Normative Values for the Spanish Version of the Voice Symptom Scale (VoiSS)

Valores normativos para la versión española de la Voice Symptom Scale (VoiSS)


Objective. The aim of this study was to establish normative values for the Voice Symptom Scale (VoiSS) in the Spanish community population (without voice problems), using a sample from a large area of southeastern Spain.

Method. The sample consisted of 115 adults from ages 16 to 87, 60 of whom were women and 55 were men. Participants included the family members of patients who attended the Otorhinolaryngology (ENT) and Speech Therapy Clinic at a referral hospital in the region of Murcia, Spain, and some of the clinic’s staff. All the participants reported never having suffered from any voice disorder before.

Results. The normative values obtained in this study for the VoiSS were 14.61 (SD=8.18) for the total score, 7.57 (SD = 5.42) for the Impairment subscale, 1.04 (SD = 1.65) for the Emotional subscale, and 5.99 (SD = 3.61) for the Physical subscale. The percentile values were also obtained for the VoiSS scale and for its three subscales.

Conclusions. This study presents normative values for the VoiSS scale that have not previously been obtained in Spain. These values can be used as a reference to detect possible voice disorders.


Download data is not yet available.

Citado por


Antonio Velandrino-Nicolás
Francisco Cabello Luque
María Monteagudo-Santamaría
Lidia Gómez-Cobos


Hogikyan ND, Rosen CA. A Review of Outcome Measurements for Voice Disorders. Otolaryngol Head Neck Surg [Internet]. 2002 May;126(5):562–72. doi:

World Health Organization. WHOQOL measuring quality of life [Internet]. New York: WHO; 2012. Available from:

Lohr K. Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res. 2002;11(3):193-205. doi:

Patrick DL, Burke LB, Powers JH, Scott JA, Rock EP, Dawisha S, et al. Patient-reported outcomes to support medical product labeling claims: FDA perspective. Value Health. 2007;10(suppl 2):S125-37.. doi:

Dejonckere PH, Bradley P, Clemente P, Cornut G, Crevier-Buchman L, Friedrich G, et al. A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Eur Arch Otorhinolaryngol [Internet]. 2001 Feb;258(2):77–82. doi:

Branski RC, Cukier-Blaj S, Pusic A, Cano SJ, Klassen A, Mener D, et al. Measuring quality of life in dysphonic patients: A systematic review of content development in patient-reported outcomes measures. J Voice. 2010;24(2):193-8. doi:

Francis DO, Daniero JJ, Hovis KL, Sathe N, Jacobson B, Penson DF, et al. Voice-related patient-reported outcome measures: A systematic review of instrument development and validation. J Speech Lang Hear Res. 2017;60(1):62-88. doi:

Deary IJ, Wilson JA, Carding PN, McKenzie, K. VoiSS: a patient-derived voice symptom scale. J Psychosom Res. 2003;54(5):483-9. doi:

Webb AL, Carding PN, Deary IJ, MacKenzie K, Steen IN, Wilson JA. Optimising outcome assessment of voice interventions, I: Reliability and validity of three self-reported scales. J Laryng Otol. 2007;121(8):763-7. doi:

Steen IN, Mackenzie K, Carding PN, Webb A, Deary IJ, Wilson JA. Optimising outcome assessment of voice interventions, II: Sensitivity to change of self-reported and observer-rated measures. J Laryngol Otol. 2007;122(1):46-51. doi:

Behlau M, Madazio G, Moreti F, Oliveira G, Alves Dos Santos LdM, Paulinelli BR, et al. Efficiency and cutoff values of self-Assessment instruments on the impact of a voice problem. J Voice. 2016;30(4): 506.e9-506.e18. doi:

Wilson JA, Webb A, Carding PN, Steen IN, MacKenzie K, Deary IJ. The Voice Symptom Scale (VoiSS) and the Vocal Handicap Index (VHI): a comparison of structure and content. Clin Otolaryngol Allied Sci [Internet]. 2004 Apr; 2004 Apr 26;29(2):169-74. doi:

Carding PN, Steen I, Webb A, Mackenzie K, Deary IJ, Wilson JA. The reliability and sensitivity to change of acoustic measures of voice quality. Clin Otolaryngol Allied Sci. 2004 Sep 15;29(5):538-44. doi:

Wilson JA, Webb AL, Carding PN, Steen N, MacKenzie K, Deary IJ. The Voice Symptom Scale (VoiSS) and the Vocal Handicap Index (VHI): a comparison of structure and content. Clin Otolaryngol Allied Sci. 2004;29(2):169-74. doi:

Mozzanica F, Robotti C, Ginocchio D, Bulgheroni C, Lorusso R, Behlau M et al. Cross-cultural adaptation and validation of the Italian Version of the Voice Symptom Scale (I-VoiSS). J Voice. 2017;31(6):773e1-e10. doi:

Moreti F, Zambon F, Oliveira G, Behlau M. Cross-cultural adaptation, validation, and cutoff values of the Brazilian version of the Voice Symptom Scale—VoiSS. J Voice. 2014;28(4):458-68. doi:

Son H, Lee C, Kim K, Kim S, Jeong H, Kim J. The Korean version of the Voice Symptom Scale for patients with thyroid operation, and its use in a validation and reliability study. J Voice. 2018;32(3):367-73. doi:

Velandrino A, Cabello F, Parra M, Nicolás MJ, Losana E. Cultural adaptation and pilot study of the Spanish version of the Voice Symptom Scale (VoiSS). Rev Log Fon Aud. 2018;38(4):141-84. doi:

Ruston FC, Moreti F, Vivero M, Malebran C, Behlau M. Cross-cultural adaptation of the Chilean version of the Voice Symptom Scale - VoiSS. Codas. 2016;28(5):625-33. doi:

Contreras F, Moreti F, Vivero M, Malebran C, Behlau M. Cross-Cultural adaptation, validation, and cutoff values of the Chilean version of the Voice Symptom Scale: VoiSS. J Voice. 2021;35(3):498.e31-498.e38. doi:

Correa S, Ribeiro VV, Behlau M. Chilean's Self-Perception of Their Self-Regulatory Behaviors and Vocal Symptoms. J Voice. 2022;36(2):292.e23-292.e28. doi:

Arffa RE, Krishna P, Gartner-Schmidt J, Rose CA. Normative values for the Voice Handicap Index-10. J Voice. 2012;26(4):462-5. doi:

Sobol M, Sielska-Badurek, EM, Osuch-Wójcikiewicz E. Normative values for singing voice handicap index - systematic review and meta-analysis. Braz J Otorhinolaryngol. 2020;86(4):497-501. doi:

Jamovi [computer program on the internet]. Version 2.3. 2023. Available from:

Botella Ausina J, Sánchez Meca J. Meta-análisis en ciencias sociales y de la salud. Madrid: Síntesis; 2015. 266 p. Available from::

Abad FJ, Olea J, Ponsoda V, García C. Medición en ciencas sociales y de la salud. Madrid: Síntesis; 2011. 566 p. Available from:

Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use. 5th ed. United Kingdom: Oxford University Press. 2015.

Fayers PM, Machin, D. Quality of Life. The assessment, analysis and reporting of patient-reported outcomes. London: John Wiley & Sons; 2016. 648 p.

Newborg J, Stock J, Wnek L. Inventario de Desarollo Batelle. Manual de aplicación. Madrid: Tea Ediciones; 2011. 168 p.

Dunn LM, Dunn, Leota M, Arribas D. PPVT-III Peabody. Test de vocabulario en imágenes: Manual. Madrid: TEA; 2010. 102 p.

Hartnick CJ, Volk M, Cunningham, M. Establishing normative voice-related quality of life scores within the pediatric otolaryngology population. Arch Otolaryngol Head Neck Surg. 2003;129(10):1090-93. doi:

Blumin J., Keppel KL, Braun NM, Kerschner JE, Merati AL. The impact of gender and age on voice related quality of life in children: Normative data. Int J Pediatr Otorhinolaryngol. 2008;72(2):229-34. doi:


Download data is not yet available.