Reliability of Flexible Fiberoptic Nasopharyngoscopy for Evaluation of Velpharyngeal Function in Clinical Population

Abstract

Flexible fiberoptic nasopharyngoscopy (FFN) has become a popular clinical tool for evaluating velopharyngeal function. The literature contains numerous reports of FFN methodology and findings. However, there are few published reports that address clinical rating and reporting schemes or that evaluate viewer reliability. This study was designed to evaluate the reliability of visual perceptual ratings of FFN video images for assessing velopharyngeal structure and function in a clinical population. Ninety-five videotaped clinical evaluations were presented to and judged by three expert raters and nine novice raters from the fields of speech pathology, otolaryngology, and plastic surgery, using a standard rating form. A clinical rating scheme was used for quantifying perceptual judgments of velopharyngeal activity. Results suggest that videotaped FFN evaluations may be rated reliably, that expert raters working as a group are more reliable than novice raters working individually, and that the 125 evaluations presented without feedback are insufficient to improve the novices' reliability. The combined auditory and visual perceptual evaluation inherent in FFN may be its most significant asset for both clinical and research applications. Flexible fiberoptic nasopharyngoscopy allows direct transnasal observation of the anatomy and dynamic activity of the velopharyngeal sphincter. Such observations can be recorded for permanent documentation by coupling FFN to a videocamera with simultaneous audio recording. Numerous published reports discuss the advantages of FFN as a clinical method for evaluating velopharyngeal function during speech (