Objective and Subjective Evaluation of Voice Across Different Degrees of Sensorineural Hearing Loss.
Abstract
Objective
To determine whether increasing severity of untreated bilateral sensorineural hearing loss is associated with severity-related alterations in perceptual, acoustic, aerodynamic, videolaryngostroboscopic, and patient-reported voice outcomes.
Methods
This prospective cross-sectional study included 150 adults allocated equally to five hearing-threshold groups: normal hearing (<25 dB HL), mild hearing loss (26-40 dB HL), moderate hearing loss (41-55 dB HL), moderately severe hearing loss (56-70 dB HL), and severe hearing loss (71-90 dB HL). Voice evaluation included GRBAS ratings, videolaryngostroboscopy, maximum phonation time, s/z ratio, acoustic analysis, and the Voice Handicap Index-10 (VHI-10). Overall group comparisons used the Kruskal-Wallis H test or chi-square tests. Dunn-Bonferroni tests were used for post-hoc comparisons. Spearman correlation assessed ordered trends, and age- and sex-adjusted regression analyses evaluated independent associations.
Results
Voice complaints (Fisher-Freeman-Halton exact P < 0.001), shouting behavior (Fisher-Freeman-Halton exact P < 0.001), and vocal loudness category (χ²(8) = 21.11, P = 0.007) differed among groups and were most prominent in Group 5. Videolaryngostroboscopic regularity (H(4) = 18.99, P < 0.001), GRBAS total score (H(4) = 18.35, P = 0.001), fundamental frequency (H(4) = 22.36, P < 0.001), and VHI-10 (H(4) = 16.99, P = 0.002) also differed among groups. Ordered associations were observed for vibratory irregularity (ρ = 0.288), GRBAS total score (ρ = 0.281), fundamental frequency (ρ = 0.350), and VHI-10 (ρ = 0.263; all P ≤ 0.001).
Conclusion
Greater hearing-loss severity was associated with subtle but measurable changes in perceptual voice quality, vibratory regularity, pitch, and self-reported voice handicap. These findings demonstrate association rather than causation; impaired auditory feedback is a plausible mechanism that requires confirmation in longitudinal or interventional studies.