A Standardized Lingual Tonsil Grading System: Interexaminer Agreement

Abstract

Objectives: Comparisons between studies involving the tongue base are limited by the lack of a universal system for grading lingual tonsils. The authors propose a new standardized grading system for lingual tonsil hypertrophy (LTH). Validation was assessed via an interexaminer agreement study. Methods: Video assessment: The proposed grading system consists of a 0 to 4 scale with: 0 = complete absence of lymphoid tissue, 1 = lymphoid tissue scattered over tongue base, 2 = lymphoid tissue covering entirety of the tongue base with limited vertical thickness, 3 = lymphoid tissue 5 to 10 mm in thickness, 4 = lymphoid tissue >1 cm in thickness (above tip of the epiglottis). A teaching video was created to demonstrate identification of this grading system. After viewing the teaching video, 8 trained otolaryngologists graded 25 video clips of the tongue base, recorded during flexible laryngoscopy. Live assessment: A second study was performed by 2 examiners directly examining the tongue base of 23 patients using flexible laryngoscopy during a routine clinic visit. Each examiner viewed and recorded the grade of the lingual tonsils independently. Results: Video assessment: The overall Fleiss kappa statistic was found to be κ = 0.449 ( P < .0001). This value denotes moderate agreement. Live assessment: The overall kappa for nominal data were found to be κ = 0.8665 ( P < .0001). This value denotes perfect agreement. Conclusions: The moderate interexaminer correlation demonstrated during video-assessment, and perfect interexaminer correlation demonstrated during live assessment, indicate that this proposed grading system may be a valuable and useful tool in creating a common language to describe lingual tonsils.

Hipertrofia de amígdala lingual y apnea obstructiva del sueño en población pediátrica: Una asociación a considerar

“…Los estudios de base de lengua poseen la limitación de que no existe una escala universal aceptada para graduar la HAL 3,21 . Friedman y cols fueron los primeros en desarrollar una escala de clasificación para evaluar la HAL en población pediátrica (Tabla 1).…”

“…No se requieren maniobras de colaboración por parte del paciente y es posible realizarlo en corto período de observación 21 . El mismo grupo de autores mencionados, evaluó la correlación interobservador, mediante el análisis por especialistas, a través de imágenes y videos, con resultados satisfactorios 3,21 . Sin embargo, esta escala aún no ha sido validada, ya que no se dispone de una herramienta que sea el estándar de oro, para compararla 21 .…”

“…Si bien pueden estar presentes en diferentes grados en la mayoría de los individuos sanos, pueden adquirir un rol clínico relevante si presentan hiperplasia patológica 3 . La HAL fue por primera vez descrita por Andrés Vesalio en 1543.…”

Lingual tonsil lymphatic tissue regrowth in patients undergoing transoral robotic surgery

“…Lingual tonsil hypertrophy (LTH) is a clinical condition often observed in clinical practice during the inspection of the tongue base region . This lymphatic hypertrophy (LH) is implicated in a variety of airway pathologies, ranging from sleep‐related breathing disorders, lingual tonsillitis, and difficult intubation procedures . Additionally, it is frequently a cause of foreign body sensation in the throat and of pharyngodynia in cases of it inflammation …”

“…The etiology regarding the growth of this lymphatic tissue (LT) has not been clearly proved . The few studies about this topic showed that previous adenotonsillectomy, laryngopharyngeal reflux (LPR), and a high body mass index could be correlated to LTH, even if defined data regarding this aspect are not available …”