A Standardized Lingual Tonsil Grading System: Interexaminer Agreement

Abstract

Objectives: Comparisons between studies involving the tongue base are limited by the lack of a universal system for grading lingual tonsils. The authors propose a new standardized grading system for lingual tonsil hypertrophy (LTH). Validation was assessed via an interexaminer agreement study. Methods: Video assessment: The proposed grading system consists of a 0 to 4 scale with: 0 = complete absence of lymphoid tissue, 1 = lymphoid tissue scattered over tongue base, 2 = lymphoid tissue covering entirety of the tongue base with limited vertical thickness, 3 = lymphoid tissue 5 to 10 mm in thickness, 4 = lymphoid tissue >1 cm in thickness (above tip of the epiglottis). A teaching video was created to demonstrate identification of this grading system. After viewing the teaching video, 8 trained otolaryngologists graded 25 video clips of the tongue base, recorded during flexible laryngoscopy. Live assessment: A second study was performed by 2 examiners directly examining the tongue base of 23 patients using flexible laryngoscopy during a routine clinic visit. Each examiner viewed and recorded the grade of the lingual tonsils independently. Results: Video assessment: The overall Fleiss kappa statistic was found to be κ = 0.449 ( P < .0001). This value denotes moderate agreement. Live assessment: The overall kappa for nominal data were found to be κ = 0.8665 ( P < .0001). This value denotes perfect agreement. Conclusions: The moderate interexaminer correlation demonstrated during video-assessment, and perfect interexaminer correlation demonstrated during live assessment, indicate that this proposed grading system may be a valuable and useful tool in creating a common language to describe lingual tonsils.