The Journal of Laryngology & Otology

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The Journal of Laryngology & Otology (2009), 123:823-829 Cambridge University Press
Copyright © JLO (1984) Limited 2009

Review Articles

Measuring voice outcomes: state of the science review

P N Cardinga1 c1, J A Wilsona1, K MacKenziea2 and I J Dearya3

a1 Department of Otolaryngology–Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, England
a2 Department of Otolaryngology–Head and Neck Surgery, Royal Infirmary, Glasgow, UK
a3 Medical Research Council Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Scotland, UK
Article author query
carding pn [PubMed]  [Google Scholar]
wilson ja [PubMed]  [Google Scholar]
mackenzie k [PubMed]  [Google Scholar]
deary ij [PubMed]  [Google Scholar]


Researchers evaluating voice disorder interventions currently have a plethora of voice outcome measurement tools from which to choose. Faced with such a wide choice, it would be beneficial to establish a clear rationale to guide selection. This article reviews the published literature on the three main areas of voice outcome assessment: (1) perceptual rating of voice quality, (2) acoustic measurement of the speech signal and (3) patient self-reporting of voice problems. We analysed the published reliability, validity, sensitivity to change and utility of the common outcome measurement tools in each area. From the data, we suggest that routine voice outcome measurement should include (1) an expert rating of voice quality (using the Grade-Roughness-Breathiness-Asthenia-Strain rating scale) and (2) a short self-reporting tool (either the Vocal Performance Questionnaire or the Vocal Handicap Index 10). These measures have high validity, the best reported reliability to date, good sensitivity to change data and excellent utility ratings. However, their application and administration require attention to detail. Acoustic measurement has arguable validity and poor reliability data at the present time. Other areas of voice outcome measurement (e.g. stroboscopy and aerodynamic phonatory measurements) require similarly detailed research and analysis.

(Accepted January 07 2009)

(Online publication May 20 2009)

Key wordsDysphonia; Voice Outcomes; Voice Disorders; Voice Quality; Voice Handicap; Self-Reported Voice Measures


c1 Address for correspondence: Prof Paul Carding, Professor of Speech/Voice Pathology, Dept of Speech, Voice and Swallowing, Otolaryngology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK. E-mail:


Professor P Carding takes responsibility for the integrity of the content of the paper.

Competing interests: None declared