title: A comparison of rating scales used in the diagnosis of extraesophageal reflux.
abstract: OBJECTIVE
  To evaluate the level of agreement between reflux area index scores, the reflux symptom index (RSI), and the reflux finding score (RFS). Inter- and intrarater reliability of the RFS was assessed. A criterion of pH 5 was used to evaluate its effects on agreement.
  
  
  METHODS
  Adult participants were enrolled in this prospective study.
  
  
  METHODS
  Eighty-two participants (72 patients and 10 controls) completed the RSI, videoendoscopy, and 24-hour pH probe monitoring. The reflux area index for extraesophageal reflux (EER) events was calculated at pH 4 and 5. Two speech-language pathologists and one otolaryngologist independently rated 36 endoscopic examinations using the RFS through a web-based system. A repeated rating of six examinations was completed.
  
  
  RESULTS
  Chi-square revealed poor agreement between the diagnostic tools, regardless of which pH criterion was used. Intraclass correlation coefficients revealed fair interrater reliability of the RFS and moderate intrarater reliability. Independent-sample t tests for the RFS and reflux area index (RAI) scores failed to identify patients from normal controls.
  
  
  CONCLUSIONS
  The results of this study highlight the lack of agreement among the current available diagnostic tools for EER. Raters were not in agreement regarding the presence and severity of physical findings of EER. Results support the need for greater consensus among the clinical tools used in the diagnosis of EER. Physical rating scales may overidentify patients and would benefit from uniform scales and training. Assessing EER occurring at pH 5 may also yield important diagnostic information. Further research is needed to verify normative RAI cutpoints.
authors.affiliation: Department of Communication Sciences & Disorders, University of Cincinnati, Cincinnati, Ohio, USA. joymusser@yahoo.com
authors.forename: Joy
authors.initials: J
authors.lastname: Musser
authors.forename: Lisa
authors.initials: L
authors.lastname: Kelchner
authors.forename: Jean
authors.initials: J
authors.lastname: Neils-Strunjas
authors.forename: Marshall
authors.initials: M
authors.lastname: Montrose
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D006863:Hydrogen-Ion Concentration; D057045:Laryngopharyngeal Reflux / Q000150:complications / Q000175:diagnosis*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D015588:Observer Variation; D009820:Ohio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014741:Video Recording