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Pediatric Otolaryngology

(293) Laryngoscopy Accuracy: Live Physician Recall vs. Post-Exam Video Review

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Avery E. Schnell, BS

    Medical Student
    Tufts University School of Medicine
    Boston, Massachusetts, United States

    • Co-Author(s)

  • MV

    Mark A. Vecchiotti, MD

    Department of Otolaryngology, Tufts Medical Center, USA

  • Alexander P. Marston, MD

    Resident physician
    Department of Otolaryngology, Tufts Medical Center
    Rochester, Minnesota, USA

  • AS

    Andrew R. Scott, MD

    Medical Director, Cleft Lip and Palate Team; Pediatric Otolaryngologist
    Department of Otolaryngology, Tufts Medical Center
    Boston, Massachusetts, United States

    • Senior Author(s)

  • AS

    Andrew R. Scott, MD

    Medical Director, Cleft Lip and Palate Team; Pediatric Otolaryngologist
    Department of Otolaryngology, Tufts Medical Center
    Boston, Massachusetts, United States

Disclosure(s):
Avery E. Schnell, BS: No relevant relationships to disclose.
Mark A. Vecchiotti, MD: No relevant relationships to disclose.
Andrew R. Scott, MD: No relevant relationships to disclose.


Introduction: Children are sent to the Otolaryngology clinic for laryngoscopy, which is done with limited cooperation and may miss subtle findings. This study aims to assess the difference in accuracy and diagnostic yield between real-time physician recall and post-exam video review to determine if recording laryngoscopies should be standardized, especially in young children.

Methods: Recruitment was in the pediatric Otolaryngology clinic at Tufts between 8/2021-5/2022. Eligibility included age 0-18 and a scheduled laryngoscopy. A physician performed laryngoscopy and filled a questionnaire live to identify rhinitis, sinusitis, turbinate hypertrophy, adenoiditis, adenoid hypertrophy, velopharyngeal insufficiency, lingual tonsil hypertrophy, glossoptosis, laryngomalacia, vocal fold nodules, laryngeal edema, and vocal fold immobility. The questionnaire was repeated during video review. Discrepancies between the live and video review were recorded.

Results: 77 eligible patients enrolled from 8/2021-5/2022. 57.1% were age < 6; 42.9% were age >6. Using an independent two-tailed t test, the average discrepancy in age < 6 (1.32+/-1.459) was not significantly different than age >6 (1.09+/-1.234). Post-hoc power analysis was .114 (d=.166, a=.05, N=77). Comparing the physicians, there was a statistically significant difference in discrepancies using one-way ANOVA (p=.021). Using Tukey post hoc test, Dr. A (.65+/-.875) had significantly lower discrepancies than Dr. B (1.69+/-1.635, p=.019). There were no significant differences between Dr. A and Dr. C (1.08+/-1.115, p=.521) or Dr. B and Dr. C (p=.199). Post hoc power analysis was .725 (d=.099, a=.05, N=20, 32, and 25 for Dr. A, B, and C).

Conclusions: There was no significant discrepancy difference between age < 6 and >6. Due to low power, more research can better stratify discrepancies by age. There were significant discrepancy differences amongst physicians, which could inform further research into physician diagnostic accuracy. Overall, data is scarce on the accuracy of laryngoscopy review done live vs. by video, and more data is needed to standardize video review.