title: Eustachian Tube Mucosal Inflammation Scale Validation Based on Digital Video Images.
abstract: BACKGROUND
  The most common cause for Eustachian tube dilatory dysfunction is mucosal inflammation. The aim of this study was to validate a scale for Eustachian tube mucosal inflammation, based on digital video clips obtained during diagnostic rigid endoscopy.
  
  
  METHODS
  A previously described four-step scale for grading the degree of inflammation of the mucosa of the Eustachian tube lumen was used for this validation study. A tutorial for use of the scale, including static images and 10 second video clips, was presented to 26 clinicians with various levels of experience. Each clinician then reviewed 35 short digital video samples of Eustachian tubes from patients and rated the degree of inflammation. A subset of the clinicians performed a second rating of the same video clips at a subsequent time. Statistical analysis of the ratings provided inter- and intrarater reliability scores.
  
  
  RESULTS
  Twenty-six clinicians with various levels of experience rated a total of 35 videos. Thirteen clinicians rated the videos twice. The overall correlation coefficient for the rating of inflammation severity was relatively good (0.74, 95% confidence interval, 0.72-0.76). The intralevel correlation coefficient for intrarater reliability was high (0.86). For those who rated videos twice, the intralevel correlation coefficient improved after the first rating (0.73, to 0.76), but improvement was not statistically significant.
  
  
  CONCLUSIONS
  The inflammation scale used for Eustachian tube mucosal inflammation is reliable and this scale can be used with a high level of consistency by clinicians with various levels of experience.
authors.affiliation: *Department of Otorhinolaryngology, Tampere University Hospital and the University of Tampere, Tampere, Finland †Department of Otolaryngology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A. ‡Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kivekäs
authors.forename: Leena
authors.initials: L
authors.lastname: Pöyhönen
authors.forename: Antti
authors.initials: A
authors.lastname: Aarnisalo
authors.forename: Markus
authors.initials: M
authors.lastname: Rautiainen
authors.forename: Dennis
authors.initials: D
authors.lastname: Poe
mesh_terms: D000328:Adult; D004427:Ear Diseases / Q000175:diagnosis*; D004724:Endoscopy / Q000379:methods; D005064:Eustachian Tube / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D015588:Observer Variation; D010036:Otolaryngology / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014741:Video Recording