title: Inter- and intra-rater reliability of nasal auscultation in daycare children.
abstract: BACKGROUND
  The aim of this study was to assess nasal auscultation's intra- and inter-rater reliability and to analyze ear and respiratory clinical condition according to nasal auscultation.
  
  
  METHODS
  Cross-sectional study performed in 125 children aged up to 3 years old attending daycare centers. Nasal auscultation, tympanometry and Paediatric Respiratory Severity Score (PRSS) were applied to all children. Nasal sounds were classified by an expert panel in order to determine nasal auscultation's intra and inter- rater reliability. The classification of nasal sounds was assessed against tympanometric and PRSS values.
  
  
  RESULTS
  Nasal auscultation revealed substantial inter-rater (K=0.75) and intra-rater (K=0.69; K=0.61 and K=0.72) reliability. Children with a "non-obstructed" classification revealed a lower peak pressure (t=-3.599, P<0.001 in left ear; t=-2.258, P=0.026 in right ear) and a higher compliance (t=-2,728, P=0.007 in left ear; t=-3.830. P<0.001 in right ear) in both ears. There was an association between the classification of sounds and tympanogram types in both ears (X=11.437, P=0.003 in left ear; X=13.535, P=0.001 in right ear). Children with a "non-obstructed" classification had a healthier respiratory condition.
  
  
  CONCLUSIONS
  Nasal auscultation revealed substantial intra- and inter-rater reliability. Nasal auscultation exhibited important differences according to ear and respiratory clinical conditions. Nasal auscultation in pediatrics seems to be an original topic as well as a simple method that can be used to identify early signs of nasopharyngeal obstruction.
authors.affiliation: Department of Physiotherapy, School of Allied Health Sciences of Porto (ESTSP), Polytechnic Institute of Porto (IPP), Vila Nova de Gaia, Portugal - ritasantosft@gmail.com.
authors.forename: Rita
authors.initials: R
authors.lastname: Santos
authors.affiliation: Department of Physiotherapy, School of Allied Health Sciences of Porto (ESTSP), Polytechnic Institute of Porto (IPP), Vila Nova de Gaia, Portugal.|Institute for Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Silva Alexandrino
authors.affiliation: Department of Audiology, School of Allied Health Sciences of Porto (ESTSP), Polytechnic Institute of Porto (IPP), Vila Nova de Gaia, Portugal.
authors.forename: David
authors.initials: D
authors.lastname: Tomé
authors.affiliation: Department of Physiotherapy, School of Allied Health Sciences of Porto (ESTSP), Polytechnic Institute of Porto (IPP), Vila Nova de Gaia, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Melo
authors.affiliation: Department of Physiotherapy, School of Allied Health Sciences of Porto (ESTSP), Polytechnic Institute of Porto (IPP), Vila Nova de Gaia, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Mesquita Montes
authors.affiliation: Department of Physiotherapy, School of Allied Health Sciences of Porto (ESTSP), Polytechnic Institute of Porto (IPP), Vila Nova de Gaia, Portugal.
authors.forename: Daniel
authors.initials: D
authors.lastname: Costa
authors.affiliation: Department of Otorhinolaryngology, Oporto Hospital Center, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Pinto Ferreira
mesh_terms: D000158:Acoustic Impedance Tests / Q000379:methods*; D001314:Auscultation / Q000379:methods*; D002654:Child Care; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004423:Ear; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015508:Nasal Obstruction / Q000175:diagnosis*; D009666:Nose; D015588:Observer Variation; D010865:Pilot Projects; D015203:Reproducibility of Results