Variability in nomenclature of benign laryngeal pathology based on video laryngoscopy with and without stroboscopy

Objectives: To assess the extent of interobserver variability in the nomenclature of benign laryngeal pathology based on evaluation of video-endoscopies with and without stroboscopy. Design: Eight video clips of benign laryngeal conditions were viewed by 35 non-voice specialist ENT surgeons. The surgeons viewed the clips in groups of varying sizes with no discussion between them and were asked to make only one diagnosis for each lesion. Setting: Specialist voice clinic in the department of ENT at The Royal Sussex County Hospital in Brighton, UK. Participants: Participating ENT surgeons were all either registrars or consultants working at different centres in UK, recruited by the author. None were voice specialists. Main outcome measure: Interobserver agreement was measured using kappa statistics. Results: Variation was widespread with only two of the eight cases (25%) showing agreement of over 75%. Agreement could be analysed statistically as moderate at best (K = 0.5 with a 95% confidence interval from 0.5 to 0.6). The seniority of the laryngologist was also analysed with consultants and senior trainees (specialist registrar years 4-6) having better agreement than junior trainees (specialist registrar years 1-3). Conclusions: The generally accepted optimum treatment for different benign laryngeal pathologies varies substantially. However, our results shows a significant high-level interobserver variability in their diagnosis by non-voice specialists, thus reducing the reliability of outcome data and treatment recommendations. It is therefore important to try and lower this interobserver variability, possibly by widespread use of improved diagnostic technology, stricter/more universally accepted definitions and supervised training of junior doctors in a voice clinic environment.