title: Interrater Reliability in Analysis of Laryngoscopic Features for Unilateral Vocal Fold Paresis.
abstract: OBJECTIVE
  The diagnosis of paresis in patients with vocal fold motion impairment remains a challenge. In particular, laryngoscopy examination may result in significant disagreement in diagnosis among providers. We hypothesize that systematically evaluating for a standard set of clinical parameters will increase the diagnostic concordance among providers.
  
  
  METHODS
  Prospective case series conducted at a Tertiary referral Laryngology office.
  
  
  METHODS
  Two laryngologists (rater 1) and two trainees (rater 2) rated laryngoscopy findings in 19 patients suspected of paresis. The diagnosis was confirmed with laryngeal electromyogram. A standard set of 27 ratings was used for each examination that included movement, laryngeal configuration, and stroboscopy signs. A kappa coefficient was calculated for agreement in laryngoscopy findings and effectiveness in predicting the laterality of paresis.
  
  
  RESULTS
  A substantial agreement (kappa coefficient > 0.61) existed between the raters for vocal fold length, vocal fold thickness, bowing, and reduction in movement. A moderate agreement (kappa coefficient > 0.41) existed between raters for piriform opening and reduced kinesis. The senior author was accurately able to diagnose the side of paresis in 89.5% of cases for a kappa coefficient of 0.78, whereas the trainees correctly predicted the side of paresis in 63.1% for a kappa coefficient of 0.35. The raters agreed on the diagnosis in 73.7% of cases for a kappa coefficient of 0.50.
  
  
  CONCLUSIONS
  Using a standard set of laryngoscopy findings may improve the provider's ability to identify the laterality of vocal fold paresis and increase interrater reliability compared with other series.
authors.affiliation: Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: tova.fischer@gmail.com.
authors.forename: Tova F
authors.initials: TF
authors.lastname: Isseroff
authors.affiliation: Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Arjun K
authors.initials: AK
authors.lastname: Parasher
authors.affiliation: Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Amanda
authors.initials: A
authors.lastname: Richards
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Sivak
authors.affiliation: Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Peak
authors.initials: P
authors.lastname: Woo
mesh_terms: D001696:Biomechanical Phenomena; D004576:Electromyography; D006801:Humans; D007828:Laryngoscopy; D009519:New York City; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D049489:Stroboscopy; D062606:Tertiary Care Centers; D014826:Vocal Cord Paralysis / Q000175:diagnosis* / Q000503:physiopathology; D014827:Vocal Cords / Q000503:physiopathology*
keywords: Interrater reliability; Laryngoscopy; Stroboscopy; Vocal fold paresis