(1005) Arytenoid Histologic and Endoscopic Associations

Introduction: Pediatric otolaryngologists frequently conduct microlaryngoscopy and bronchoscopy (MLB) for airway disorders, relying on subjective visual assessments of airway inflammation. While eosinophils and mast cells found at biopsy serve as histologic indicators of inflammation, the correlation between surgeons' subjective ratings of airway inflammation and these indicators requires further characterization.

Methods: A total of 24 patients under the age of 18 who had a MLB with biopsy from 2019-2023 were selected to represent a wide range of histologic inflammation. Additionally, 25 academic otolaryngologists completed a survey to rate airway inflammation for each patient on a scale from 1-5 based on two MLB photographs of the supraglottic and glottic/subglottic airway. The intraclass correlation coefficient method was used to assess interrater reliability. Linear regression was used to quantify the correlation between surgeons' ratings and number of eosinophils and mast cells per high-power field (hpf) on biopsy.

Results: The intraclass coefficient measuring interrater reliability across the 25 surgeons who took the survey was 0.66 (95% CI 0.54 - 0.79). Linear regression comparing surgeons’ ratings of airway inflammation to both eosinophils/hpf and mast cells/hpf had adjusted R² values of 0.003 (p = 0.09) and 0.009 (p = 0.01). For the 14 experienced surgeons surveyed (> 5 years experience and > 5 airway cases/year), the adjusted R² values for eosinophils/hpf and mast cells/hpf were 0.002 (p = 0.2) and 0.009 (p = 0.05).

Conclusions: The surgeons' ratings of airway inflammation showed a moderate to good level of interrater agreement. However, linear regression revealed limited correlation between inflammation ratings and number of eosinophils and/or mast cells on biopsy, even among experienced surgeons. These findings emphasize the complexity of accurately characterizing airway inflammation visually, urging further exploration of the assessment of pediatric airway inflammation. Based on these data, even for experienced surgeons, calling laryngeal inflammation based on endoscopy is akin to a coin flip.