The Journal of Laryngology & Otology

Main Articles

An endoscopic grading system for vocal process granuloma

D G Farwella1 c1, P C Belafskya1 and C J Reesa1

a1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA

Abstract

Background: A reliable grading system allows the clinician to classify disease severity, monitor progress and evaluate treatment efficacy. There is no currently accepted grading system for vocal process granuloma of the larynx.

Aim: To evaluate the reliability of a new grading system for vocal process granuloma.

Methods: All vocal process granuloma images from a digital laryngeal image library were abstracted. Granulomas were graded on a one to four system, as follows: grade one, sessile, non-ulcerative granuloma limited to vocal process; grade two, pedunculated or ulcerated granuloma limited to vocal process; grade three, granuloma extending past vocal process but not crossing midline of airway in fully abducted position; and grade four, granuloma extending past vocal process and past the midline of the airway in the fully abducted position. The granulomas were additionally graded A if unilateral and B if bilateral. Two laryngologists and two otolaryngology residents rated the granulomas on two separate occasions. Intra- and inter-observer reliability was evaluated with the kappa (κ) test statistic.

Results: Thirty-five vocal process granulomas were identified. The percentage intra-observer agreement for the two laryngologists was 97 and 100 per cent (κ = 0.94 and 1.00, respectively). The percentage inter-observer agreement between the two laryngologists was 91 per cent (κ = 0.83). The percentage intra-observer agreement for the two residents was 89 and 91 per cent (κ = 0.83 and 0.77, respectively). The percentage inter-observer agreement between the two residents was 83 per cent (κ = 0.67).

Conclusions: The proposed grading system for vocal process granuloma displayed excellent intra- and inter-observer reliability among residents and experienced laryngologists.

(Accepted November 19 2007)

(Online publication March 03 2008)

Footnotes

Presented at the American Academy of Otolaryngology Annual Meeting, September, 20 2006, Toronto, Ontario, Canada.

Dr D G Farwell takes responsibility for the integrity of the content of the paper.

Competing interests: None declared