Normal Mildly impaired Moderately impaired Severely impaired
If you had voice problems have settled until the date of completing this questionnaire, please estimate how soon after the operation your symptoms settled ………………….………………….
These are statements that many people have used to describe their voices and the effects of their voices on their lives. Check the response that indicates how frequently you have the same experience:
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Almost never
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Sometimes
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Almost always
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Always
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F 1. My voice makes it difficult for people to hear me.
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P 2. I run out of air when I talk.
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F 3. People have difficulty understanding me in a noisy room.
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P 4. The sound of my voice varies throughout the day
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F 5. My family has difficulty hearing me when I call them throughout the house
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F 6. I use the phone less often than I would like
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E 7. I’m tense when talking with others because of my voice
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F 8. I tend to avoid groups of people because of my voice.
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E 9. People seem irritated with my voice
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P 10. People ask “What is wrong with your voice”
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F 11. I speak with friends, neighbours or relatives less often because of my voice
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| Never |
Almost never
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Sometimes
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Almost always
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Always
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F 12. People ask me to repeat myself when speaking face-to-face
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P 13. My voice sounds creaky and dry
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P 14. I feel as though I have to strain to produce voice
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E 15. I find other people don’t understand my voice problem
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F 16. My voice difficulties restrict my person and social life.
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P 17. The clarity of my voice is unpredictable.
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P 18. I try to change my voice to sound different.
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F 19. I feel left out of conversations because of my voice.
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P 20. I use a great deal of effort to speak.
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P 21. My voice is worse in the evening.
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F 22. My voice problem causes me to lose income.
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E 23. My voice problem upsets me.
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E 24. I am less outgoing because of my voice problem.
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E 25. My voice makes me feel handicapped.
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P 26. My voice “gives out” on me in the middle of speaking.
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E 27. I feel annoyed when people ask me to repeat.
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E 28. I feel embarrassed when people ask me to repeat.
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E 29. My voice makes me feel incompetent.
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E 30. I am ashamed of my voice problem.
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Voice-related quality of life questionnaire
Please determine the severity and frequency of the problem by answering each question on the voice quiz indicating how “bad” it is (the amount of each problem that you have) with five being the worst possible.
Your answer should be based upon your average voice quality for the past week or so.
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NONE NOT A PROBLEM
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A SMALL AMOUNT
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A MODERATE (MEDIUM) AMOUNT
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FREQUENTLY
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PROBLEM IS “AS BAD AS IT CAN BE”
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I have trouble speaking loudly or being heard in noisy situations
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I run out of air and need to take frequent breaths when talking.
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I do not know what will come out when I begin speaking.
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I am anxious or frustrated.
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I get depressed.
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I have trouble using the telephone.
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I have trouble doing my job or practicing my profession.
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I avoid going out socially.
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I have to repeat myself to be understood.
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I have become less outgoing.
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Please add any comments that you would like to make about your voice
................................................................................................................................................................
................................................................................................................................................................
Do you have any comments about this questionnaire? We welcome your comments about the questionnaire in general or about specific questions, especially any that were unclear or confusing to you.
................................................................................................................................................................
................................................................................................................................................................
In addition to voice changes, you might experience problems during swallowing.
Please tick a box on each row according to whether or not the statement is true.
| Never |
Almost never
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Sometimes
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Almost always
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Always
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I have to clear my throat
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I am afraid of chocking when I drink liquids
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I cough when I swallow fluids
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Swallowing liquids takes extra effort
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Swallowing pills takes extra effort
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Swallowing solids takes extra effort
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I cough when I eat
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I have food sticking in my throat
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I feel a “foreign body” in my throat when I swallow
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I worry I might not be able to swallow a piece of meat / bread / tablets
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Swallowing is painful
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Swallowing is stressful
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Swallowing problems frustrate me
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Swallowing problems depress me
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Swallowing problems are a distraction in my life
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It takes me longer to eat than other people
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The pleasure of eating is affected by my swallowing
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I don’t go out for meals because of my swallowing problems
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Swallowing problems have caused me to loose weight
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THANK YOU FOR YOUR COOPERATION !
Please return to Radu Mihai, Consultant Surgeon,
Blenheim Head and Neck Centre, Churchill Hospital,
Old Road, Oxford OX3 7LE
REC 16/EM/0070 ThyVoice _ V2- Feb 2016 IRAS number 197725
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