Multicenter Interrater and Intrarater Reliability in the Endoscopic Evaluation of Velopharyngeal Insufficiency

Abstract

Objective: To explore interrater and intrarater reliability (R inter and R intra , respectively) of a standardized scale applied to nasoendoscopic assessment of velopharyngeal (VP) function, across multiple centers. Design: Multicenter blinded R inter and R intra study.

Revisional surgery following the superiorly based posterior pharyngeal wall flap. Historical perspectives and current considerations

“…The interpretation of imaging techniques, such as (video)fluorography and (video)endoscopy, is subjective 30,31 . Skolnick and Cohn 31 state that the conduct and interpretation of videofluoroscopic studies are as much an art as a science.…”

“…Skolnick and Cohn 31 state that the conduct and interpretation of videofluoroscopic studies are as much an art as a science. Sie et al 30 argue that in the absence of an objective, quantifiable measure of VP function, it is important to understand the reliability of clinical tools used in the treatment of patients with VPI. In their study on reliability in the endoscopic evaluation of VPI, they found that the inter-observer reliability of rating qualitative characteristics is variable and is too low to be used for comparing subjects across centres.…”

“…Most authors agree that perceptual evaluation serves as the gold standard against which instrumental measurements must be validated. Until now, the trained ear has been the primary tool for determining the presence and severity of VPI 30 and is the final arbiter on determining the functional result with regard to nasal resonance.…”

“…Encouraging results have been obtained, but the interpretation of such imaging is subjective 30,31 . As an alternative, the incidence of revisional surgery can be used as a measure of the functional outcome of SBPP surgery 8,19,23 .…”

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

“…Items rated in this scale include right and left lateral pharyngeal wall movement, right and left palate movement and elevation, posterior pharyngeal wall movement, and estimate of gap size. Given that endoscopy cannot absolutely measure the distance of movements, the scale system has some limitations [ 17 ] . The clinician should position the scope in the nasopharynx adjacent to the vomer bone to view velar function.…”