Introduction: Measuring the impact of chronic cough on voice quality can be difficult and challenging in daily practice. Evidence about its potential effects on diagnostic tools used in voice evaluation is lacking. We hypothesized that the presence of chronic cough plays a role in patients' perception of dysphonia severity, leading to a mismatch between the subjective, objective, and perceptual evaluations.
Methods: A retrospective chart review involving patients with a diagnosis of dysphonia and a complete speech voice evaluation was performed. A total of 311 patients were stratified into two different groups according to the presence of chronic cough. A total of 151 patients were assigned to the dysphonia and chronic cough group, while 160 patients were assigned to the dysphonia only group. During the initial evaluation, patients completed the Voice Handicap Index (VHI)-30, Glottal Function Index (GFI), and Reflux Symptoms Index (RSI). Voice evaluation also included aerodynamic/acoustic measures and the application of the GRBAS scale by a speech-language specialist. A paired t test and a linear regression analysis were used to compare subjective, perceptual, and aerodynamic/acoustic measures in both groups.
Results: The mean VHI-30 and GFI were elevated in both groups but significantly lower among patients with dysphonia and chronic cough when compared to patients with dysphonia only (P= 0.01). Additionally, a significantly higher RSI was found among patients with dysphonia and chronic cough (P< 0.01). No difference in aerodynamic/acoustic measures was found between groups (P> 0.05). Our linear regression model demonstrated a significant effect of the presence of chronic cough on the VHI-30, RSI, and GFI questionnaires (P< 0.05). Our model also found that the VHI-30 is a significant predictor for the (G), (B), (A), and (S) components of the GRBAS scale (P< 0.05).
Conclusion: The presence of chronic cough has a significant impact on the different patient-reported outcome measures, including VHI-30, RSI, and GFI. The use of VHI-30 as a predictor for the GRBAS scale reinforces the importance of subjective and perceptual assessment among patients with voice disorders and establishes a new area for exploration.
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