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

Ofer Amir*, Rachel Blais, Ilan Roziner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
JournalJournal of Voice
StateAccepted/In press - 2024


  • Categories
  • Continuous scales
  • Laryngeal disorders
  • Pathology
  • Voice disorders


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