The Laryngoscope V C 2009 The American Laryngological, Rhinological and Otological Society, Inc. Development and Validation of the Singing Voice Handicap-10 Seth M. Cohen, MD, MPH; Melissa Statham, MD; Clark A. Rosen, MD; Thomas Zullo, PhD Objectives/Hypothesis: To develop a shortened version of the validated health status instrument for singers, the Singing Voice Handicap Index (SVHI). Study Design: Prospective item analysis of the SVHI in patients with singing voice problems and creation and validation of an abbreviated SVHI, the SVHI-10. Methods: Patients presenting to two tertiary care voice clinics prospectively completed the SVHI. Principal component analysis was performed. Individ- ual item to total correlations were calculated, and indi- vidual items were also evaluated for bipolar response patterns. A clinical consensus conference prioritized each individual item. Items were then eliminated, and the internal consistency was evaluated. A second cohort of patients with singing voice problems com- pleted the Voice Handicap Index-10 (VHI-10) and SVHI-10 at two time points. Singers without voice problems also completed the SVHI-10. SVHI-10 scores were compared between the groups, correlations between the SVHI-10 and VHI-10 were performed, and test-retest reliability of the SVHI-10 assessed. Results: Singers with voice problems had worse SVHI-10 scores than normal singers (P < .0001, t test). Test-retest reliability was high (Spearman cor- relation ¼ 0.86, P < .001). Internal consistency of the SVHI-10 demonstrated a Cronbach a of .94, and the correlation between the SVHI-10 and VHI-10 was 0.7 (P < .001, Spearman correlation). Conclusions: The SVHI-10 is a valuable instru- ment to assess self-perceived handicap associated with singing voice problems with reduced patient burden. Key Words: Quality of life, voice handicap, singing, dysphonia. Laryngoscope, 119:1864–1869, 2009 INTRODUCTION Singers represent a distinct population at risk for voice problems, leading to medical evaluation and treat- ment. Compared to nonsingers, singers may be more sensitive to vocal abnormalities, and they experience their impairment differently. 1–4 As a result of their voice problem, singers have reported more disability, more emotional impact, and are more likely to seek medical attention than nonsingers. 1,4 Hence, in order to measure the impact of dysphonia among singers, a need to de- velop a validated, health-status instrument for singers with voice problems exists. The Singing Voice Handicap Index (SVHI) is a newly developed tool for measuring the voice handicap associated with singing voice problems. 5 The SVHI has 36 items, each measured on a five-point Likert scale, with higher scores indicating more handicap. The SVHI is reliable, valid, and more sensitive than the Voice Handicap Index (VHI) in measuring treatment-related changes among the singing population. 6,7 However, with 36 items, the SVHI may overburden patients, especially when repeatedly measured during treatment and when combined with other surveys. The purpose of this study is to develop and validate an abbreviated version of the SVHI. This will facilitate the assessment of a patient’s singing voice handicap. MATERIALS AND METHODS Institutional review board approval was obtained from Duke University Medical Center and the University of Pitts- burgh Medical Center. At their initial presentation, 297 dysphonic singers completed the SVHI (Table I). Demographic information and diagnosis were collected. The internal consistency of the SVHI was determined by Cronbach a. Principal component analysis was performed to assess for potential subscales of the SVHI. Individual item to total correlations were conducted in a reliability analysis to identify items that minimally contributed to the internal reli- ability of the SVHI. Individual items were also evaluated for bipolar response patterns. A clinical consensus conference was held to evaluate the original 36 items. Participants, including three fellowship- trained laryngologists, two laryngology fellows, two singing voice specialists, and three speech-language pathologists, rated each item zero to four to denote their assessment of the item’s content validity. The average score for each item was obtained. From the Duke Voice Care Center, Division of Otolaryngology–Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina (S.M.C.); and University of Pittsburgh Voice Center, Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh Medical Center (M.S., C.A.R.), and the Department of Dental Public Health, University of Pittsburgh Dental School (T.Z.), Pittsburgh, Pennsylvania, U.S.A. Editor’s Note: This Manuscript was accepted for publication May 13, 2009. Presented at the American Laryngological Association 130th An- nual Meeting, Phoenix, Arizona, U.S.A., May 28–29, 2009. Send correspondence to Seth M. Cohen, MD, DUMC 3805, Dur- ham, NC 27710. E-mail: seth.cohen@duke.edu DOI: 10.1002/lary.20580 Laryngoscope 119: September 2009 Cohen et al.: Singing Voice Handicap-10 1864