{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:55:25Z","timestamp":1790002525730,"version":"4.0.1"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,8,7]],"date-time":"2017-08-07T00:00:00Z","timestamp":1502064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To design and validate a classification system for endoscopic ear surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Validation study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A classification system was devised that quantifies use of the endoscope during middle ear surgery. Otologic operative reports were reviewed by attending surgeons and trainees. A power analysis was performed to determine number of cases needed to review. The following categories were used: class 0 is defined by using the microscope only; class 1 describes the use of endoscope for inspection without dissection; and class 2 describes mixed use of the endoscope and the microscope. It is further subdivided into 2a and 2b, where the endoscope is used for less than 50% of dissection and more than 50% of dissection, respectively. Class 3 describes the use of the endoscope for the entire surgery. Fifty cases were reviewed by three attending otologic surgeons, one resident, and one medical student.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Weighted Cohen's Kappa for inter\u2010rater agreement between the two institutional surgeons was 0.79 (95% bias corrected [BC] confidence interval [CI]: 0.58\u20100.93). Agreement between the external surgeon and the two institutional surgeons was 0.77 (95% BC CI: 0.58\u20100.89) and 0.76 (95% BC CI: 0.57\u20100.88). Weighted Kappa between institutional surgeons and a resident was 0.73 (95% BC CI: 0.53\u20100.88) and 0.62 (95% BC CI: 0.38\u20100.80), and between institutional surgeons and a medical student was 0.75 (95% BC CI: 0.56\u20100.89) and 0.70 (95% BC CI: 0.49\u20100.85).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There was substantial inter\u2010rater agreement. This classification system can be used as a simple and reliable tool to describe the extent to which an endoscope was used during ear surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>NA. <jats:italic>Laryngoscope<\/jats:italic>, 128:967\u2013970, 2018<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.26802","type":"journal-article","created":{"date-parts":[[2017,8,7]],"date-time":"2017-08-07T06:52:42Z","timestamp":1502088762000},"page":"967-970","source":"Crossref","is-referenced-by-count":49,"title":["Development and validation of an endoscopic ear surgery classification system"],"prefix":"10.1002","volume":"128","author":[{"given":"Michael S.","family":"Cohen","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary, Boston  Massachusetts"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6045-2768","authenticated-orcid":false,"given":"Razan A.","family":"Basonbul","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary, Boston  Massachusetts"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Faculty of Medicine in Rabigh, King Abdulaziz University Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel R.","family":"Barber","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary, Boston  Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0305-0682","authenticated-orcid":false,"given":"Elliott D.","family":"Kozin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary, Boston  Massachusetts"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro C.","family":"Rivas","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary, Boston  Massachusetts"},{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts 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