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 pathologist's 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 the 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] = 71%), roughness (ICC = 68%), pitch (ICC = 68%), and overall severity (ICC = 67%). Reliability was lower for ratings of loudness (ICC = 57%) and strain (ICC = 35%). For each rater, the intrarater reliability on all but one parameter (strain) was moderate to strong (ICC = 63-93%). There was a strong interrater reliability 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.