Research Article| Volume 37, ISSUE 2, P251-256, March 2023

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Effect of Chronic Cough on Voice Measures in Patients With Dysphonia

Published:January 08, 2021DOI:



      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.


      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.


      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).


      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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        • Cohen SM
        • Kim J
        • Roy N
        • et al.
        Prevalence and causes of dysphonia in a large treatment-seeking population.
        Laryngoscope. 2012; 122: 343-348
        • Schwartz SR
        • Cohen SM
        • Dailey SH
        • et al.
        Clinical practice guideline: hoarseness (dysphonia).
        Otolaryngol Head Neck Surg. 2009; 141: S1-S31
        • ASHA
        Voice disorders.
        American Speech-Language-Hearing Association, 2020 (Accessed June 29, 2020)
        • Stachler RJ
        • Francis DO
        • Schwartz SR
        • et al.
        Clinical practice guideline: hoarseness (dysphonia) (update).
        Otolaryngol–Head Neck Surg. 2018; 158: S1-S42
        • Gibson PG
        • Vertigan AE
        Speech pathology for chronic cough: a new approach.
        Pulm Pharmacol Ther. 2009; 22: 159-162
        • Bauer V
        • Aleric Z
        • Jancic E
        Comparing voice self-assessment with auditory perceptual analysis in patients with multiple sclerosis.
        Int Arch Otorhinolaryngol. 2015; 19: 100-105
        • Umeno H
        • Hyodo M
        • Haji T
        • et al.
        A summary of the clinical practice guideline for the diagnosis and management of voice disorders, 2018 in Japan.
        Auris Nasus Larynx. 2020; 47: 7-17
        • Jacobson BH
        • Johnson A
        • Grywalski C
        • et al.
        The Voice Handicap Index (VHI).
        Am J Speech-Lang Pathol. 1997; 6: 66-70
        • Belafsky PC
        • Postma GN
        • Koufman JA
        Validity and reliability of the reflux symptom index (RSI).
        J Voice. 2002; 16: 274-277
        • Bach KK
        • Belafsky PC
        • Wasylik K
        • et al.
        Validity and reliability of the glottal function index.
        Arch Otolaryngol Head Neck Surg. 2005; 131: 961-964
        • Goland H
        • Thompson C
        Cough management: the speech-language pathologist’s role in the treatment of chronic cough.
        Chronic Cough. Plural Publishing, San Diego, CA2019: 143-171
        • Pribuisiene R
        • Pribuisis K
        • Liutkevicius V
        • et al.
        Glottal function index questionnaire for screening of pediatric dysphonia.
        Int J Pediatr Otorhinolaryngol. 2019; 123: 97-101
        • French CL
        • Irwin RS
        • Curley FJ
        • et al.
        Impact of chronic cough on quality of life.
        Arch Internal Med. 1998; 158: 1657-1661
        • Domeracka-Kołodziej A
        • Grabczak EM
        • Dąbrowska M
        • et al.
        Comparison of voice quality in patients with GERD-related dysphonia or chronic cough.
        Otolaryngol Pol = Pol Otolaryngol. 2014; 68: 220-226
        • Niebudek-Bogusz E
        • Woznicka E
        • Zamyslowska-Szmytke E
        • et al.
        Correlation between acoustic parameters and Voice Handicap Index in dysphonic teachers.
        Folia Phoniat Logopaed. 2010; 62: 55-60
        • Benninger MS
        • Holy CE
        • Bryson PC
        • et al.
        Prevalence and occupation of patients presenting with dysphonia in the United States.
        J Voice. 2017; 31: 594-600
        • Cohen SM
        • Kim J
        • Roy N
        • et al.
        Direct health care costs of laryngeal diseases and disorders.
        Laryngoscope. 2012; 122: 1582-1588
        • Vertigan AE
        • Theodoros DG
        • Winkworth AL
        • et al.
        A comparison of two approaches to the treatment of chronic cough: perceptual, acoustic, and electroglottographic outcomes.
        J Voice. 2008; 22: 581-589
        • Lourenço BM
        • Costa KM
        • da Silva Filho M
        Voice disorder in cystic fibrosis patients.
        PLoS One. 2014; 9: e96769
        • Dejonckere PH
        • Remacle M
        • Fresnel-Elbaz E
        • et al.
        Differentiated perceptual evaluation of pathological voice quality: reliability and correlations with acoustic measurements.
        Rev Laryngol Otol Rhinol (Bord). 1996; 117: 219-224
        • Omori K
        • Kojima H
        • Kakani R
        • et al.
        Acoustic characteristics of rough voice: subharmonics.
        J Voice. 1997; 11: 40-47
        • Speyer R
        • Bogaardt HCA
        • Passos VL
        • et al.
        Maximum phonation time: variability and reliability.
        J Voice. 2010; 24: 281-284
        • Omori K
        Diagnosis of Voice Disorders.
        • Papadakis CE
        • Asimakopoulou P
        • Proimos E
        • et al.
        Subjective and objective voice assessments after recurrent laryngeal nerve-preserved total thyroidectomy.
        J Voice. 2017; 31: 515.e515-515.e521
        • Soni RS
        • Ebersole B
        • Jamal N
        Does even low-grade dysphonia warrant voice center referral?.
        J Voice. 2017; 31: 753-756