Vocal cord movement: can it be accurately graded?

Area of Science:

• Otolaryngology
• Diagnostic Imaging
• Vocal Cord Physiology

Background:

• Flexible nasendoscopy (FNE) is the primary method for assessing vocal cord movement.
• The subjective nature of FNE may limit the reliability of vocal cord movement grading by clinicians.

Purpose of the Study:

• To evaluate the accuracy and consistency of grading vocal cord movement observed during FNE.
• To compare the reliability of a five-category scale versus a three-category scale for vocal cord movement assessment.

Main Methods:

• Six head and neck surgeons assessed 30 FNE videos independently.
• Vocal cord movement was graded using a five-category scale, repeated three times.
• Inter-rater and intra-rater agreement and reliability were analyzed.

Main Results:

• Using a five-category scale, mean inter-rater agreement was 67.7% and intra-rater agreement was 78.3%.
• A derived three-category scale significantly improved mean inter-rater agreement to 91.4% and intra-rater agreement to 93.1%.
• Vocal cord motion discrimination was more reliable with the three-category scale (k=0.68) than the five-category scale (k=0.52).

Conclusions:

• Accurate and consistent grading of subtle vocal cord movement differences via FNE is difficult.
• A three-category scale enhances agreement and reliability compared to a five-category scale.
• There is a need for objective measures to aid in vocal cord movement assessment.