title: A standardized lingual tonsil grading system: interexaminer agreement.
abstract: OBJECTIVE
  Comparisons among studies involving the tongue base are limited by lack of a universal system for grading lingual tonsils. The authors propose a new standardized clinical grading system for lingual tonsil hypertrophy (LTH). Validation was assessed via an interexaminer agreement study.
  
  
  METHODS
  Kappa interrater agreement study.
  
  
  METHODS
  Tertiary academic center.
  
  
  METHODS
  Video assessment: The proposed grading system consists of a 0-to-4 scale: 0 = complete absence of lymphoid tissue; 1 = lymphoid tissue scattered over tongue base; 2 = lymphoid tissue covering entirety of tongue base with limited vertical thickness; 3 = significantly raised lymphoid tissue covering entirety of the tongue base, approximately 5 to 10 mm in thickness; 4 = lymphoid tissue rising above the tip of the epiglottis, ≥1 cm in thickness. The vertical height of the tonsils is a clinical approximate. A teaching video demonstrated identification of this grading system. Fourteen trained otolaryngologists graded 20 video clips of the tongue base, recorded during flexible laryngoscopy. Live assessment: A second study was performed by 2 examiners directly examining the tongue base of 23 patients using flexible laryngoscopy.
  
  
  RESULTS
  Video assessment: The overall Fleiss kappa statistic was 0.775 (P < .0001). This denotes substantial agreement. Live assessment: The overall kappa for nominal data was 0.8665 (P < .0001). This denotes near perfect agreement.
  
  
  CONCLUSIONS
  The substantial interexaminer correlation demonstrated during video assessment and perfect interexaminer correlation in live assessment indicate that the proposed grading system may be a valuable and useful tool in creating a common language to describe lingual tonsils.
authors: Rush University Medical Center, Chicago, Illinois, USA Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA mfriedman@chicagoent.com.
authors: Michael
authors: M
authors: Friedman
authors: Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors: Sreeya
authors: S
authors: Yalamanchali
authors: Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
authors: Gleb
authors: G
authors: Gorelick
authors: Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
authors: Ninos J
authors: NJ
authors: Joseph
authors: Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
authors: Michelle S
authors: MS
authors: Hwang
mesh_terms: D006801:Humans; D006984:Hypertrophy; D007828:Laryngoscopy; D008221:Lymphoid Tissue / Q000473:pathology; D015588:Observer Variation; D014066:Palatine Tonsil / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014059:Tongue
keywords: lingual tonsil hypertrophy; standardized grading system