Development of a modified diagnostic classification system for voice disorders with inter-rater reliability study

Abstract

Diversity in nomenclature and on-going dilemmas over the conceptual bases for the classification of voice disorders make it virtually impossible for the collation and accurate comparison of evidence-based data across different clinical settings. This has significant implications for treatment outcome studies. The first aim of this study was to develop a modified diagnostic classification system for voice disorders with clearly defined operational guidelines by which we might reliably distinguish voice disorders from one another. The second aim was to establish the face validity and reliability of the system as an effective diagnostic tool for the allocation of patients to different diagnostic groups for clinical and research purposes. After the Diagnostic Classification System for Voice Disorders (DCSVD) had been developed, it was used in an inter-rater reliability study for the independent assessment of 53 new consecutive patients referred to the Voice Analysis Clinics of three tertiary hospitals. There were three raters present for the assessment and diagnostic allocation of each patient. The high levels of inter-rater reliability suggest this may be a robust classification system that has good face validity and even at this early stage, strong construct validity.

Effects of Questionnaire-Based Diagnosis and Training on Inter-Rater Reliability Among Practitioners of Traditional Chinese Medicine

“…[15][16][17] This should not be used to cast doubt about the validity and=or role of diagnosis within TCM. Biomedical diagnoses suffer from similar difficulties, [18][19][20] as do psychological diagnoses. 21,22 The current study investigated whether practitioners could be trained to diagnose with greater inter-rater reliability.…”

Multiparametric Assessment of the Efficacy of Voice Therapy in the Management of Hyper functional Voice Disorders

“…Positive effects were found in the perceptual and voice related quality-of-life outcomes. The DSI value of twelve out of the twenty participants reached normal range of DSI of Kannada speakers ranging from 3.79 to 6.25 [13,25]. In case of remaining eight participants, although they improved from their baseline DSI, did not reach the reference value of DSI with six sessions of therapy [26][27][28].…”

Patterns of Emotional Expression and Responses to Health and Illness in Women With Functional Voice Disorders (MTVD) and a Comparison Group

“…1,2 For the current purposes, FVD is defined as an aphonia or dysphonia that exists in the absence of pathology, or with insufficient pathology to account for its nature and severity, or with pathology such as vocal nodules or polyps considered consequences of the functional problem. 3 Studies consistently show that FVDs occur more frequently in women than in men, in ratios ranging from 2:1 to 19:1. 4,5 Speculative explanations for this phenomenon include that women have different anatomy and vocal fold physiology, 6 that they are more highly represented in at-risk occupations such as teaching, 7,8 and are more vulnerable to a range of psychosocial difficulties that prompt them to seek help.…”

“…9 Within the broad class of FVDs, further divisions include muscle tension voice disorder (MTVD) and psychogenic voice disorder (PVD) subgroups. 1,3 Dysregulated vocal behaviors are thought to predominate over psychological factors for those with MTVD, 10 whereas psychological factors appear more significant for PVD. 11,12 These distinctions are equivocal; however, the search for etiological and clinical profiles that differentiate between MTVD and PVD subgroups, and between subtypes of these classifications, is ongoing.…”