{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:37:30Z","timestamp":1785454650905,"version":"3.56.0"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The key exam finding in the diagnosis of paradoxical vocal fold motion (PVFM) is visualization of adduction of the true vocal folds during inspiration on laryngoscopy. This study aims to assess the reliability of visualizing PVFM on laryngoscopic exam.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Laryngoscopic exams of 60 patients being evaluated for PVFM were rated by 13 individual otolaryngologists at 2 different timepoints, 1\u2009month apart. At the second timepoint, half of the exams were accompanied by a clinical history potentially suggestive of PVFM. Raters were asked to determine whether patients exhibited PVFM on the video shown, the degree of adduction of the vocal folds (complete, partial, or none), and the level of certainty with the diagnosis. Inter\u2010rater and intra\u2010rater reliability were calculated using Fleiss' and Cohen's kappa, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Interpretation of the presence of PVFM was quite variable. There was only fair inter\u2010rater reliability (Fleiss' kappa\u2009=\u20090.36 at Timepoint 1 and 0.34 at Timepoint 2) and moderate to fair intra\u2010rater reliability (median Cohen's kappa\u2009=\u20090.47 for videos without clinical history and 0.36 for videos shown with clinical histories). Ratings on degree of adduction were quite heterogeneous.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Though laryngoscopic findings of PVFM are the gold standard physical exam finding in support of diagnosis, only fair agreement was found when raters assessed laryngoscopy recordings for PVFM. Intra\u2010rater reliability was also quite varied. Improvement in assessment of vocal fold function and understanding the role of clinical history in diagnosis may improve the care of patients with suspected PVFM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.32367","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T06:28:12Z","timestamp":1750832892000},"page":"3748-3755","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Now You See It, Now You Don't: Laryngoscopy Findings of Paradoxical Vocal Fold Motion"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6840-6283","authenticated-orcid":false,"given":"William","family":"Strober","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Washington University School of Medicine in St Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3927-3984","authenticated-orcid":false,"given":"Matthew R.","family":"Naunheim","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8744-4098","authenticated-orcid":false,"given":"Matthew L.","family":"Rohlfing","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Washington University School of Medicine in St Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorina","family":"Kallogjeri","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Washington University School of Medicine in St Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay F.","family":"Piccirillo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Washington University School of Medicine in St Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3857-5315","authenticated-orcid":false,"given":"Molly N.","family":"Huston","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Washington University School of Medicine in St Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2014.10.003"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2004.01.003"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2013.08.014"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iac.2019.07.008"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1044\/2015_AJSLP-14-0120"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2006.052522"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200206000-00016"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2015.12.009"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20945"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00070-2017"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28081"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0892-1997(05)80227-9"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/001316447303300309"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/001316446002000104"},{"key":"e_1_2_8_17_1","volume-title":"Rank Correlation Methods","author":"Kendall M. 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