Table 2. Median Rankings of Attributes by the Delphi Consensus Group (DCG) and the Community Experts, and the Percent Agreement Among the Community Experts With the Median Rank.
| Original Item Number in DCG List | Attribute | DCG Median Rank | Community Experts Median Rank | Agreement Among Community Experts, % |
|---|---|---|---|---|
| AD1a | Intermittent glottal stops (vowel breaks) in vowels on all voiced sentences | 1 | 1 | 53 |
| AD2a | Strain-strangled, effortful, tight voice quality | 2 | 2 | 44 |
| AD14a | Patient report of speaking effort | 6 | 3 | 47 |
| AD3a | Symptoms reduced during whisper | 7 | 6 | 27 |
| AD10 | Symptoms reduced with voiceless consonants | 5 | 5 | 33 |
| AD4 | Symptoms reduced during singing | 7 | 6 | 33 |
| AD7a | Normal structure and symmetry of vocal folds at rest | 9 | 7 | 18 |
| AD8 | Patient reports symptoms worse on telephone | 7 | 8 | 27 |
| AD5 | Symptoms reduced during shouting or yelling | 9 | 9 | 31 |
| AD6 | Symptoms reduced during laughing or crying | 8 | 9 | 36 |
| AD12 | Symptoms reduced during high pitch phonation | 7 | 11 | 40 |
| AD11a | Intermittent vocal fold/arytenoid hyper adduction | 12 | 11 | 49 |
| AB1a | Intermittent breathy breaks on voiceless consonants before vowels in speech | 1 | 1 | 97 |
| AB7a | Symptoms most evident during connected speech | 4 | 2 | 76 |
| AB10a | Few symptoms on prolonged vowels | 4 | 3 | 55 |
| AB2a | Intermittent abductor spasm of vocal folds/arytenoids during speech | 8 | 4 | 50 |
| AB9 | Patient reports of “running out of air” while speaking | 6 | 5 | 39 |
| AB8 | Patient report of symptoms worse on the telephone | 6 | 7 | 29 |
| AB3a | Normal structure and symmetry of vocal folds at rest | 7 | 7 | 29 |
| AB4 | Symptoms reduced during whisper | 8 | 8 | 26 |
| AB5 | Symptoms reduced during singing | 7 | 9 | 32 |
| AB14 | Patient reports avoidance of specific words | 8 | 8 | 32 |
| AB6 | Symptoms may reduce during shouting or yelling | 11 | 11 | 58 |
| MTD1a | Continuous effortful strained voice quality | 1 | 1 | 78 |
| MTD3a | Similar voice quality abnormalities on all types of sounds | 3 | 2 | 68 |
| MTD2a | Continuous supraglottic compression obscuring vocal fold view during voice production | 2 | 3 | 44 |
| MTD4a | Absence of phonatory breaks | 4 | 5 | 32 |
| MTD6 | Patient complaint of pain in the throat area that may increase with laryngeal palpation | 6 | 5 | 34 |
| MTD5 | Voice quality does not improve during singing or shouting | 7 | 6 | 32 |
| MTD8 | Symptoms may improve with instruction or laryngeal manipulation | 8 | 6 | 32 |
| MTD9 | Signs of increased neck tension and elevated laryngeal position during speech | 8 | 7 | 27 |
| MTD10 | Patient may report rapid onset of disorder | 9 | 9 | 37 |
| MTD12 | Symptoms may not improve during whisper | 11 | 10 | 37 |
| MTD11 | Patient may report that symptoms go away for more than a day | 10 | 11 | 51 |
| TR1a | Regular pitch and/or amplitude oscillation during a sustained vowel | 1 | 1 | 97 |
| TR4a | Tremor on multiple sites on nasolaryngoscopy (eg, vocal folds, pharynx, tongue) | 2 | 2 | 88 |
| TR3 | Not affected by phonetic content | 3 | 3 | 52 |
| TR2 | Voice tremor (shaky voice) less obvious during connected speech | 3 | 4 | 52 |
| TR5a | Laryngeal position may show regular bobbing | 5.5 | 5 | 61 |
| TR8 | Severe cases may have regular glottal stops during vowels | 6 | 6 | 61 |
| TR6 | Patient may have head and/or hand tremor | 6 | 7 | 55 |
| TR7 | May have visible tremor at rest in affected sites | 6.5 | 8 | 76 |
Abbreviations: AB, abductor spasmodic dysphonia; AD, adductor spasmodic dysphonia; MDT, muscular tension dysphonia; TR, vocal fold tremor.
a
Items were included by DCG at stage 4.