Abstract
PurposeLaryngeal electromyography (LEMG) has been considered as gold standard in diagnostics of vocal fold movement impairment, but is still not commonly implemented in clinical routine. Since the signal interpretation of LEMG signals (LEMGs) is often a subjective and semi-quantitative matter, the goal of this study was to evaluate the inter-rater reliability of neurolaryngologists on LEMGs of volitional muscle activity.MethodsFor this study, 52 representative LEMGs of 371 LEMG datasets were selected from a multicenter registry for a blinded evaluation by 7 experienced members of the neurolaryngology working group of the European Laryngological Society (ELS). For the measurement of the observer agreement between two raters, Cohen’s Kappa statistic was calculated. For the interpretation of agreements of diagnoses among the seven examiners, we used the Fleiss’ Kappa statistic.ResultWhen focusing on the categories “no activity”, “single fiber pattern”, and “strongly decreased recruitment pattern”, the inter-rater agreement varied from Cohen’s Kappa values between 0.48 and 0.84, indicating moderate to near-perfect agreement between the rater pairs. Calculating with Fleiss’ Kappa, a value of 0.61 showed good agreement among the seven raters. For the rating categories, the Fleiss’ Kappa value ranged from 0.52 to 0.74, which also showed a good agreement.ConclusionA good inter-rater agreement between the participating neurolaryngologists was achieved in the interpretation of LEMGs. More instructional courses should be offered to broadly implement LEMG as a reliable diagnostic tool in evaluating vocal fold movement disorders in clinical routine and to develop future algorithms for therapy and computer-assisted examination.
Highlights
In 1944, Weddell et al [1] introduced the laryngeal electromyography (LEMG)
During the 1980s and 1990s, diagnosis and treatment of voice disorders have been described using various tools based on laryngeal LEMG
Similar result was presented for Europe by Volk et al [10], with only 3.6% of the responding that LEMG is the most important
Summary
In 1944, Weddell et al [1] introduced the laryngeal electromyography (LEMG). During the 1980s and 1990s, diagnosis and treatment of voice disorders have been described using various tools based on laryngeal LEMG. In most ENT or phoniatric departments LEMG is still not commonly used in clinical routine. Clinicians still mainly use laryngoscopy and stroboscopy for diagnosing vocal fold paralysis/paresis. According to Wu et al [9], only 1.7% of the otolaryngologists responded to use LEMG for the diagnosis of vocal fold paresis (VFP) in the US. Similar result was presented for Europe by Volk et al [10], with only 3.6% of the responding that LEMG is the most important
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