Multicenter interrater and intrarater reliability in the endoscopic evaluation of velopharyngeal insufficiency.
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.


METHODS
Multicenter blinded R (inter) and R (intra) study.


METHODS
Eight academic tertiary care centers.


METHODS
Sixteen otolaryngologists from 8 centers.


METHODS
Raters estimated lateral pharyngeal and palatal movement on nasoendoscopic tapes from 50 different patients. Raters were asked to (1) estimate gap size during phonation and (2) note the presence of the Passavant ridge, a midline palatal notch on the nasal surface of the soft palate, and aberrant pulsations. Primary outcome measures were R (inter) and R (intra) coefficients for estimated gap size, lateral wall, and palatal movement; kappa coefficients for the Passavant ridge, a midline palatal notch on the nasal soft palate, and aberrant pulsations were also calculated.


RESULTS
The R (inter) coefficients were 0.63 for estimated gap size, 0.41 for lateral wall movement, and 0.43 for palate movement; corresponding R (intra) coefficients were 0.86, 0.79, and 0.83, respectively. Interrater kappa values for qualitative features were 0.10 for the Passavant ridge; 0.48 for a notch on the nasal surface of the soft palate, 0.56 for aberrant pulsations, and 0.39 for estimation of gap size.


CONCLUSIONS
In these data, there was good R (intra) and fair R (inter) when using the Golding-Kushner scale for rating VP function based on nasoendoscopy. Estimates of VP gap size demonstrate higher reliability coefficients than total lateral wall, mean palate estimates, and categorical estimate of gap size. The reliability of rating qualitative characteristics (ie, the presence of the Passavant ridge, aberrant pulsations, and notch on the nasal surface of the soft palate) is variable.
Sie
Kathleen C Y
KC
Division of Pediatric Otolaryngology, Childhood Communication Center, Children's Hospital and Regional Medical Center, PO Box 5371/6E-1, Seattle, WA 98105-0371, USA. kathysie@u.washington.edu
Starr
Jacqueline R
JR
Bloom
David C
DC
Cunningham
Michael
M
de Serres
Lianne M
LM
Drake
Amelia F
AF
Elluru
Ravindhra G
RG
Haddad
Joseph
J
Hartnick
Christopher
C
Macarthur
Carol
C
Milczuk
Henry A
HA
Muntz
Harlan R
HR
Perkins
Jonathan A
JA
Senders
Craig
C
Smith
Marshall E
ME
Tollefson
Travis
T
Willging
Jay Paul
JP
Zdanski
Carlton J
CJ
D004724:Endoscopy; D006801:Humans; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D016037:Single-Blind Method; D014681:Velopharyngeal Insufficiency / Q000145:classification / Q000175:diagnosis*; D014743:Videotape Recording