Teachers at Risk: Exploring Hoarseness of Voice and the Effectiveness of Self-Report Screening Tools Vocal Handicap Index (VHI) & Voice Symptom Scale (VoiSS) in a Saudi Population

Abstract

Teachers who use their voices for extended periods of time in less than ideal environments are more likely to develop voice disorders like hoarseness. Preventing long term vocal impairment requires early detection with validated screening instruments. To compare the diagnostic performance of the Voice Handicap Index (VHI) and the Voice Symptom Scale (VoiSS) as screening instruments. A cross-sectional study was conducted among 101 randomly selected school teachers from 15 schools in Bisha, Asir Region. Data were collected using a validated, self-administered questionnaire, including VHI and VoiSS. Statistical analysis was performed using SPSS version 27. The gold standard was a speech language pathologist's clinical voice evaluation. To assess the diagnostic precision of VHI and VoiSS, sensitivity, specificity, and Receiver Operating Characteristic (ROC) curves were computed. ROC analysis demonstrated high diagnostic accuracy for both tools, with AUCs of 0.86 (VHI) and 0.89 (VoiSS). At optimal cut-off scores, the VoiSS showed higher sensitivity (88.9%) and specificity (81.3%) than the VHI (84.4% and 78.7%, respectively).Hoarseness of voice is very common among school teachers. While both VoiSS and VHI are useful screening tools, VoiSS performs marginally better in terms of diagnosis. In educational settings, routine use of these tools may help with early diagnosis and treatment of voice disorders.