between VHI-10 score and VFMI status, F(2410) = 22.9, P < 0.0001. The highest group mean VHI-10 score was in the complete VFMI group (17.6 ± 14.0), followed by partial VFMI (12.4 ± 12.4), with patients with no VFMI reporting the lowest VHI-10 scores (6.5 ± 9.0). Receiver operator curve analysis demonstrated an area under the curve of 0.73 to classify complete VFMI status. Patients with a VHI-10 greater than the established pathological cut point of 11 had 4.0 times higher odds of exhibiting any degree of VFMI and 6.0 times higher odds of a complete VFMI, P < 0.05. CONCLUSION: Approximately one in four patients demonstrated VFMI following surgery. VHI-10 scores significantly differed according to VFMI status, in a severity-dependent manner. The VHI-10 demonstrated a moderate discriminant ability to classify VFMI. LEVEL OF EVIDENCE: Level 2 - single-center, non-randomized controlled prospective cohort.