{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:54:45Z","timestamp":1791968085907,"version":"4.3.4"},"reference-count":42,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,8,26]],"date-time":"2017-08-26T00:00:00Z","timestamp":1503705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["K08HS022932"],"award-info":[{"award-number":["K08HS022932"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Tympanostomy tube (TT) placement is common in children; however, family\u2010centeredness and utility of online information used for decision making and understanding is unknown. We evaluate the quality of leading Internet resources describing TT placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Cross\u2010sectional descriptive design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a Google (Menlo Park, CA) search for terms related to TTs. We defined quality using scaled readability measures (Flesch Reading Ease and Flesch\u2010Kincaid Grade\u2010Level), understandability and actionability (Patient Education Materials Assessment Tool), shared decision\u2010making centrality (Center for Medicare and Medicaid Services informed consent guidelines), and clinical practice guideline (CPG) compatibility. Three reviewers coded each measure. Fleiss \u03ba interrater reliability analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ten most frequently encountered websites were analyzed. One of 10 met national health literacy standards (mean 10th\u2010grade level reading, median 9th, range 6\u201315th). All sites were understandable (mean understandability 81.9%, range 73%\u201392%). Most had low actionability scores (7 of 10, median 47%, mean 44.6%, range 0\u201380). Shared decision\u2010making centrality was high (mean 5, range 4\u20136), but most did not list alternative treatment options. Although CPG compatibility was high (mean 3.4, range 1\u20134), many websites contained inconsistent recommendations about tube duration, follow\u2010up, and water precautions. There was inter\u2010rater agreement for understandability scoring (\u03ba = 0.20;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Internet resources about TT placement vary in quality pertaining to health literacy, principles of shared decision making, and consistency with practice guidelines. With growing emphasis on patient\u2010\/family\u2010centered engagement in healthcare decision making, standardization of content and improved usability of educational materials for common surgical procedures in children such as tympanostomy tube placement should be a public health priority.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      NA.\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 128:496\u2013501, 2018\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.26824","type":"journal-article","created":{"date-parts":[[2017,8,26]],"date-time":"2017-08-26T06:36:38Z","timestamp":1503729398000},"page":"496-501","source":"Crossref","is-referenced-by-count":37,"title":["Consulting\n                    <scp>D<\/scp>\n                    r.\n                    <scp>G<\/scp>\n                    oogle: Quality of Online Resources About Tympanostomy Tube Placement"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8741-756X","authenticated-orcid":false,"given":"Vandra C.","family":"Harris","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne R.","family":"Links","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8766-3266","authenticated-orcid":false,"given":"Paul","family":"Hong","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2013Head and Neck Surgery, Department of Surgery Dalhousie University Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desi P.","family":"Schoo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Tunkel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles M.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily F.","family":"Boss","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."},{"name":"Department of Health Policy and Management Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,8,26]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"S1","article-title":"clinical practice guideline: tympanostomy tubes","volume":"149","author":"Rosenfeld RM","year":"2013","journal-title":"Otolaryngol Head and Neck Surg"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2016.04.034"},{"key":"e_1_2_6_4_1","unstructured":"FoxS DugganM.Health Online. 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