Multi-institutional Validation of the Interarytenoid Assessment Protocol for Pediatric Laryngeal Cleft

Jennifer M Siu; Shaunak Amin; Evan J Propst; Nikolaus E Wolter; Jeremy Prager; Michelle Wyatt; Claire Lawlor; Douglas Sidell; Deepak Mehta; Reema Padia; Nicholas Smith; Christopher Hartnick; Catherine K Hart; Xing Wang; Kaalan Johnson

doi:10.1002/lary.31866

Multi-institutional Validation of the Interarytenoid Assessment Protocol for Pediatric Laryngeal Cleft

Laryngoscope. 2024 Nov 13. doi: 10.1002/lary.31866. Online ahead of print.

Authors

Jennifer M Siu^{1

2}, Shaunak Amin^{2

3}, Evan J Propst¹, Nikolaus E Wolter¹, Jeremy Prager⁴, Michelle Wyatt⁵, Claire Lawlor⁶, Douglas Sidell⁷, Deepak Mehta⁸, Reema Padia⁹, Nicholas Smith¹⁰, Christopher Hartnick¹¹, Catherine K Hart¹², Xing Wang^{1

3}, Kaalan Johnson^{2

3}

Affiliations

¹ Division of Pediatric Otolaryngology - Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, U.S.A.
² Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.
³ Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
⁴ Division of Pediatric Otolaryngology - Head & Neck Surgery, Children's Hospital Colorado, Aurora, Colorado, U.S.A.
⁵ Division of Pediatric Otolaryngology - Head & Neck Surgery, Great Ormond Street Hospital, London, UK.
⁶ Division of Pediatric Otolaryngology - Head & Neck Surgery, Children's National Health Center, Washington, DC, U.S.A.
⁷ Division of Pediatric Otolaryngology - Head & Neck Surgery, Stanford Pediatric Aerodigestive Center, Palo Alto, California, U.S.A.
⁸ Division of Pediatric Otolaryngology - Head & Neck Surgery, Texas Children's Hospital, Houston, Texas, U.S.A.
⁹ Division of Pediatric Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
¹⁰ Division of Otolaryngology - Head and Neck Surgery, Children's of Alabama, Birmingham, Alabama, U.S.A.
¹¹ Division of Pediatric Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.
¹² Division of Pediatric Otolaryngology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.

PMID: 39539104
DOI: 10.1002/lary.31866

Abstract

Background: Current assessment techniques for determining whether a patient has normal interarytenoid anatomy, a deep interarytenoid notch, or a minor laryngeal cleft are highly variable. However, differentiating between these three entities is important, given it may distinguish whether a patient should be considered for surgical intervention. The Interarytenoid Assessment Protocol (IAAP) was developed to provide standardization of interarytenoid anatomy evaluations. We aimed to assess the reliability of the IAAP for assessment of interaytenoid mucosal height (IAMH) through a multi-institutional validation study.

Methods: Reliability of the IAAP was assessed by 10 pediatric otolaryngologists all from different academic centers. 30 de-identified endoscopic videos of interarytenoid assessments were rated at two separate time points, 2 months apart. Intra-class correlation (ICC) coefficients with two-way models were used to evaluate inter- and intra-rater reliability.

Results: Thirty endoscopic videos were collected for patients with a median (IQR) age of 4.9 years (59 months; range: 1 month to 20 years). On the first video assessment, inter-rater reliability was 0.74 (95% CI 0.63-0.84), and on the second video assessment, inter-rater reliability was 0.75 (95% CI 0.63-0.85) indicating strong inter-rater reliability. Overall intra-rater test-retest reliability was 0.75 (95% CI 0.69-0.79) indicating strong agreement. In almost half, 14 (46.6%) raters chose IAAP classification levels within 1 level of each other.

Conclusions: Multi-institutional validation of the IAAP demonstrates strong inter- and intra-rater reliability for assessment of IAMH when evaluated through pictorial analysis. Standardization of anatomical evaluations may improve our ability to perform more reliable outcomes studies of pediatric pharyngeal dysphagia in the future.

Level of evidence: NA Laryngoscope, 2024.

Keywords: deep interarytenoid notch; interarytenoid anatomy; laryngeal cleft.

Grants and funding

T32DC000018/DC/NIDCD NIH HHS/United States