A Novel Grading System for Supraglottic Stenosis Based on Morphology and Functional Status

Authors

Steven Aziz, Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A.
Karla O'Dell, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A.
Michael Johns, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A.
Josh Schindler, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A.
Al Merati, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
Abdullah Alanazi, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
Stephanie Watts, Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A.
David Garber, Department of Otolaryngology-Head and Neck Surgery, New York Medical College, Valhalla, New York, U.S.A.
Rebecca Nelson, Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Yael Bensoussan, Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A.

Author Type(s)

Faculty

DOI

10.1002/lary.30371

Journal Title

The Laryngoscope

First Page

1442

Last Page

1447

Document Type

Article

Publication Date

6-1-2023

Department

Otolaryngology

Abstract

OBJECTIVE: Currently, no classification system exists to grade the severity of supraglottic stenosis. The aim of this investigation was to (1) develop a novel grading system for supraglottic stenosis that can both enhance communication between providers and relay information about patient functional status and (2) determine the reliability of the grading system. METHODS: A retrospective analysis of patients with supraglottic stenosis at three institutions from 2010-2021 was conducted. After demographic data were collected, two focus group meetings of five laryngologists were held to develop a grading system based on functional status and morphology of stenosis seen on laryngoscopy. Three laryngologists then used the grading system to rate 20 case examples of supraglottic stenosis. Quadratic-weighted kappa coefficients were calculated to assess inter-rater and intra-rater reliabilities of the novel grading system. RESULTS: Twenty-eight patients were included. Epiglottic and arytenoid fixation were morphological features associated with worse functional outcomes such as requiring a G-tube or a tracheostomy, respectively. Inter-rater reliability was substantial to almost perfect (Kw = 0.79-0.81) and intra-rater reliability was almost perfect for all raters (0.88-1.0) when using the novel grading system. CONCLUSION: A grading system for supraglottic stenosis has been proposed with strong inter-rater and intra-rater reliabilities. The proposed system has the advantage of being descriptive of both patient functionality and morphology of the stenosis. LEVEL OF EVIDENCE: 3-According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines, this non-randomized retrospective cohort study is classified as level 3 evidence Laryngoscope, 133:1442-1447, 2023.

Recommended Citation

Aziz, S., O'Dell, K., Johns, M., Schindler, J., Merati, A., Alanazi, A., Watts, S., Garber, D., Nelson, R., & Bensoussan, Y. (2023). A Novel Grading System for Supraglottic Stenosis Based on Morphology and Functional Status. The Laryngoscope, 133 (6), 1442-1447. https://doi.org/10.1002/lary.30371