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Development and validation of an endoscopic ear surgery classification system.

Michael S Cohen1,2, Razan A Basonbul1,2,3, Samuel R Barber1

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A new classification system for endoscopic ear surgery was developed and validated. The system reliably quantifies endoscope use, showing substantial inter-rater agreement among surgeons and trainees.

Keywords:
Endoscopic ear surgeryclassificationvalidation

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Area of Science:

  • Otolaryngology
  • Surgical Innovation
  • Medical Classification Systems

Background:

  • Endoscopic ear surgery is increasingly utilized.
  • Standardized methods are needed to quantify endoscope utilization during these procedures.
  • Current documentation may lack consistency in describing surgical technique.

Purpose of the Study:

  • To design and validate a novel classification system for endoscopic ear surgery.
  • To quantify the extent of endoscope use in middle ear operations.
  • To assess the reliability of this classification system among various surgical personnel.

Main Methods:

  • A classification system was devised, categorizing endoscope use from microscope-only (Class 0) to full endoscopic (Class 3).
  • Subcategories (2a, 2b) were defined based on the percentage of dissection performed with the endoscope.
  • Fifty operative reports were reviewed by attending surgeons, a resident, and a medical student to assess inter-rater reliability using Weighted Cohen's Kappa.

Main Results:

  • Substantial inter-rater agreement was achieved across different levels of surgical experience.
  • Weighted Kappa values ranged from 0.62 to 0.79, indicating good to excellent agreement.
  • Reliability was demonstrated between attending surgeons, and between attending surgeons and trainees.

Conclusions:

  • The developed classification system is a simple and reliable tool.
  • It effectively describes the degree of endoscope utilization in ear surgery.
  • This system can aid in standardizing surgical reporting and comparative studies.