Voice Handicap Index-10 (VHI-10) Scoring — Cheatsheet
Printable scoring reference for the Voice Handicap Index-10 (Rosen 2004) with Arffa (2012) severity bands, domain breakdowns, and clinical cut scores.
Overview
The VHI-10 (Rosen et al., 2004) is the 10-item short form of the original 30-item Voice Handicap Index and is the single most commonly used patient-reported outcome in US voice clinics. Patients rate how much each of ten statements describes their own voice on a 0–4 Likert scale; the items sum to a total from 0 to 40. Arffa, Krishna, Gartner-Schmidt, and Rosen (2012) published the clinical severity bands most clinics use to translate the raw sum into a meaningful clinical category. This cheatsheet is the one-page printable clinicians keep in the intake folder.
This cheatsheet is a static reference intended for clinical and educational use. Every page is rendered from a peer-reviewed source and cited below the printable sheet. Clinicians must adapt to the individual patient and to the current edition of any cited instrument manual before clinical use.
How to use this sheet
Hand the VHI-10 form to the patient in the waiting room or give it through a portal before the visit. Score each of the ten items 0 (never) to 4 (always) and sum to a total out of 40. Find the total on this cheatsheet and report the Arffa severity band verbatim in the clinical note, along with the three domain subtotals (Functional, Physical, Emotional — items are grouped on the original Rosen form). Use the severity band as a pre/post marker: a shift of ≥ 6 points on the total is the published minimal clinically important difference (MCID) and is the value most insurers will accept as treatment-response evidence. Do not use the VHI-10 as a screening instrument — it is a self-report of perceived handicap, not a diagnostic test, and it should be paired with a CAPE-V perceptual rating and laryngoscopy before any treatment decision.
“Patients routinely score 0/40 on the VHI-10 right after surgery because they are afraid to use their voice. A zero score in a post-op context is a red flag, not a pass — follow up with CAPE-V and stroboscopy before clearing them.”
Automate this workflow
Stop hand-copying the vhi-10 numbers into every report
Upload the session audio and ConductSpeech extracts the metrics, formats them against the published norm band, and drops a ready-to-paste present levels paragraph next to the cheatsheet values. Built for school-based SLPs on 50-student caseloads.
Printable sheet
| Total (0–40) | Arffa severity band | Clinical interpretation | Typical next step |
|---|---|---|---|
| 0 – 10 | Normal (WNL) | No clinically meaningful voice handicap. | Document baseline; no active intervention |
| 11 – 15 | Mild | Mild perceived voice handicap; possible early pathology. | CAPE-V + laryngoscopy if persistent |
| 16 – 25 | Moderate | Moderate voice-related disability; treatment usually indicated. | Voice therapy referral; otolaryngology consult |
| 26 – 40 | Severe | Severe self-reported voice handicap, often with occupational impact. | Immediate ENT/voice-clinic referral |
Rosen et al. (2004) VHI-10 total with Arffa et al. (2012) severity bands. MCID for treatment response is ≥ 6-point reduction on the total.
Common pitfalls
- Administering the VHI-10 in a clinic visit to a patient who has not been primed on the 0–4 scale. Untrained respondents cluster on 0 or 4 and wash out the total.
- Interpreting a low VHI-10 in a professional voice user (teacher, singer) as "no problem". Professional voice users are trained to compensate and can show significant laryngeal pathology on scope with a <10 VHI-10.
- Tracking change at the item level rather than the total. Item-level drift is noisy; the published MCID is on the total.
- Using the VHI-10 in a child. The VHI-10 is not validated under age 18 — use the pVHI (Pediatric Voice Handicap Index, Zur et al. 2007) instead.
Free tools paired with this cheatsheet
Voice Handicap Index-10 Calculator
Free interactive Voice Handicap Index-10 (VHI-10) calculator for speech-language pathologists, otolaryngologists, and voice clinics. Score the 10-item Rosen et al. (2004) patient self-report instrument and get the total (0 - 40), the Arffa et al. (2012) clinical severity band (normal, mild, moderate, severe), and per-domain subtotals (Functional, Physical, Emotional). Built for SLP voice intake, otolaryngology clinics, occupational voice screening, pre / post phonosurgery comparison, and graduate voice-evaluation training. Mobile-friendly, client-side, no sign-up.
Open toolCAPE-V Voice Rating
Free interactive CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) rating tool for speech-language pathologists, voice clinic laryngologists, and voice-therapy trainees. Rate the six perceptual parameters — Overall Severity, Roughness, Breathiness, Strain, Pitch, and Loudness — on the 100 mm visual analog scale as published by Kempster et al. (2009) and get instant severity classification (within normal limits, mild MI, moderate MO, severe SE) anchored to the Kempster printed-form bands. Built for voice clinic intake, voice therapy progress visits, pre- and post-laryngology surgical follow-up, and SLP graduate training in voice evaluation. Mobile-friendly, client-side, no sign-up.
Open toolEAT-10 Dysphagia Screener
Free interactive Eating Assessment Tool-10 (EAT-10) calculator for speech-language pathologists, otolaryngologists, gastroenterologists, and dysphagia clinics. Score the 10-item Belafsky et al. (2008) patient self-report instrument and get the total (0 - 40), the ≥ 3 abnormality flag, and a descriptive severity band (normal, mild, moderate, severe). Built for SLP and ENT dysphagia intake, voice clinic co-screening, head-and-neck cancer surveillance, stroke rehabilitation, neurodegenerative disease caseloads, older-adult home-health, and graduate dysphagia-assessment training. Mobile-friendly, client-side, no sign-up.
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DysphagiaEAT-10 Dysphagia Screening — Scoring Cheatsheet
Printable scoring reference for the Eating Assessment Tool-10 (Belafsky 2008) with the ≥3 abnormality cut and clinical severity interpretation.
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Printable reference of unfamiliar-listener speech intelligibility expectations by age, pooled from Coplan & Gleason (1988), Flipsen (2006), and Hustad et al. (2021).
References
- Rosen, C. A., Lee, A. S., Osborne, J., Zullo, T., & Murry, T. (2004). Development and validation of the Voice Handicap Index-10. The Laryngoscope, 114(9), 1549–1556.
- Arffa, R. E., Krishna, P., Gartner-Schmidt, J., & Rosen, C. A. (2012). Normative values for the Voice Handicap Index-10. Journal of Voice, 26(4), 462–465.
- Zur, K. B., Cotton, S., Kelchner, L., Baker, S., Weinrich, B., & Lee, L. (2007). Pediatric Voice Handicap Index (pVHI): A new tool for evaluating pediatric dysphonia. International Journal of Pediatric Otorhinolaryngology, 71(1), 77–82.