Perceptual Evaluation of Severe Pediatric Voice Disorders: Rater Reliability Using the Consensus Auditory Perceptual Evaluation of Voice

The purpose of this nonrandomized prospective study was to quantify the inter- and intrarater reliability of experienced speech-language pathologistʹs perceptual ratings of voice in pediatric patients post-laryngotracheal reconstruction (LTR). Moderate to severe dysphonia is common in this population. Using the sentence portion of theآ Consensus Auditory Perceptual Evaluation-Voice (CAPE-V) rating scale, three experienced speech-language pathologists independently rated randomized voice samples of 50 participants ages 4–20 years, who had acquired or congenital airway conditions requiring at least one LTR on the six salient perceptual vocal attributes. Data collection and listening conditions were carefully controlled. Seventeen (34%) of the samples were randomly selected for rerating at a later time. Estimates of interrater reliability were strongest for perceptual ratings of breathiness (intraclass correlation coefficient [ICC]آ =آ 71%), roughness (ICCآ =آ 68%), pitch (ICCآ =آ 68%), and overall severity (ICCآ =آ 67%). Reliability was lower for ratings of loudness (ICCآ =آ 57%) and strain (ICCآ =آ 35%). For each rater, the intrarater reliability on all but one parameter (strain) was moderate to strong (ICCآ =آ 63–93%). There was a strong interrater eliability for four of six vocal parameters rated using the CAPE-V in a population of children and adolescents with marked dysphonia. The parameter of strain, when rated by auditory sample alone and apart from the clinical context, was difficult to rate.