Rearranging Voice Disorders: Refining the New Two-Dimensional Continuous Model

Background Voice and laryngeal pathologies are traditionally arranged in categories. A recent study has suggested an alternative approach, using two continuous scales, Organicity and Tonicity, which form a two-dimensional plane on which all pathologies/conditions can be arranged. Objectives This study was designed to examine the validity and reliability of the new continuous 2D model and to learn how it is affected by experts' background characteristics. Methods Ninety-three international experts from 16 countries participated in the study and rated a comprehensive list of 35 laryngeal and voice pathologies/conditions on two continuous scales. On the Organicity scale, 0 represented “nonorganic,” and 10 defined “organic.” Similarly, on the Tonicity scale, 0 described “hypotonic” and 10 represented “hypertonic.” Results Cronbach's alphas were high for Organicity and Tonicity (0.99), with varied interexpert agreement scores. Pathologies/conditions populated all four quadrants of the constructed two-dimensional plane, with a majority of 21 of the 35 located in the first quadrant (high-Tonicity, high-Organicity). Results showed strong replicability when compared to the preliminary study. In addition, ratings on the two scales were found consistent and statistically unaffected by the experts' background characteristics. Conclusions The new two-dimensional model is valid and reliable, and it provides a simple yet comprehensive approach for arranging voice disorders using a continuous perspective rather than a categorical one. Furthermore, the new model offers a framework that facilitates examination of the differences in how professional experts view different laryngeal pathologies and conditions.