INTRODUCTION: To update the European guidelines for the assessment of voice quality (VQ) in clinical practice. METHODS: Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. RESULTS: Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases. CONCLUSION: The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach.

Department of Biomedical and Clinical Sciences Università degli Studi di Milano Milan Italy

Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy

Department of Laryngology and Broncho Esophagology EpiCURA Hospital Anatomy Department of University of Mons Mons Belgium

Department of Otolaryngology and Head and Neck Surgery Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Department of Otolaryngology and Phoniatrics Head and Neck Surgery Helsinki University Hospital and University of Helsinki Helsinki Finland

Department of Otolaryngology Fonomer Ankara Turkey

Department of Otolaryngology Head and Neck Surgery Comenius University University Hospital Bratislava Slovakia

Department of Otolaryngology Head Neck Surgery CHU Saint Pierre Brussels Belgium

Department of Otolaryngology Head Neck Surgery Foch Hospital University of Paris Saclay Paris France

Department of Otorhinolaryngology and Head and Neck Surgery University Hospital Motol 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Otorhinolaryngology Head and Neck Surgery Amsterdam UMC Location AMC University of Amsterdam Amsterdam The Netherlands

Department of Otorhinolaryngology Head and Neck Surgery Center Hospitalier de Luxembourg Eich Luxembourg

Department of Otorhinolaryngology Head and Neck Surgery CHU de Liege Université de Liège Liège Belgium

Department of Otorhinolaryngology Head and Neck Surgery Leiden University Medical Center Leiden The Netherlands

Department of Otorhinolaryngology Hospital Clínic Barcelona Spain

Department of Otorhinolaryngology Medical University of Vienna Vienna Austria

Department of Phoniatrics and Speech Pathology Clinic for Otorhinolaryngology Head and Neck Surgery University Hospital Zurich University of Zurich Zurich Switzerland

Department of Surgery Otolaryngology Service Hospital Universitario Mayor Mederi Universidad del Rosario Bogotá Colombia

ENT Head and Neck Surgery Antwerp University Hospital Edegem Belgium

Medical Voice Center Hamburg Germany

Phonetics and Phonology Laboratory Paris France

University of Barcelona Barcelona Spain

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European clinical practice guideline: managing and treating laryngopharyngeal reflux disease