Although the terms ‘‘breathy’’ and ‘‘rough’’ are frequently applied to pathological voices, widely accepted definitions are not available and the relationship between these qualities is not understood. To investigate these matters, expert listeners judged the dissimilarity of pathological voices with respect to breathiness and roughness. A second group of listeners rated the voices on unidimensional scales for the same qualities. Multidimensional scaling analyses suggested that breathiness and roughness are related, multidimensional constructs. Unidimensional ratings of both breathiness and roughness were necessary to describe patterns of similarity with respect to either quality. Listeners differed in the relative importance given to different aspects of voice quality, particularly when judging roughness. The presence of roughness in a voice did not appear to influence raters’ judgments of breathiness; however, judgments of roughness were heavily influenced by the degree of breathiness, the particular nature of the influence varying from listener to listener. Differences in how listeners focus their attention on the different aspects of multidimensional perceptual qualities apparently are a significant source of interrater unreliability (noise) in voice quality ratings.