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Voice Handicap Index (VHI-10)

10-item self-report of voice-related disability (Rosen 2004). Each 0 (never) to 4 (always). Total 0–40. Score >11 abnormal; ≥17 indicates significant voice handicap.

Q1. My voice makes it difficult for people to hear me*

Q2. I run out of air when I talk*

Q3. People have difficulty understanding me in a noisy room*

Q4. The sound of my voice varies throughout the day*

Q5. My family has difficulty hearing me when I call them*

Q6. I use the phone less often than I would like*

Q7. I am tense when talking with others because of my voice*

Q8. I tend to avoid groups of people because of my voice*

Q9. People seem irritated with my voice*

Q10. People ask, 'What's wrong with your voice?'*

Score interpretation

Normal voice 0–11

→ No specific voice intervention. Vocal hygiene advice if at-risk occupation (teachers, singers).

Mild voice handicap 12–16

→ Refer to speech and language therapy (SLT) for voice therapy. Consider laryngoscopy if persistent >3 weeks (NICE NG12 — urgent if hoarseness ≥3 weeks in adult >45).

Moderate voice handicap 17–28

→ Stroboscopic laryngoscopy + SLT voice therapy. Treat reflux, vocal-fold lesions, atrophy. Phonosurgery for nodules / polyps if SLT fails.

Severe voice handicap 29–40

→ Urgent ENT referral. Strobosocpy + imaging if structural lesion. Consider laryngeal EMG, neurological causes (vagal palsy, spasmodic dysphonia, Parkinson's). Multidisciplinary voice clinic.

Interpretation bands for the VHI-10. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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