Speech quality

Speech Quality

Patient reported speech outcome after treatment for head and neck cancer

The Speech Handicap Index (SHI) questionnaire with 30-items on speech problems in daily life and a question on overall speech quality was developed to assess speech problems in patients and validated in a sample of 92 patients with cancer of the oral cavity or pharynx and a sample of 110 healthy subjects.

All subjects completed the SHI and the EORTC H&N35 questionnaire at a single point in time. A randomly selected subset of patients (n = 29) completed the SHI on a second occasion approximately 3 months later for purposes of assessing test-retest reliability.

Factor analysis identified two well-defined subscales within the SHI, one assessing speech function and the other psychosocial functioning related to speech. The internal consistency and test-retest reliability of the SHI was high (> 0.90 and 0.85 respectively). The construct (“known groups”) validity of the SHI was evidenced by its ability to distinguish clearly between patient subgroups formed on the basis of tumor grade. A SHI cut-off score of 6 points was defined to identify patients with speech problems. A difference score of 12 points or more is proposed as a relevant difference score for multiple group study designs.

The results of this initial psychometric study indicate that the SHI is a reliable and valid questionnaire for assessing speech problems in daily life. Additional research is needed to evaluate the responsiveness of the questionnaire to changes in speech-related problems over time.

The SHI is now used in clinical practice (in OncoQuest) and in other research projects. For instance, in a study among  88 patients treated more than 3 months earlier for laryngeal cancer, correlation between VHI (Voice Handicap Index) and SHI scores was high (r=.98). ROC analyses revealed equal values as compared to patients with oral or oropharyngeal cancer for the SHI (cut off 6: sensitivity 97%, specificity 87%). Speech was significantly associated with quality of life (r=.43) and distress (r=.50). In laryngeal cancer patients.

AmsterdamUMC, location VUmc, department of Otolaryngology – Head & Neck Surgery.


  • Rinkel RN, Verdonck-de Leeuw IM, Doornaert P, Buter J, de Bree R, Langendijk JA, Aaronson NK, Leemans CR. Prevalence of swallowing and speech problems in daily life after chemoradiation for head and neck cancer based on cut-off scores of the patient-reported outcome measures SWAL-QOL and SHI. Eur Arch Otorhinolaryngol. 2016 Jul;273(7):1849-55.
  • Rinkel RN, Verdonck-de Leeuw IM, de Bree R, Aaronson NK, Leemans CR. Validity of patient-reported swallowing and speech outcomes in relation to objectively measured oral function among patients treated for oral or oropharyngeal cancer. Dysphagia. 2015 Apr;30(2):196-204.
  • Rinkel RN, Verdonck-de Leeuw IM, van den Brakel N, de Bree R, Eerenstein SE, Aaronson N, Leemans CR. Patient-reported symptom questionnaires in laryngeal cancer: voice, speech and swallowing. Oral Oncol. 2014 Aug;50(8):759-64.
  • Cnossen IC, de Bree R, Rinkel RN, Eerenstein SE, Rietveld DH, Doornaert P, Buter J, Langendijk JA, Leemans CR, Verdonck-de Leeuw IM. Computerized monitoring of patient-reported speech and swallowing problems in head and neck cancer patients in clinical practice. Support Care Cancer. 2012 Nov;20(11):2925-31.
  • Rinkel RN, Verdonck-de Leeuw IM, van Reij EJ, Aaronson NK, Leemans CR. Speech Handicap Index in patients with oral and pharyngeal cancer: better understanding of patients’ complaints. Head Neck. 2008 Jul;30(7):868-74.

For questions, please contact Rico N.P.M. Rinkel, MD, ENT-specialist, laryngologist via s.biemans@amsterdamumc.nl