Two-dimensional Scheme for Arranging Voice Disorders

Ofer Amir*, Idit Gutman, Ron J. Baken, Adi Primov-Fever, Nitzan Hertzog, Gaya Noam, Ilan Roziner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Importance: Prevalent schemes that have been used for arranging voice pathologies have shaped theoretical and clinical views and the conceptualization of the pathologies and of the field as a whole. However, these available schemes contain inconsistencies and categorical overlaps. Objective: To develop and evaluate a new approach for arranging voice pathologies, using 2 continuous scales, organicity and tonicity, which were used to construct a 2-dimensional plane. Design, Setting, and Participants: This survey study was conducted among experts in the fields of laryngology and/or voice disorders from 10 countries. The survey was conducted using an online platform from March to May 2021. The data were analyzed in June 2021. Of the 45 experts who were initially approached, 39 (86.7%) completed the survey. Main Outcomes and Measures: The primary outcome measures were group ratings on 2 rating scales: Organicity and tonicity. On the organicity scale, 0 represented nonorganic and 10 organic. On the tonicity scale, 0 represented hypotonic and 10 hypertonic. Results: Participants included 16 laryngologists and 23 speech-language pathologists, of whom 27 (69.2%) were women and 12 (30.8%) men with a mean age of 55 years. The Cronbach α was high for organicity and tonicity (0.98 and 0.97, respectively). Interrater agreement (rwg) was moderate to very strong (rwg≥0.50) for most pathologies. The correlation between the 2 scales was moderate and negative (r =-0.38; P =.03). The pathologies were scattered across the full range of both scales and the 4 quadrants of the 2-dimensional plane, suggesting the continuity and bidimensionality of the new arrangement scheme. In addition, a latent profile analysis suggested that the 4-cluster solution is valid and roughly corresponded to the 4 quadrants of the constructed plane. Conclusions and Relevance: The findings of this survey study suggest the potential use of a 2-dimensional plane that was based on 2 continuous scales as a new arrangement scheme for voice disorders. The results suggest that this approach provides a valid representation of the field based on 2 basic measures beyond the specific etiology of each laryngeal pathology or condition. This simple and comprehensive organization scheme has the potential to facilitate new insights on the nature of voice pathologies, considering the interpathology similarities and differences.

Original languageEnglish
Pages (from-to)139-144
Number of pages6
JournalJAMA Otolaryngology - Head and Neck Surgery
Issue number2
StatePublished - Feb 2022


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