Liu Yi-Chun Carol, McElwee Tyler, Musso Mary, Rosenberg Tara L, Ongkasuwan Julina
Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
Baylor College of Medicine, Houston, TX, USA.
Int J Pediatr Otorhinolaryngol. 2017 Sep;100:157-159. doi: 10.1016/j.ijporl.2017.07.005. Epub 2017 Jul 8.
Flexible nasolaryngoscopy (FNL) is considered the gold standard for evaluation of vocal fold mobility but there has been no data on the reliability of interpretation in the infant population. Visualization may be limited by excessive movement, secretions, or floppy supraglottic structures that prevent accurate diagnosis of vocal fold movement impairment (VFMI). We sought to evaluate the inter- and intra-rater reliability of FNL for the evaluation of VFMI in young infants.
Case-control.
Twenty infants were identified: 10 with VFMI and 10 normal as seen on FNL. Three pediatric otolaryngologists reviewed the video without sound and rated the presence and/or degree of vocal fold mobility. Twelve videos were repeated to assess intra-rater reliability.
There was substantial agreement between the reviewers regarding the identification normal vs. any type of VFMI (kappa = 0.67) but only moderate agreement regarding the degree of vocal fold movement (kappa = 0.49). Intra-rater reliability ranges from moderate to perfect agreement (kappa = 0.48-1).
FNL in infants is an extremely challenging procedure. Clinically, physicians frequently use the quality of the cry and the past medical and surgical history to help make a judgment of vocal fold movement when the view is suboptimal. These other factors, however, may bias the interpretation of the FNL. Without sound, there is only moderate inter-rater and variable intra-rater reliability for the identification of degree of movement on FNL. Otolaryngologists must be cognizant of the limitations of FNL when using it as a clinical tool or as a "gold standard" against which other modalities are measured.
可弯曲鼻咽喉镜检查（FNL）被认为是评估声带活动度的金标准，但尚无关于婴儿群体中解读可靠性的数据。可视化可能会受到过度活动、分泌物或松弛的声门上结构的限制，这些会妨碍对声带运动障碍（VFMI）的准确诊断。我们试图评估FNL在评估幼儿VFMI方面的评分者间和评分者内可靠性。
病例对照研究。
确定了20名婴儿：10名患有VFMI，10名FNL检查显示正常。三名儿科耳鼻喉科医生在不播放声音的情况下查看视频，并对声带活动度的存在和/或程度进行评分。重复查看12个视频以评估评分者内可靠性。
在识别正常与任何类型的VFMI方面， reviewers之间存在高度一致性（kappa = 0.67），但在声带运动程度方面只有中度一致性（kappa = 0.49）。评分者内可靠性范围从中度到完全一致（kappa = 0.48 - 1）。
婴儿的FNL检查是一项极具挑战性的操作。临床上，当视野不佳时，医生经常利用哭声质量以及既往病史和手术史来辅助判断声带运动情况。然而，这些其他因素可能会使FNL的解读产生偏差。在不播放声音的情况下，FNL在识别运动程度方面评分者间只有中度可靠性，评分者内可靠性也存在差异。耳鼻喉科医生在将FNL用作临床工具或作为衡量其他检查方法的“金标准”时，必须认识到其局限性。
