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Pediatric Otolaryngology

The "Active Larynx": Reliability of Visual Assessments of Laryngeal Inflammation

Sunday, October 1, 2023
5:30 PM - 5:36 PM East Coast USA Time
Location: 207CD

    Presenting Author(s)

  • Michael J. Boutros, BS

    Medical Student
    1. Nationwide Children's Hospital Department of Otolaryngology 2. University of Miami Miller School of Medicine
    Sylvania, OH, United States

    • Co-Author(s)

  • Amy M. Manning, MD

    Assistant Professor
    Nationwide Children's Hospital
    Columbus, Ohio, United States

  • ML

    Meredith N. Lind, MD

    Associate Professor of Otolaryngology
    1. Nationwide Children's Hospital Department of Otolaryngology 2. The Ohio State University College of Medicine
    Columbus, OH, United States

  • TC

    Tendy Chiang, MD

    Assistant Professor
    Nationwide Children's Hospital
    Columbus, Ohio, USA

  • JG

    Jonathan M. Grischkan, MD, MS

    Assoc Prof of Otolaryngology- Head & Neck Surgery
    Nationwide Children's Hospital Department of Otolaryngology
    COLUMBUS, OH, United States

    • Senior Author(s)

  • Prasanth Pattisapu, MD, MPH

    Assistant Professor
    Nationwide Childrens Hospital
    Columbus, Ohio, United States

Disclosure(s):
Michael J. Boutros, BS: No relevant relationships to disclose.
Meredith N. Lind, MD: No relevant relationships to disclose.
Introduction: The term “active larynx” is used by otolaryngologists to describe laryngeal inflammation and can influence timing of airway reconstruction. However, this is a subjective and unvalidated visual assessment. The purpose of this study was to measure the reliability of visual indicators of laryngeal inflammation for later scale development.

Methods: For this IRB-approved study, an image library was created from a direct laryngoscopy and bronchoscopy (DLB) database at a single tertiary pediatric care center. Subjects were asked to rate seven potential characteristics of laryngeal inflammation (edema, erythema, cobblestone appearance, ventricular eversion, nodules, exudate, and crusting) on 5-point Likert scales, as well as the overall “activeness” (10-point scale) and whether laryngeal inflammation would influence their decision for surgery (yes/no). Intraclass correlations with two-way random effects model were used to evaluate interrater reliability and item-test correlations and Cronbach’s alpha were used to test internal consistency.

Results: Three pediatric otolaryngologists reviewed 15 larynges for a total of 45 image-ratings. Intraclass coefficients indicated substantial agreement for edema (0.76) and erythema (0.83) and moderate agreement for ventricular eversion (0.58). All other inflammatory characteristics had low agreement (ICC < 0.20). Agreement was substantial for ratings of “activeness” of the larynx (ICC 0.76) and moderate for whether inflammation would influence delay in reconstructive surgery (ICC 0.47). Item-total correlations ranged from moderate to strong (R = 0.49 to 0.83) for characteristics tested. Cronbach’s alpha for the seven characteristics was 0.76, indicating good internal consistency. However, a limited scale evaluating edema, erythema, and overall degree of activeness had an alpha of 0.85.

Conclusions: In this preliminary study, interrater reliability was variable for characteristics of laryngeal inflammation, but internal consistency was good. Future research will validate measures to guide surgical planning.