{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:24:00Z","timestamp":1760955840233,"version":"build-2065373602"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The term \u201cactive larynx\u201d is a nonspecific and subjective term used by otolaryngologists to describe laryngeal inflammation that can influence the timing of airway reconstruction. We sought to measure the reliability of visual assessments of laryngeal inflammation for later scale development.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>A cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Pediatric tertiary care center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We created an image library from a direct laryngoscopy and bronchoscopy database. Blinded judges were asked to rate the characteristics of laryngeal inflammation (edema, erythema, cobblestoned appearance, and ventricular eversion; 5\u2010point Likert scale), the overall \u201cactiveness\u201d of the larynx (10\u2010point scale), and whether laryngeal inflammation would influence a delay in reconstructive surgery (yes\/no). A tentative scale was also constructed. Intraclass correlations with 2\u2010way random effects, and Fleiss's <jats:italic>\u03ba<\/jats:italic> were used to evaluate interrater reliability. The convergent and discriminant validity of the tentative scale were measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three pediatric otolaryngologists reviewed 15 larynges for a total of 45 image ratings. Intraclass coefficients indicated substantial agreement for edema (0.76) and erythema (0.83) and moderate agreement for ventricular eversion (0.58). Cobblestoning had low agreement (intraclass correlation coefficient [ICC]\u2009&lt;\u20090.20). The agreement was substantial for overall \u201cactiveness\u201d (ICC 0.76) and moderate for whether inflammation would delay surgery (ICC 0.47). By Fleiss's <jats:italic>\u03ba<\/jats:italic>, edema and erythema had moderate agreement (0.50 and 0.61, respectively), whereas all others had poor agreement. The convergent and discriminant validity of the tentative scale were reassuring.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While the reliability of laryngeal inflammation by visual assessment is variable, the creation of an active larynx scale appears feasible.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1155","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T05:23:25Z","timestamp":1739251405000},"page":"1342-1347","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cActive Larynx\u201d: Preliminary Evaluation of the Reliability of Visual Assessments of Laryngeal Inflammation"],"prefix":"10.1002","volume":"172","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6857-2086","authenticated-orcid":false,"given":"Prasanth","family":"Pattisapu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Nationwide Children's Hospital The Ohio State University Columbus Ohio USA"},{"name":"Center for Child Health Equity and Outcomes Research and the Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7385-3103","authenticated-orcid":false,"given":"Amy M.","family":"Manning","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Nationwide Children's Hospital The Ohio State University Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2218-5029","authenticated-orcid":false,"given":"Michael J.","family":"Boutros","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Nationwide Children's Hospital The Ohio State University Columbus Ohio USA"},{"name":"University of Miami Leonard M. Miller School of Medicine Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"McNutt","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Nationwide Children's Hospital The Ohio State University Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1448-5873","authenticated-orcid":false,"given":"Tendy","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Nationwide Children's Hospital The Ohio State University Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8083-3242","authenticated-orcid":false,"given":"Jonathan M.","family":"Grischkan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Nationwide Children's Hospital The Ohio State University Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3399-6495","authenticated-orcid":false,"given":"Meredith N.","family":"Lind","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Nationwide Children's Hospital The Ohio State University Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3082-5535","authenticated-orcid":false,"given":"John F.P.","family":"Bridges","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, College of Medicine The Ohio State University Wexner Medical Center Columbus Ohio 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