Inter-Rater Variability of Reflux Finding Score Amongst Otolaryngologists

Jahshan, Forsan; Ronen, Ohad; Qarawany, Jamal; Markel, Boaz; Sberro, Amiel; Yeung, Winnie; Lahav, Yonatan; Layous, Eli; Eisenbach, Netanel; Sela, Eyal; Marshak, Tal

doi:10.1016/j.jvoice.2020.07.021

Cited by 8 publications

(10 citation statements)

References 11 publications

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“…[15][16][17] There are multiple studies demonstrating limited inter-rater reliability and lack of agreement between experts when evaluating laryngoscopic examinations, suggesting that diagnoses made based on laryngoscopic findings remain fairly subjective. [18][19][20] Interestingly, our results suggest a moderate predictive ability of the algorithm to identify patients requiring operative airway intervention. In addition, the algorithm demonstrated similar ability to predict operative airway intervention in patients with nerve injury versus prolonged intubation using the AGA, suggesting that this tool may be helpful in counseling patients with bilateral vocal immobility regardless of etiology (i.e., nerve injury versus stenosis).…”

Section: Discussionmentioning

confidence: 71%

“…Glottic opening is often not formally measured, 14 and objective respiratory measurements such as spirometry or body plethysmography are rarely employed, in part due to logistical barriers to formal testing especially when results will not alter the imminent airway plan 15–17 . There are multiple studies demonstrating limited inter‐rater reliability and lack of agreement between experts when evaluating laryngoscopic examinations, suggesting that diagnoses made based on laryngoscopic findings remain fairly subjective 18–20 . Interestingly, our results suggest a moderate predictive ability of the algorithm to identify patients requiring operative airway intervention.…”

Section: Discussionmentioning

confidence: 85%

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Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility

et al. 2022

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Objective(1) To compare maximum glottic opening angle (anterior glottic angle, AGA) in patients with bilateral vocal fold immobility (BVFI), unilateral vocal fold immobility (UVFI) and normal larynges (NL), and (2) to correlate maximum AGA with patient‐reported outcome measures.MethodsPatients wisth BVFI, UVFI, and NL were retrospectively studied. An open‐source deep learning‐based computer vision tool for vocal fold tracking was used to analyze videolaryngoscopy. Minimum and maximum AGA were calculated and correlated with three patient‐reported outcomes measures.ResultsTwo hundred and fourteen patients were included. Mean maximum AGA was 29.91° (14.40° SD), 42.59° (12.37° SD), and 57.08° (11.14° SD) in BVFI (N = 70), UVFI (N = 70), and NL (N = 72) groups, respectively (p < 0.001). Patients requiring operative airway intervention for BVFI had an average maximum AGA of 24.94° (10.66° SD), statistically different from those not requiring intervention (p = 0.0001). There was moderate negative correlation between Dyspnea Index scores and AGA (Spearman r = −0.345, p = 0.0003). Maximum AGA demonstrated high discriminatory ability for BVFI diagnosis (AUC 0.92, 95% CI 0.81–0.97, p < 0.001) and moderate ability to predict need for operative airway intervention (AUC 0.77, 95% CI 0.64–0.89, p < 0.001).ConclusionsA computer vision tool for quantitative assessment of the AGA from videolaryngoscopy demonstrated ability to discriminate between patients with BVFI, UVFI, and normal controls and predict need for operative airway intervention. This tool may be useful for assessment of other neurological laryngeal conditions and may help guide decision‐making in laryngeal surgery.Level of EvidenceIII Laryngoscope, 133:2285–2291, 2023

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 85%

Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility

et al. 2022

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“…These endolaryngeal signs mainly consist of erythema and edema, which can be caused by any other form of local inflammation. Some authors believe that the reliability of applying the RFS questionnaire alone is low 19 . Thus, we infer that the laryngoscopic signs arising from LPRD are just as nonspecific or maybe even less specific than the LPRD‐related symptoms.…”

Section: Discussionmentioning

confidence: 84%

A Study of the Diagnostic Value of the Sign and Symptom Questionnaires for Laryngopharyngeal Reflux Disease

Zhang,

Liu,

Liu

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo investigate the diagnostic value of symptom questionnaires, sign questionnaires, and the combination of 2 questionnaires for laryngopharyngeal reflux disease (LPRD).Study DesignProspective, single‐centered.SettingSeventy‐seven patients who were hospitalized in the Department of Otolaryngology–Head and Neck Surgery from October 2022 to April 2023 were included.MethodsIncluded patients completed the RSS, RSI, RSA, and RFS questionnaires and underwent 24‐hour hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH monitoring (HEMII‐pH). The RSS, RSI, RSA, RFS, RSS+RSA, RSS+RFS, RSI+RSA, RSI+RFS, and RSI+RFS diagnostic value were compared using Cohen's k test and receiver operating characteristic analysis.ResultsBased on the 24 hours HEMII‐pH results, 52 patients had LPRD, and 25 patients did not have LPRD. The Kappa values of RSS, RSI, RSA, RFS, RSS+RSA,2 RSS+RFS, RSI+RSA, and RSI+RFS with the 24 hours HEMII‐pH monitoring results were 0.565, 0.442, 0.318, 0.431, 0.517, 0.631, 0.451, and 0.461, respectively. The RSS+RFS questionnaire had the highest AUC of 0.836 (95% confidence interval [CI] 0.762‐0.909) and the RSA questionnaire had the lowest AUC (AUC = 0.665, 95% CI 0.560‐0.790). The sensitivity of RSS was the highest (98%), the specificities of RSS+RFS and RSI+RFS were the highest (96%), and the specificity of RSS was the lowest (52%). RSS+RFS had a sensitivity of 75%, second only to RSS and RFS (76%).ConclusionAmong the 8 methods, the RSS combined with the RFS had the highest concordance with 24 hours HEMII‐pH monitoring results and AUC values when screening for LPRD.

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“…In this study, laryngeal signs such as posterior commissure hypertrophy or laryngeal erythema had a high but comparable SE than pharyngeal (tongue tonsil hypertrophy) or oral (anterior pillar erythema) findings. In this study, the evaluation of findings was performed by 2 laryngologists exhibiting an adequate interclass coefficient, which is a strength regarding the overall low interrater reliability outcome in previous reflux studies using the reflux finding score 25,26 …”

Section: Discussionmentioning

confidence: 99%

“…In this study, the evaluation of findings was performed by 2 laryngologists exhibiting an adequate interclass coefficient, which is a strength regarding the overall low interrater reliability outcome in previous reflux studies using the reflux finding score. 25,26 The key role of oral findings is particularly interesting for nonotolaryngologic specialists. Indeed, laryngopharyngeal disease and GERD are prevalent in gastroenterology, pulmonology, and general and internal medicine.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity, Specificity, and Predictive Values of Laryngopharyngeal Reflux Symptoms and Signs in Clinical Practice

Lechien

2022

Otolaryngol.--head neck surg.

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Objective To investigate the sensitivity (SE), specificity (SP), and positive and negative predictive value (PPV and NPV) of symptoms and signs of laryngopharyngeal reflux (LPR). Study Design Prospective controlled. Setting University medical center. Methods Patients presenting with LPR symptoms and signs were consecutively included after diagnosis confirmation through 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance–pH monitoring. Healthy individuals were recruited to compose a control group. Symptoms and signs were evaluated with the reflux symptom score and reflux sign assessment. The SE, SP, PPV, and NPV of symptoms and signs were assessed. Results The study included 403 patients with LPR and 144 healthy individuals. Throat clearing, globus sensation, heartburn, and excess throat mucus were symptoms with the highest SE (67.5%-69.7%), SP (12.5%-20.8%), and NPV (48.3%-49.2%). The combination of throat clearing, heartburn, globus sensation, and excess throat mucus led to a high SE (96.0%) and NPV (85.2%). Anterior pillar erythema, tongue tonsil hypertrophy, and posterior commissure hypertrophy resulted in the highest SE (75.5%-83.5%). The highest SP was found for uvula erythema/edema, epiglottis erythema, and interarytenoid granulatory tissue (97.1%-97.2%). The association of nonendoscopic signs (anterior pillar erythema, uvula erythema/edema, and coated tongue) had an SE and SP of 80.1% and 47.2%, respectively. The association of throat clearing, heartburn, globus, anterior pillar erythema, and uvula erythema/edema had the highest SE (98.8%), SP (33.3%), PPV (94.3%), and NPV (70.6%). Conclusion LPR symptoms and signs reported low SP and NPV. The SE, SP, PPV, and NPV may be maximized with the association of throat clearing, heartburn, globus sensation, anterior pillar erythema, and uvula erythema/edema.

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Inter-Rater Variability of Reflux Finding Score Amongst Otolaryngologists

Cited by 8 publications

References 11 publications

Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility

Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility

A Study of the Diagnostic Value of the Sign and Symptom Questionnaires for Laryngopharyngeal Reflux Disease

Sensitivity, Specificity, and Predictive Values of Laryngopharyngeal Reflux Symptoms and Signs in Clinical Practice

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