The reliability of flexible nasolaryngoscopy in the identification of vocal fold movement impairment in young infants

Liu, Yi‐Chun Carol; McElwee, Tyler; Musso, Mary Frances; Rosenberg, Tara L.; Ongkasuwan, Julina

doi:10.1016/j.ijporl.2017.07.005

Cited by 19 publications

(15 citation statements)

References 6 publications

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“…Several anatomic and technical limitations raise diagnostic uncertainty, 2-4 especially with respect to degree of vocal cord movement. 6 However, the ability to record and replay examinations using high-definition equipment improves accuracy. 1 In the subgroup of patients included in this secondary study, a bedside diagnosis of left VCP after PDA repair occurred in 16.2% of patients.…”

Section: Discussionmentioning

confidence: 99%

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Recorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort

Chorney

Zur

Buzi

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: Assessing vocal cord mobility by flexible nasolaryngoscopy (FNL) can be difficult in neonates. To date, prospective studies evaluating the incidence and diagnostic accuracy of vocal cord paralysis (VCP) after surgical patent ductus arteriosus (PDA) ligation are limited. It is unknown whether video FNL improves diagnosis in this population. This study compared video recordings with bedside evaluation for diagnosis of VCP and determined inter-rater reliability of the diagnosis of VCP in preterm infants after PDA ligation. Methods: Prospective cohort of preterm neonates undergoing bedside FNL within two weeks of extubation following PDA ligation. In a subset, FNL was recorded. Two pediatric otolaryngologists, blinded to the initial diagnosis, reviewed the FNL video recordings. Results: Eighty infants were enrolled and 37 with a recorded FNL were included in the cohort. Average gestational age at birth was 25.2 weeks (SD: 1.2) and postmenstrual age at FNL was 37.0 weeks (SD: 4.5), which was 9.5 days (SD: 14.7) after extubation following PDA repair. There were 6 diagnosed with left VCP (16.2%; 95% CI: 4.3-28.1%) at bedside, and 9 diagnosed by video review (24.3%; 95% CI: 10.5-38.1%) ( P = .56). Videos confirmed all 6 VCP diagnosed initially, but also identified 3 additional cases. Though imperfect, reviewing FNL by video showed substantial reliability (kappa = .75), with 91.9% agreement. Conclusion: Video recorded FNL most often confirms a bedside diagnosis of VCP, but may also identify discrepancies. Physicians should consider the limitations of diagnosis especially when infants persist with symptoms such as weak voice or signs of postoperative aspiration. Level of Evidence 2b

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Section: Discussionmentioning

confidence: 99%

“…5 However, recorded laryngoscopies of children at one month of age only provide moderate inter-rater reliability for degree of vocal cord movement in a small case-control study. 6…”

Section: Introductionmentioning

confidence: 99%

Recorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort

Chorney

Zur

Buzi

et al. 2020

Ann Otol Rhinol Laryngol

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“…ReliabilityInter-and intra-rater reliability was calculated using the generalised Fleiss's kappa 4,6,7 to compare with comparable studies reported in the literature. The kappa statistic ranges from 0 to 1, where 0 depicts that raters are in agreement only by chance.…”

Section: Discussionmentioning

confidence: 99%

“…Any value over 0 may be interpreted as representing: poor (below 0.40), fair to good (between 0.40-0.75) and excellent (above 0.75) agreement beyond chance. The rating scale was considered as an ordinal scale and an ordinal weighting scheme was used in the computation of Fleiss's kappa 4,6 .…”

Section: Discussionmentioning

confidence: 99%

“…The former studies reported a 95% inter-rater reliability and a 99% intra-rater agreement for binary vocal cord assessment and the latter an inter-rater reliability of 0.334 (Fleiss's kappa). A three category scale (paralysis, paresis, normal) was used in reliability studies in paediatric patients 4 . They reported an inter-rater reliability (Cohen's kappa) of 0.67 for diagnosis of normal vs impaired movement, and lesser reliability of 0.49 when identifying the degree of movement (normal, paresis, paralysis).…”

Section: Introductionmentioning

confidence: 99%

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Vocal cord movement -- can it be accurately graded?

Douglas¹,

Menon²,

Montgomery³

et al. 2020

Preprint

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Background: Flexible nasendoscopy is the principle method of assessment of vocal cord movement. As this procedure is inherently subjective it may be that it is not possible for clinicians to grade degree of vocal cord movement reliably. Aim: The aim of this study was to assess the accuracy and consistency of grading of vocal cord movement viewed via flexible nasendoscopy. Design: Prospective video analysis study. Methods: Thirty flexible nasendoscopy videos, without sound or clinical information, were assessed by 6 consultant Head and Neck surgeons. They were asked to assess and grade right and left vocal cord movement independently, based on a 5-category scale. This process was repeated three times at separate time intervals. Agreement and reliability were assessed. Participants: 6 consultant head and neck surgeons. Results: The mean overall percentage of observed inter-rater agreement was 67.7% (SD 1.9) with the 5-categories scale, increasing to 91.4% ( SD 1.9) when a 3-category scale was derived. The mean overall percentage of observed intra-rater agreement was 78.3% (SD 9.7) for 5 categories, increasing to 93.1% (SD 3.3) for 3 categories. Discriminating vocal cord motion using the 5-category scale is less reliable (k= 0.52) than with the 3-category scale (k = 0.68). Conclusion: This study demonstrates quantitatively that it is challenging to accurately and consistently grade subtle differences of vocal cord movement as proven by lesser agreement and reliability when using a 5 point scale instead of a 3 point scale. It highlights the need to have an objective measure to help in the assessment of vocal cord movement.

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The Best Modality to Assess Vocal Fold Mobility in Children: Flexible Fiberoptic Laryngoscopy or Ultrasound?

Lawlor

Choi

2023

The Laryngoscope

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The reliability of flexible nasolaryngoscopy in the identification of vocal fold movement impairment in young infants

Cited by 19 publications

References 6 publications

Recorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort

Recorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort

Vocal cord movement -- can it be accurately graded?

The Best Modality to Assess Vocal Fold Mobility in Children: Flexible Fiberoptic Laryngoscopy or Ultrasound?

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