Consistency in Clinical Reporting of Nasopharyngoscopy Findings: A Multisite Study

Abstract

Velopharyngeal insufficiency (VPI) is caused by incomplete closure of the velum against the posterior pharyngeal wall during phonation and can cause speech to sound hypernasal. One of the most common imaging methods used to assess VPI is nasopharyngoscopy. However, there are inconsistencies in what is being measured and reported in clinical reports. The International Working Group proposed guidelines for the standardization of clinical scope reports, but these guidelines were not universally adopted. This has resulted in inconsistencies in data reported between cleft teams. 148 clinical scope reports were collected and deidentified from 13 cleft teams. Descriptive statistics were used to summarize the proportion of reports that followed the International Working Group’s recommendations. The International Working Group recommended reports include the extent of velar movement, left and right lateral pharyngeal wall (LPW) movement, total percent closure, and the closure pattern. 73.5% (n=109) of reports included the degree of velar movement, 37.8% (n=56) included left and right LPW movement, 73.6% (n=109) reported the total percent closure, and 87.2% (n=129) included the closure pattern. Only 35.1% (n148-52=52) included all four measures. Despite the differences in the measures reported, 65.5% (n=97) of reports recommended a specific surgery to correct the patient’s VPI. The analysis of clinical scope reports revealed variability across cleft teams. Standardizing the information included and how it is reported in scope reports would allow teams to compare treatment outcomes and expanded opportunities for multisite research. By improving consistency in clinical scope reports, cleft teams could increase their quality of patient care.