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Updated: Dec 10, 2025
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Inter-Rater Variability of Reflux Finding Score Amongst Otolaryngologists
Forsan Jahshan1, Ohad Ronen2, Jamal Qarawany3
1Department of Otolaryngology Head and Neck Surgery, Nottingham University Hospitals NHS Trust, United Kingdom.
Background:
Laryngopharyngeal reflux (LPR) is an extra-oesophageal variant of gastro-oesophgeal reflux disease. Patients often do not present with the classic reflux symptoms of heartburn or regurgitation. Accurate diagnosis of LPR can be challenging. The reflux finding score (RFS) is system based on the assessment of eight parameters seen on fibre optic laryngoscopy, used to determine the presence and the severity of laryngopharyngeal reflux (LPR). Scoring the RFS is subjective and highly dependent on the examiner's eye and experience. In this study, we investigated the inter-rater reliability between three otolaryngologists scoring a large library of video-recorded laryngoscopies for RFS.
Aim:
To evaluate the usefulness of RFS in daily clinical practice by assessing inter-rater reliability among otolaryngologists when interpreting a bank of identical fibre optic laryngoscopy examinations.
Method:
Three board-certified otolaryngologists with different subspecialist interests examined video-recorded fibre optic laryngoscopies of 193 patients with or without LPR symptoms and rated each video for RFS. Statistical analysis was performed. Results were compared to determine the inter-rater reliability.
Results:
Fair to poor correlation was found between the three expert raters for total RFS score, as well as for RFS component items with nonbinary outcomes. For the dichotomous items, the inter-rater reliability was slight to moderate. Inter-rater correlation for determining whether an examination is pathological or nonpathological was fair.
Conclusion:
The RFS alone was not reliable for confirming the diagnosis of LPR, due to low inter-rater reliability and the subjective nature of the scoring system.
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