Multicenter interrater and intrarater reliability in the endoscopic evaluation of velopharyngeal insufficiency

Kathleen C.Y. Sie, Jacqueline R. Starr, David C. Bloom, Michael Cunningham, Lianne M. De Serres, Amelia F. Drake, Ravindhra G. Elluru, Joseph Haddad, Christopher Hartnick, Carol MacArthur, Henry A. Milczuk, Harlan R. Muntz, Jonathan A. Perkins, Craig Senders, Marshall E. Smith, Travis Tottefson, Jay Paul Willging, Carlton J. Zdanski

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Objective: To explore interrater and intrarater reliability (R inter and Rintra, respectively) of a standardized scale applied to nasoendoscopic assessment of velopharyngeal (VP) function, across multiple centers. Design: Multicenter blinded Rinter 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 Rinter and Rintra coefficients for estimated gap size, lateral wall, and palatal movement; κ coefficients for the Passavant ridge, a mid- line palatal notch on the nasal soft palate, and aberrant pulsations were also calculated. Results: The Rinter coefficients were 0.63 for estimated gap size, 0.41 for lateral wall movement, and 0.43 for palate movement; corresponding Rintra coefficients were 0.86, 0.79, and 0.83, respectively. Interrater k 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 Rintra 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.

Original languageEnglish (US)
Pages (from-to)757-763
Number of pages7
JournalArchives of Otolaryngology - Head and Neck Surgery
Issue number7
StatePublished - Jul 2008

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


Dive into the research topics of 'Multicenter interrater and intrarater reliability in the endoscopic evaluation of velopharyngeal insufficiency'. Together they form a unique fingerprint.

Cite this