The effect of anchors on reliability of endoscopic tremor ratings.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to determine the effects of anchors and training on intrarater and inter-rater reliability for visual-perceptual, endoscopic tremor ratings. STUDY DESIGN: Prospective cohort study. METHODS: Nasoendoscopy recordings of 10 participants with a diagnosis of essential voice tremor were evaluated by five voice specialists using the Vocal Tremor Scoring System. Ratings were performed before, immediately after, and 4 weeks after implementation of a training program with anchor stimuli. Immediate and long-term post-training ratings were performed with simultaneous use of anchor samples for each rating. RESULTS: Intrarater reliability showed significant improvement from pretraining to immediate and long-term post-training. Mean correlation coefficients (Spearman's rho) increased from 0.71 at pretraining to 0.84 and 0.90 at immediate and long-term post-training, respectively. Inter-rater reliability was not affected by training with anchors, with mean correlation coefficients ranging from 0.62 at pretraining to 0.58 and 0.64 at immediate and long-term post-training, respectively. CONCLUSIONS: Consistent, reproducible ratings are critical for the interpretation and comparison of endoscopic tremor data. Reliability findings from this study indicate that the use of anchor samples as referents for making ordinal judgments about the severity of tremor in oropharyngeal and laryngeal regions was helpful for improving internal standards and consistency but less useful for calibrating across different raters. LEVEL OF EVIDENCE: 4 Laryngoscope, 2016 127:411-416, 2017.

Determining cochlear implant users' true noise tolerance: use of speech reception threshold in noise testing.

OBJECTIVE: The speech perception abilities of cochlear implant (CI) recipients have significantly improved over the past decade. At the same time, clinical test batteries to measure their performance in noise remain mostly unchanged, resulting in ceiling-level performance for the most successful recipients. The goal of this study is to determine the true noise tolerance abilities of CI recipients using adaptive speech reception threshold (SRT) in noise testing. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary care hospital; CI program. PATIENTS: Ten CI users, either unilateral or bilateral, with HINT scores that equaled or exceeded 80% when administered with a fixed +10 dB signal-to-noise (SNR) ratio (i.e., HINT(+10dB)). INTERVENTION: The HINT with adaptive SNR levels and QuickSIN test were administered to measure noise tolerance at speech thresholds where 50% of the stimuli were correctly perceived. MAIN OUTCOME MEASURE(S): SRTs were measured for both the adaptive SNR HINT (i.e., HINT(50%)) and the QuickSIN test. These SRTs were compared with the fixed noise level HINT(+10dB) scores as well as to CNC monosyllable word perception scores. RESULTS: Despite small variance in performance levels on the HINT(+10dB), results of the HINT(50%) (∼16 dB range) and QuickSIN (∼12 dB range) tests demonstrate significant differences in noise tolerance levels among these CI recipients. CONCLUSION: For excellent CI users, use of adaptive speech threshold tests in noise better defines a user's actual ability to perceive speech than do fixed SNR level tests. SRT-in-noise tests have the advantage of being quick to administer, and the same stimuli can be used over a very wide range of performance levels. The use of adaptive SRT-in-noise tests should be considered a viable and valuable replacement of fixed SNR tests in the CI clinical test battery.