title: 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.
  
  
  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.
authors.affiliation: 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
authors.forename: Kathleen C Y
authors.initials: KC
authors.lastname: Sie
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Starr
authors.forename: David C
authors.initials: DC
authors.lastname: Bloom
authors.forename: Michael
authors.initials: M
authors.lastname: Cunningham
authors.forename: Lianne M
authors.initials: LM
authors.lastname: de Serres
authors.forename: Amelia F
authors.initials: AF
authors.lastname: Drake
authors.forename: Ravindhra G
authors.initials: RG
authors.lastname: Elluru
authors.forename: Joseph
authors.initials: J
authors.lastname: Haddad
authors.forename: Christopher
authors.initials: C
authors.lastname: Hartnick
authors.forename: Carol
authors.initials: C
authors.lastname: Macarthur
authors.forename: Henry A
authors.initials: HA
authors.lastname: Milczuk
authors.forename: Harlan R
authors.initials: HR
authors.lastname: Muntz
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Perkins
authors.forename: Craig
authors.initials: C
authors.lastname: Senders
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Smith
authors.forename: Travis
authors.initials: T
authors.lastname: Tollefson
authors.forename: Jay Paul
authors.initials: JP
authors.lastname: Willging
authors.forename: Carlton J
authors.initials: CJ
authors.lastname: Zdanski
mesh_terms: 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