Objective: Unlike glottic and subglottic stenosis, there is no classification system 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 reliability of the rating scale.
Methods: A retrospective review of patients with supraglottic stenosis at three institutions from 2010-2021 was conducted. After demographic data was 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. Interrater and intrarater reliability was assessed using quadratic weighted kappa coefficients.
Results: 30 patients were included. Epiglottis fixation and extension into glottis and/or subglottis were features associated with worse patient functional status. A grading system was developed: grade 1- involvement of <2 supraglottic structures without dysphagia/dyspnea; grade 2- mild dysphagia/dyspnea or involvement of ≥2 supraglottic structures; grade 3- moderate dysphagia/dyspnea or fixation of epiglottis or glottic/subglottic involvement; grade 4- severe functional impairment (+/- Trach (T), G-tube (G) or both (TG). Interrater reliability was substantial to almost perfect (Kw = 0.79-0.81). Intrarater reliability was almost perfect for all raters (0.88-1.0).
Conclusion: A grading system for supraglottic stenosis has been proposed with strong interrater and intrarater reliability. The proposed system has the advantage of being descriptive of both patient functionality and morphology of the stenosis.