A Two-Dimensional Continuous Approach for Organizing Voice and Laryngeal Pathologies

Objective: Voice and Laryngeal pathologies are traditionally arranged into categories based on etiology. However, these categorical approaches provide incomplete and rigid representations of the field. Recently, a new approach to organizing the field of laryngeal and voice disorders was presented, using two continuous scales, Organicity and Tonicity, forming a two-dimensional plane on which all pathologies are arranged. The present study aimed to refine the new approach and examine its validity and reliability.
Methods: Ninety-three international experts (ENT and SLPs) from 17 countries rated a comprehensive list of voice/laryngeal pathologies and conditions. On the Organicity scale, 0 represented ‘non-organic’, and 10 represented ‘organic’, while on the Tonicity scale, 0 represented ‘hypo-tonic’, and 10 represented ‘hyper-tonic’.
Results: Cronbach’s alphas were high for both scales (.99). Inter-rater agreement for the different pathologies varied between weak (rwg .05).
Conclusions: This study provides empirical support for the continuous two-dimensional approach for organizing voice disorders as a valid and dynamic representation of the field. Moreover, the new approach provides new insights, and highlights significant differences in how international experts judge and evaluate specific pathologies.