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Development and reliability of the revised Patterson Edema Scale.

Heather M Starmer1, Michael Drinnan2, Mandeep Bhabra3

  • 1Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, CA, USA.

Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
|February 2, 2021
PubMed
Summary

The Revised Patterson Edema Scale improves reliability for measuring laryngeal and pharyngeal edema in head and neck cancer patients. It shows moderate-substantial interrater reliability across most structures, aiding clinical assessment.

Keywords:
flexible laryngoscopyhead and neck cancerlaryngeal edemalymphedema

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Area of Science:

  • Otolaryngology
  • Oncology
  • Speech-Language Pathology

Background:

  • The original Patterson Edema scale (2007) lacked reliability and sensitivity for assessing laryngeal and pharyngeal edema.
  • Head and neck cancer patients often experience edema, impacting swallowing and voice.
  • A reliable scale is crucial for objective assessment and treatment monitoring.

Purpose of the Study:

  • To revise the Patterson Edema Scale for improved reliability and clinical utility.
  • To enhance the assessment of laryngeal and pharyngeal edema in head and neck cancer patients.

Main Methods:

  • Prospective investigation involving a consensus group and expert raters (Speech-Language Pathologists, Otolaryngologists, Radiation Oncologists).
  • Revision of the Patterson scale based on literature review and rater feedback.
  • Interrater reliability assessed using quadratic weighted Kappa on eight laryngeal/pharyngeal parameters.

Main Results:

  • The Revised Patterson Edema Scale demonstrated good interrater agreement for epiglottis, vallecula, arytenoids, and false vocal folds.
  • Moderate agreement was found for aryepiglottic folds, pharyngoepiglottic folds, and pyriform sinuses.
  • Fair agreement was noted for true vocal folds, with suggestions for improved clarity.

Conclusions:

  • The Revised Patterson Edema Scale offers moderate-substantial interrater reliability for most assessed parameters.
  • It serves as a reliable tool for clinicians and researchers evaluating edema in the supraglottic larynx and pharynx.
  • Further refinement may be needed for true vocal fold edema assessment.