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Purpose  This study aims to analyse differences in fiberoptic laryngoscopy (FOL) versus high definition laryngoscopy (HDL) by examining videolaryngoscopy images by a large group of observers with different levels of clinical expertise in ear, nose and throat (ENT) medicine.    Methods  This study is a 111 observer paired analysis of laryngoscopy videos during an interactive presentation. During a National Meeting of the Dutch Society of ENT/Head and Neck Surgery, observers assessed both FOL and HDL videos of nine cases with additional clinical information. Observers included 41 ENT consultants (36.9%), 34 ENT residents (30.6%), 22 researchers with Head and Neck interest (19.8%) and 14 with unspecified clinical expertise (12.6%). For both laryngoscopic techniques, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were determined for identifying a normal glottis, hyperkeratosis, radiotherapy adverse effects and squamous cell carcinoma. The sensitivities for FOL and HDL were analysed with regard to the different levels of clinical expertise.    Results  The overall sensitivity for correctly identifying the specific histological entity was higher in HDL (FOL 61% vs HDL 66.3%,  p  < 0.05). HDL was superior to FOL in identifying a normal glottis (FOL 68.1% vs HDL 91.6%,  p  < 0.01) and squamous cell carcinoma (FOL 70.86% vs HDL 79.41%,  p  = 0.02). Residents and researchers with Head and Neck interest diagnosed laryngeal lesions more correctly with HDL ( p  < 0.05).    Conclusions  In a large population of observers with different levels of clinical expertise, HDL is superior to FOL in identifying laryngeal lesions.

High-definition videolaryngoscopy is superior to fiberoptic laryngoscopy: a 111 multi-observer study