Inter- and Intra-Rater Reliability of Laryngeal Sensation Testing with the Touch Method During Flexible Endoscopic Evaluations of Swallowing

Abstract

Objectives: Sensation is an integral component of laryngeal control for breathing, swallowing, and vocalization. Laryngeal sensation is assessed by elicitation of the laryngeal adductor reflex (LAR), a brainstem-mediated adduction of the true vocal folds. During Flexible Endoscopic Evaluations of Swallowing (FEES), the touch method can be used to elicit the LAR to judge laryngeal sensation. Despite the prevalence of this method in clinical practice and research, prior studies have yet to examine inter- and intra-rater reliability. Methods: Four speech-language pathologists rated 125 randomized video clips for the presence, absence, or inability to rate the LAR. Fifty percent of video clips were re-randomized and re-rated 1 week later. Raters then created guidelines and participated in formal consensus training sessions on a separate set of videos. Ratings were repeated post-training. Results: Overall inter-rater reliability was fair (κ = 0.22) prior to training. Pre-training intra-rater reliability ranged from fair (κ = 0.35) to almost perfect (κ = 0.89). Inter-rater reliability significantly improved after training (κ = 0.42, P < .001), though agreement did not reach prespecified acceptable levels (κ ≥ 0.80). Post-training intra-rater reliability ranged from moderate (κ = 0.49) to almost perfect (κ = 0.85). Conclusion: Adequate inter-rater reliability was not achieved when rating isolated attempts to elicit the LAR. Acceptable within-rater reliability was observed in some raters 1 week after initial ratings, suggesting that ratings may remain consistent within raters over a short period of time. Limitations and considerations for future research using the touch method are discussed.

Laryngeal sensation and its association with aspiration and cough in children with neurological impairment

“…Despite the high prevalence of LAR measurement by endoscopic touch, its inter‐rater reliability is insufficient 19 . An alternative method to test the LAR is by an air‐pulse applied through the working channel of the endoscope, a technique first described by Aviv et al in 1993 26 .…”

“…Furthermore, drinking and eating of different textures according to the patients' age were observed and the following parameters were recorded: premature spillage, laryngeal penetration, aspiration, and residue of the bolus in the hypopharynx after swallowing. For the evaluation of laryngopharyngeal sensation, the aryepiglottic fold was touched with the tip of the endoscope 19 . If no immediate swallowing, cough, or laryngeal adductor reflex was observed, ILS was assumed.…”

Stereo Laryngoscopic Impact Site Prediction for Droplet-Based Stimulation of the Laryngeal Adductor Reflex

“…The invisibility of these bursts impedes the targeted and reproducible stimulation of a desired area. If a laryngoscope tip is used for mucosal stimulation, occlusions can hinder the assessment of the obtained frame sequences and a poor interrater reliability has recently been reported, even after specialized training of the rating personnel [19]. Manual, tactile stimulation of the laryngeal mucosa has also been reported to show a poor reproducibility [20].…”

Evaluation and Treatment of Post-Extubation Dysphagia: The Importance of the Speech Pathologist in the Intensive Care Unit

“…Specifically, is a CSE sufficient or do recently extubated patients require an instrumental evaluation to safely recommend an oral diet? Recently extubated patients are at risk for silent aspiration, with estimates of silent aspiration ranging from 8% to 56% (Marvin et al, 2018;Scheel et al, 2016) with a majority of studies finding incidence of silent aspiration between 10% and 25% (Ajemain et al, 2001;Borders et al, 2020;El Solh et al, 2003;Hafner et al, 2008;Leder et al, 1998;Moss et al, 2020). This raises concern that a CSE may not be sensitive enough to detect PED.…”