title: Evaluation of VPI-assessment with videofluoroscopy and nasoendoscopy.
abstract: The purpose of this study was to investigate how different amounts of visual assessment information influence the recommended treatment for velopharyngeal insufficiency (VPI). Is a patient presented with videofluoroscopy (VF) in lateral projection recommended the same treatment as when frontal projection, nasoendoscopy, or both, are added? Retrospective material with video recorded assessment of VPI was blinded and copied in random order. Each patient was then presented in four separate combinations: VF in lateral projection; VF in lateral and frontal projection; VF in lateral projection and nasoendoscopy; and VF in lateral and frontal projection and nasoendoscopy (all of the available assessment material). The cleft palate team of Göteborg, Sweden, mutually rated velopharyngeal function and recommended action based on the presented material.
  
  
  METHODS
  Nineteen consecutive patients (median age 7:5 years, range 4:4-19:7) investigated with VF in lateral and frontal projection and nasoendoscopy during 1997-99 at the cleft palate centre in Göteborg, Sweden. Post operative assessments were excluded. Percent agreement and Kappa calculations were used to compare the different combinations of parts of information to all of the available information.
  
  
  RESULTS
  Thirteen of the 19 patients (68%) were recommended the same action regardless of the amount of presented information. Percent agreement (Kappa) between parts and all of the available information: VF in lateral projection 84% (0.75), VF in lateral and frontal projection 79% (0.74), and VF in lateral projection and nasoendoscopy 84% (0.72).
  
  
  CONCLUSIONS
  VF in lateral projection is recommended to be the first step in visualising velopharyngeal function, and nasoendoscopy the next when further investigation is required.
authors.affiliation: Department of Logopedics and Phoniatrics, Institute of Selected Clinical Sciences, Sahlgrenska Academy at Göteborg University, SE-405 30 Göteborg, Sweden. christina.havstam@vgregion.se
authors.forename: Christina
authors.initials: C
authors.lastname: Havstam
authors.forename: Anette
authors.initials: A
authors.lastname: Lohmander
authors.forename: Christina
authors.initials: C
authors.lastname: Persson
authors.forename: Hans
authors.initials: H
authors.lastname: Dotevall
authors.forename: Agneta
authors.initials: A
authors.lastname: Lith
authors.forename: Jan
authors.initials: J
authors.lastname: Lilja
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000150:complications; D002972:Cleft Palate / Q000150:complications; D004724:Endoscopy; D005471:Fluoroscopy; D006801:Humans; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis* / Q000209:etiology; D014741:Video Recording