title: Perceptual Assessment of Velopharyngeal Dysfunction by Otolaryngology Residents.
abstract: To assess the ability of otolaryngology residents to rate the hypernasal resonance of patients with velopharyngeal dysfunction. We hypothesize that experience (postgraduate year [PGY] level) and training will result in improved ratings of speech samples.
  
  
  
  Prospective cohort study.
  
  
  
  Otolaryngology training programs at 2 academic medical centers.
  
  
  
  Thirty otolaryngology residents (PGY 1-5) were enrolled in the study. All residents rated 30 speech samples at 2 separate times. Half the residents completed a training module between the rating exercises, with the other half serving as a control group. Percentage agreement with the expert rating of each speech sample and intrarater reliability were calculated for each resident. Analysis of covariance was used to model accuracy at session 2.
  
  
  
  The median percentage agreement at session 1 was 53.3% for all residents. At the second session, the median scores were 53.3% for the control group and 60% for the training group, but this difference was not statistically significant. Intrarater reliability was moderate for both groups. Residents were more accurate in their ratings of normal and severely hypernasal speech. There was no correlation between rating accuracy and PGY level. Score at session 1 positively correlated with score at session 2.
  
  
  
  Perceptual training of otolaryngology residents has the potential to improve their ratings of hypernasal speech. Length of time in residency may not be best predictor of perceptual skill. Training modalities incorporating practice with hypernasal speech samples could improve rater skills and should be studied more extensively.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York, USA sydney.butts@downstate.edu.
authors.forename: Sydney C
authors.initials: SC
authors.lastname: Butts
authors.affiliation: College of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Truong
authors.affiliation: College of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Forde
authors.affiliation: Scientific Computing Center, State University of New York Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: Dimitre G
authors.initials: DG
authors.lastname: Stefanov
authors.affiliation: Central New York Cleft and Craniofacial Center, State University of New York Upstate Medical Center, Syracuse, New York, USA.
authors.forename: Eileen
authors.initials: E
authors.lastname: Marrinan
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002648:Child; D002972:Cleft Palate / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D015588:Observer Variation; D010036:Otolaryngology / Q000193:education*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013064:Speech Disorders / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation*; D013068:Speech Production Measurement; D011795:Surveys and Questionnaires; D014481:United States; D014681:Velopharyngeal Insufficiency / Q000534:rehabilitation*; D014833:Voice Quality
keywords: cleft palate; hypernasal resonance; resident education; velopharyngeal dysfunction