Multicenter Interrater Reliability in the Endoscopic Assessment of Velopharyngeal Function Using a Video Instruction Tool.

OBJECTIVE: Assess interrater agreement of endoscopic assessment of velopharyngeal (VP) function before and after viewing the video instruction tool (VIT). We hypothesized improvement in interrater agreement using the Golding-Kushner scale (GKS) after viewing the VIT. STUDY DESIGN: Prospective study. SETTING: Multi-institutional. METHODS: Sixteen fellowship-trained pediatric otolaryngologists who treat velopharyngeal insufficiency (VPI) rated 50 video segments using the GKS before and after watching the VIT. Raters assessed gap size percentage and lateral pharyngeal wall (LPW), soft palate (SP), and posterior pharyngeal wall (PPW) movement. Intraclass correlation coefficient was estimated for these continuous measures. Raters also indicated the presence of a palatal notch, Passavant's ridge, and aberrant pulsations (categorical variables). Fleiss κ coefficient was used for categorical variables. Wilcoxon signed-rank test was performed on the difference between the pre/post individual video ratings. RESULTS: Reliability improved for all continuous variables after watching the instructional video. The improvement was significant for PPW (0.22-0.30, P < .001), SP (left: 0.63-0.68, P < .001 and right: 0.64-0.68, P = .001), and LPW (left: 0.49-0.54, P = .01 and right: 0.49-0.54, P = .09) but not significant for gap size (0.65-0.69, P = .36). Among categorical variables, agreement on Passavant's ridge significantly improved (0.30-0.36, P = .03). CONCLUSION: Exposure to a video instruction tool improves interrater agreement of endoscopic assessment of VP function. Significant improvement was observed in our primary end points, specifically posterior pharyngeal wall movement, soft palate movement, and lateral pharyngeal wall movement. There was less impact of the VIT on the interrater agreement of the categorical variables, palatal notch, Passavant's ridge, and aberrant pulsations.

Health disparities in pediatric cochlear implantation: an audiologic perspective.

OBJECTIVES: A national survey of pediatric cochlear implantation (PCI) audiologists was conducted with three aims: (1) to determine if PCI audiologists perceive within their clinical practice a negative effect of low socioeconomic status (SES) on postimplant speech and language outcomes; (2) to understand their perceptions of the underlying factors leading to outcome disparities; and (3) to elicit suggestions for improving outcomes in disadvantaged populations. We hypothesized that audiologists would perceive reduced speech and language outcomes within their lower SES patient population, and that this noted disparity would be related to parental adherence (compliance) and access to habilitation. DESIGN: A survey containing 22 quantitative and open-ended questions was electronically mailed to a data base of 234 PCI audiologists. Forty-four percent (N = 103 of 234) responded to the survey, with the majority (98 of 103) answering all questions. Quantitative responses were analyzed using the Stata 9 statistical package with significance at p < 0.05. Qualitative responses were analyzed using standardized codebook and content analysis. Transcripts were read and coded for the main ideas expressed in each response. The codes were then analyzed for patterns and organized into subthemes that were then grouped into themes. RESULTS: Seventy-eight percent (N = 76 of 98) of respondents perceived an effect of SES on postimplant speech and language outcomes. Qualitative responses uniformly demonstrated audiologists' perception that lower SES patient populations were more likely to experience reduced speech and language outcomes. Two major themes emerged in audiologists' explanations of SES-related disparities: internal factors of parental influence (i.e., parental self-efficacy, adherence, and habilitation carryover), and external factors (i.e., inadequate therapy and lack of available resources). Three primary suggestions were offered for reducing the disparity: improvement in cochlear implant services (92%), increased emphasis on parental education and intervention (87%), and the development of stricter candidacy requirements (15%). CONCLUSIONS: This study offers evidence to show that PCI audiologists note an SES-related disparity in the field of PCI. Respondents suggest the need for a broad and culturally sensitive effort to both increase access to qualified healthcare professionals and develop approaches that will aid parents in the at-home habilitation process.