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Multicenter Interrater and Intrarater Reliability in the Endoscopic Evaluation of Velopharyngeal Insufficiency
Kathleen C. Y. Sie, MD;
Jacqueline R. Starr, PhD;
David C. Bloom, MD;
Michael Cunningham, MD;
Lianne M. de Serres, MD;
Amelia F. Drake, MD;
Ravindhra G. Elluru, MD, PhD;
Joseph Haddad Jr, MD;
Christopher Hartnick, MD;
Carol MacArthur, MD;
Henry A. Milczuk, MD;
Harlan R. Muntz, MD;
Jonathan A. Perkins, DO;
Craig Senders, MD;
Marshall E. Smith, MD;
Travis Tollefson, MD;
Jay Paul Willging, MD;
Carlton J. Zdanski, MD
Arch Otolaryngol Head Neck Surg. 2008;134(7):757-763.
Objective To explore interrater and intrarater reliability (R inter and R intra, respectively) of a standardized scale applied to nasoendoscopic assessment of velopharyngeal (VP) function, across multiple centers.
Design Multicenter blinded R inter and R intra study.
Setting Eight academic tertiary care centers.
Participants Sixteen otolaryngologists from 8 centers.
Main Outcome Measures Raters estimated lateral pharyngeal and palatal movement on nasoendoscopic tapes from 50 different patients. Raters were asked to (1) estimate gap size during phonation and (2) note the presence of the Passavant ridge, a midline palatal notch on the nasal surface of the soft palate, and aberrant pulsations. Primary outcome measures were R inter and R intra coefficients for estimated gap size, lateral wall, and palatal movement;  coefficients for the Passavant ridge, a midline palatal notch on the nasal soft palate, and aberrant pulsations were also calculated.
Results The R inter coefficients were 0.63 for estimated gap size, 0.41 for lateral wall movement, and 0.43 for palate movement; corresponding R intra coefficients were 0.86, 0.79, and 0.83, respectively. Interrater values for qualitative features were 0.10 for the Passavant ridge; 0.48 for a notch on the nasal surface of the soft palate, 0.56 for aberrant pulsations, and 0.39 for estimation of gap size.
Conclusions In these data, there was good R intra and fair R inter when using the Golding-Kushner scale for rating VP function based on nasoendoscopy. Estimates of VP gap size demonstrate higher reliability coefficients than total lateral wall, mean palate estimates, and categorical estimate of gap size. The reliability of rating qualitative characteristics (ie, the presence of the Passavant ridge, aberrant pulsations, and notch on the nasal surface of the soft palate) is variable.
Author Affiliations: Division of Pediatric Otolaryngology, Childhood Communication Center, Children's Hospital and Regional Medical Center, Seattle, Washington (Drs Sie and Perkins); Departments of Pediatrics and Epidemiology, Children's Craniofacial Center, Children's Hospital and Regional Medical Center, University of Washington, Seattle (Dr Starr); Eastern Virginia Medical School and Uniformed Services University Health Sciences, Naval Medical Center Portsmouth, Portsmouth (Dr Bloom); Departments of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston (Dr Cunningham and Hartnick), and New York Medical College, Ardsley (Dr de Serres); Division of Pediatric Otolaryngology, Department of Otolaryngology, University of North Carolina, Chapel Hill, School of Medicine, Chapel Hill (Drs Drake and Zdanski); Division of Pediatric Otolaryngology, Children's Hospital Medical Center, Cincinnati, Ohio (Dr Elluru and Willging); Departments of Otolaryngology, Children's Hospital of New York, New York (Dr Haddad), and Oregon Health and Science University, Portland (Drs MacArthur and Milczuk); Division of Otolaryngology, University of Utah, Salt Lake City (Drs Muntz and Smith); and Department of Otolaryngology, University of California, Davis, Sacramento (Drs Senders and Tollefson).
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