Measuring the impact of dysphonia on quality of life using health state preferences

Objectives: Formal evaluation of health states related to dysphonia have not been rigorously evaluated in affected patients. The objective of this project was to evaluate the health states of mild, moderate, and severe dysphonia using formal health state preference evaluation, and to compare these outcomes with the degree of voice handicap. Design: Prospective health state preference assessment. Methods: A convenience sample of patients presenting with voice complaints were enrolled from an academic voice center. Demographic and voice handicap index (VHI-10) data were obtained, and an assessment of preference for five health states (monocular blindness, binocular blindness, mild dysphonia, moderate dysphonia, and severe dysphonia) was performed. Utility scores were calculated on a scale from 0 (death) to 1 (perfect health). Analysis was performed with ANOVA testing with post-hoc comparisons and correlation statistics. Results: Of 209 assessments, 149 (75.6%) met quality criteria. Relative to monocular blindness (score 0.61 [CI 0.57–0.64]), moderate dysphonia (0.58 [0.54–0.62]) was rated equivalently, with severe dysphonia (0.33 [0.29–0.37]) ranking significantly worse and mild dysphonia (0.96 [0.95–0.98]) significantly better. Binocular blindness (0.18 [0.15–0.21]) was the worst-ranked health state. There was a weak inverse correlation of VHI-10 with dysphonia-related preference scores; with worsening reported voice handicap, scores decreased. Conclusion: This study demonstrated that dysphonia had a significant impact of quality of life, with moderate dysphonia ranking equivalently with monocular blindness. These numerical estimates may be used for ongoing research into the value and cost-effectiveness of medical, therapeutic, and surgical interventions for voice disorders. Level of Evidence: 2c (outcomes research). Laryngoscope, 130:E177–E182, 2020.