A Novel Grading System for Supraglottic Stenosis Based on Morphology and Functional Status

Steven Aziz, Karla O'Dell, Michael Johns, Josh Schindler, Al Merati, Abdullah Alanazi, Stephanie Watts, David Garber, Rebecca Nelson, Yael Bensoussan

Research output: Contribution to journalArticlepeer-review


Objective: Currently, no classification system exists to grade the severity of supraglottic stenosis. The aim of this investigation was to (1) develop a novel grading system for supraglottic stenosis that can both enhance communication between providers and relay information about patient functional status and (2) determine the reliability of the grading system. Methods: A retrospective analysis of patients with supraglottic stenosis at three institutions from 2010–2021 was conducted. After demographic data were collected, two focus group meetings of five laryngologists were held to develop a grading system based on functional status and morphology of stenosis seen on laryngoscopy. Three laryngologists then used the grading system to rate 20 case examples of supraglottic stenosis. Quadratic-weighted kappa coefficients were calculated to assess inter-rater and intra-rater reliabilities of the novel grading system. Results: Twenty-eight patients were included. Epiglottic and arytenoid fixation were morphological features associated with worse functional outcomes such as requiring a G-tube or a tracheostomy, respectively. Inter-rater reliability was substantial to almost perfect (Kw = 0.79–0.81) and intra-rater reliability was almost perfect for all raters (0.88–1.0) when using the novel grading system. Conclusion: A grading system for supraglottic stenosis has been proposed with strong inter-rater and intra-rater reliabilities. The proposed system has the advantage of being descriptive of both patient functionality and morphology of the stenosis. Level of Evidence: Level 3—According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines, this non-randomized retrospective cohort study is classified as level 3 evidence Laryngoscope, 2022.

Original languageEnglish (US)
StateAccepted/In press - 2022


  • airway
  • classification
  • grading
  • stenosis
  • supraglottic

ASJC Scopus subject areas

  • Otorhinolaryngology


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