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What is singing voice Handicap index?




Dr. T. Balasubramanian M.S. D.L.O.


Singers have demanding voice needs. They are also more exposed to the risk of developing voice problems. Measuring the impact of singing voice problems from the patient's perspective will facilitate evaluation and management of patients who sing.

Classic voice handicap index: This was introduced as a tool for measuring the psychological consequences of voice disorders. This is a self administered instrument consisting of 30 statements on voice related dysfunction. It measures the emotional physical and functional problems related to voice.

Questionnaire  to evaluate voice handicap index:


Never - 0 points, Almost never - 1 point, Sometimes - 2 points, Almost always - 3 points, Always - 4 points


Almost never sometimes Almost always
My voice makes it difficult for people to hear me        
I run out of air when I talk        
People find it difficult to understand me in a noisy room        
The sound of my voice varies throughout the day        
My family has difficulty in hearing me        
I use phone less often than I like        
I am tense when I talk with others due to my voice        
I tend to avoid groups of people because of my voice        
People seem irritated because of my voice        
People ask what is wrong with my voice        
People ask me to repeat myself        
My voice sounds creaky and dry        

Lower the score better is the index.

This index scores has been found to be lower in singers than non singers. This could be due to:

1. Voice problems of singers are different from that of non singers

2. Singers may be more sensitive to voice changes and may seek help fairly early

3. Voice handicap index may not be able to address singing voice problems

4. Since voice handicap index may not be sensitive enough for use in singers as important handicaps experienced by them amy go unmeasured / unnoticed.

5. Singing voice may be more susceptible to various medical disorders like reflux / allergy


With the above said factors in mind the new singing voice handicap index Questionnaire has been devised.


Almost never
Almost always
Takes lot of effort to sing        
My voice cracks / Breaks        
Frustrated by my singing        
People ask "what is wrong with your voice?" on singing        
Ability to sing varies from day to day        
Voice gives out on me while singing        
My singing voice upsets me        
My singing problems make me not want to perform        
I am embarrased by my singing        
I am unable to use my high voice        
I get nervous before I sing because of my voice problems        
My speaking voice is not normal        
Throat is dry when I sing        
Have to eliminate certain songs from my performance        
I have no confidence on my singing voice        
My singing voice is never normal        
I have trouble in making my voice do what I want it to do        
Have to push it to produce my voice when singing        
Have trouble controlling breathiness in voice        
Have trouble controlling raspiness in voice        
Have trouble singing loudly        
Have difficulty staying on pitch when I sing        
Feel anxious about my singing        
My singing sounds forced        
My speaking voice is hoarse when I sing        
Voice quality is inconsistent        
My singing voice makes it difficult for audience to hear me        
My singing makes me feel handicapped        
My singing voice tires easily        
Feel pain /tickling/chocking when I sing        
Unsure whether my voice will come out when I sing        
Feel something is missing in my life because of my inability to sing        
Worried that my singing problems will cause monitory loss        
Feel left out of music scene because of voice problems        
Singing makes me feel incomplete        
Have to cancel performances        

Scores range between 0 - 144

Higher scores indicates more self perceived handicap.

This is a valid instrument for measuring patient perceived impact of singing voice problems. This can also aid in the diagnosis and assessment of dysphonic singers. This test also is a viable tool to evaluate the outcome of treatment.


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