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Proposed Classification System for Office-based Blue Laser Tissue Effect in Reinke's Edema
Abdul-Latif Hamdan1, Jerome R Lechien2, Patrick Abou Raji Feghali1
1Department of Otolaryngology - Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Objective:
To describe a new classification system for blue laser-induced tissue effect in Reinke's edema (RE).
Method:
All video recordings of patients with RE who had undergone office-based blue laser therapy between October 2022 and May 2026 were reviewed, and a total of 16 video clips were selected to include the different types of tissue effects observed. Each video clip included a short segment showing part of the laser procedure and the immediate posttreatment tissue effect. The compiled video recordings were blindly rated by three board-certified laryngologists based on a 4-point proposed classification; Blanching of the mucosa with or without angiolysis (RE-BLL1); Blanching of the mucosa with epithelial disruption or violation (RE-BLL2); Epithelial disruption with submucosal tissue ablation/evaporation (RE-BLL3), and Epithelial disruption with submucosal tissue extraction/removal (RE-BLL4).
Results:
The overall agreement in rating among the three reviewers was 96.7% (58 of 60 ratings). The agreement in rating RE-BLL1 tokens was 100% (15 of 15 ratings), 93.3% for RE-BLL2 tokens (14 of 15 ratings), 93.3% for RE-BLL3 tokens (14 of 15 ratings), and 100% for RE-BLL4 tokens (15 of 15 ratings). All reviewers demonstrated 100% intra-rater agreement with their own classification of the unidentified repeated recordings. Inter-rater reliability among the three blinded reviewers was excellent. Using a two-way mixed-effects model with absolute agreement, the single-measure ICC was 0.975 (95% CI: 0.948-0.989), indicating excellent reliability of an individual reviewer's grading. The average-measure ICC was 0.991 (95% CI: 0.982-0.996), indicating excellent reliability when the three reviewers' scores were considered together.
Conclusion:
The proposed 4-point classification system for tissue effects of blue laser treatment of RE had an excellent inter-rater and intra-rater reliability. By standardizing the description of the blue laser-induced tissue effect in RE, this classification could help improve consistent communication among laryngologists and other voice care providers.
