2002 Papers - Marathe


Comparison of Live and Stored Digital Image Laryngeal Examinations
Umesh S. Marathe MD, Michael R. Holtel MD, Lawrence P. Burgess MD, Mark J. Syms MD, Deborah Birkmire-Peters Ph.D.
Tripler Army Medical Center

Objectives: Stored digital laryngeal images have the potential to be used to evaluate and triage patients with limited access to otolaryngologists. Prior to the widespread adoption of remote videolarygoscopy for evaluation of laryngeal pathology, the efficacy of evaluating video images needs to be established. We seek to evaluate the interobserver reliability of stored forward digital images compared to live examinations.

Methods: This is a blinded study of 59 patients undergoing videolaryngoscopy in the office setting. All patients had a thorough documented medical history, including a laryngeal complaint questionnaire. Examiners obtained and stored video images of the larynx as .WAV files using the Kay Video strobe. Those patients with one of three diagnoses during real time exam of a normal laryngeal examination, arytenoid erythema/edema or laryngeal mass were entered into the study. Two board certified staff otolaryngologists (OTO1 and OTO2) then reviewed the stored images, first without the clinical history, then with the history. The degree of agreement between live examination and video evaluation was measured.

Results: Level of agreement was measured using kappa. Interobserver agreement between live examination and OTO1 without clinical history kappa was 0.77, with clinical history kappa was 0.79. There was 100% agreement for the diagnosis of laryngeal mass. Interobserver agreement between live examination and OTO2 without clinical history kappa was 0.66, with clinical history kappa was 0.77. There was 95% agreement for the diagnosis of laryngeal mass. All kappa values were statistically significant, p less than 0.001.

Conclusions: The use of stored forward digital laryngeal images shows promise in delayed consultative telemedicine. Interobserver agreement was excellent. The diagnosis of a laryngeal mass, with the greatest imlocations for further evaluation and care, had an interobserver agreement of nearly 100%.