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Objectives: Propose and validate a scoring system of the findings of sleep nasopharyngoscopy (SNP) for children with sleep disordered breathing (SBD). Methods: We conducted an inter- and intra-rater agreement study on video documentations of SNP performed on children (non-syndromic or dysmorphic) presenting with SDB. Videos used represented different types of pharyngeal findings including normal, collapse, mixed picture, or obstruction. Three “non-expert” raters at various stages in their otolaryngological career rated the videos twice and independently. One calculation assumed equal spacing between categories, the second assumed unequal spacing between the first and the second two based on need for surgical intervention. Results: Sixty-three videos were rated by each observer (2 weeks apart). None were syndromic or dysmorphic patients. Intra-observer agreement was 0.6442 ± 0.0835 (95%CI 0.4806-0.8078), 0.7373 ± 0.0718 (95%CI 0.5965-0.8781), 0.5853 ± 0.0789 (95%CI 0.4306-0.74), for raters 1, 2, and 3. Weighted kappa was 0.593 ± 0.1864 (95%CI 0.2277-0.9583), 0.85 ± 0.0884 (95%CI 0.6848-1), 0.79 ± 0.0772 (95%CI 0.6458-0.9506), respectively. Inter-rater agreements between raters 1 and 2, 2 and 3, 3 and 4 were 0.8304 ± 0.0604 (95%CI 0.7119-0.9489), 0.5168 ± 0.0827 (95%CI 0.3546-0.697), and 0.5306 ± 0.0829 (95%CI 0.368-0.693), respectively. Weighted kappa was 0.81 ± 0.1504 (95%CI 0.5231-1), 0.72 ± 0.1147 (95%CI 0.5-0.95), and 0.6658 ± 0.052 (95%CI 0.5253-0.8), respectively. Conclusions: This is the first proposed scoring method for SNP in children. It is based on a generic interpretation of SNP into four types. Overall reproducibility among the three raters and their agreement was good.

Objective The literature on the entity of the anterior larynx (AL) is restricted to little evidence on the difficulty encountered in exposing the larynx for intubation, perioperative morbidity and mortality, and scant reports on its prevalence in general adults and children. Here, we describe the prevalence of AL in a series of children presenting with aerodigestive symptoms and explore its association with functional abnormalities, congenital and structural anomalies or conditions. Setting Tertiary paediatric centre. Methods We conducted a retrospective case–control study. Using a prospectively collected surgical database, we identified patients diagnosed with AL (Grades IIb‐III‐IV Modified Cormack‐Lehane scale) and sex and age‐matched controls who had undergone full airway endoscopy for aerodigestive symptoms. We collected the demographics, presentations, associated diagnoses and investigations. We compared the proportion of patients with large airway abnormalities and dysmorphism and estimated the prevalence of AL. Results Over a 5.5‐year period, 58 children with AL (28 females, mean age 0.38 years) were matched with 58 controls (mean age 0.42 years). Although both groups presented with permutations of stridor, respiratory failure, cyanotic spells, swallowing and feeding difficulties and SDB, AL presented much more with swallowing and feeding problems (33 vs. 20, p < .05). There were significantly more children with dysmorphism in the AL group (29 vs. 9, p < .05). The prevalence of AL was 4.9% (SE 0.0063). Conclusions AL was detected in 4.9% of a sample of children who had undergone airway examination for aerodigestive symptoms. It is significantly associated with dysmorphism, and swallowing difficulties that warrant instrumental evaluation.