IVORY Guidelines (Instructional Videos in Otorhinolaryngology by YO-IFOS): A Consensus on Surgical Videos in Ear, Nose, and Throat

Evaluation of the Quality of Tympanoplasty Videos on YouTube Using the Ivory Grading System

Purpose

YouTube has become a key platform for sharing information on surgical procedures. However, the absence of peer review raises concerns about the educational quality and reliability of its content. The IVORY grading system was developed to address this gap in otorhinolaryngology. This study aims to evaluate the educational quality of tympanoplasty videos on YouTube using the IVORY system and identify deficiencies.

Methods

Ninety-four tympanoplasty videos were analyzed based on inclusion and exclusion criteria. Video metrics such as duration, views, and likes were recorded, and videos were scored on a 0-2 scale using the IVORY system. Total scores were categorized from A to F. Statistical analyses examined the relationships between IVORY scores and video characteristics.

Results

The median IVORY score of the videos was 21.0 (IQR: 17.0-24.0). Only 4.3% of the videos (A and B categories) were of high educational quality, while 68.1% were classified as low quality (F category). A weak but significant correlation was found between IVORY scores and metrics such as views (p = 0.008, r = 0.271) and likes (p = 0.005, r = 0.288). Video duration showed a significant negative correlation with IVORY scores (beta = -0.05, p = 0.012). Geographic differences significantly affected video quality (p < 0.05).

Conclusion

This study highlights YouTube's potential as a resource for surgical education while also revealing significant shortcomings in video quality. The broader adoption of guidelines like the IVORY system and the encouragement of producing content aligned with these standards would be an important step toward improving the quality of surgical educational materials.

Level of Evidence

NA.

Evaluation of the Educational Quality of Endonasal Endoscopic Dacryocystorhinostomy Videos on YouTube with IVORY and LAP-VEGaS Guidelines

Objective: The aim of this study was to evaluate the educational quality of endonasal endoscopic dacryocystorhinostomy (EE-DCR) videos on YouTube with Instructional Videos in Otorhinolaryngology by YO-IFOS (IVORY) and LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) guidelines and to evaluate the correlation of the 2 guidelines. Methods: EE-DCR videos were queried using search terms on YouTube. Views, likes, likes/dislikes ratio, age, and length of videos were noted. Videos were evaluated using the IVORY and LAP-VEGaS guidelines. Two IVORY scores were created: total (IVORY-1) and organ-specific (IVORY-2). The correlation analysis between video features and guideline scores was performed. Results: A total of 61 EE-DCR videos were evaluated. The mean score of LAP-VEGaS was 10.3 (±SD 2.7), the mean IVORY-1 score was 22.5 (±SD 5.5), and the mean IVORY-2 score was 10.6 (±SD 1.94). Correlation analysis revealed a statistically significant correlation between the IVORY-1 total score and the number of likes, the duration of the video, the age of the video, and the LAP-VEGaS score. Linear regression analysis showed that higher IVORY-1 scores predicted longer video duration, newer video age, and higher LAP-VEGaS scores. There was a significant association between LAP-VEGaS categories and the IVORY-1 total score (P < .001). Conclusion: The quality of EE-DCR videos is generally low to moderate. The IVORY and LAP-VEGaS guidelines were found to be correlated with each other. Both guidelines can be used to evaluate EE-DCR videos and otolaryngology surgical education videos in general. We believe that scales such as IVORY and LAP-VEGaS may be improved according to specific surgical procedures.

Educational endoscopic videos improve teaching of middle ear anatomy

PURPOSE

Videos and images are becoming an educational tool in every domain. The objective was to assess the contribution of short educational endoscopic videos in learning the complex anatomy of the tympanic cavity.

METHODS

We conducted a prospective study amongst all the otolaryngology residents in 2021 in the greater Paris area (n = 74), from the first year to fifth year. We divided the residents into two groups who had the same 30-min anatomy class based on anatomical drawings. The second group had a 4-min endoscopic educational video at the end, whereas the first group did not. A video test of 10 surgical situations with each time 5 anatomic structures to identify was created. All the residents took the test just after the class, and 1 month later to assess long-term memory. The MERSQI score (design to assess the quality of educational studies) applied to our study was calculated.

RESULTS

The two groups were comparable in terms of training. The "video" group had significantly better results in the first test, mean score 24.40/50 (± 11.7) versus 16.74/50 (± 11.1) (p = 0.005) and also at 1 month, mean score 23.25/50 (± 12.3) versus 18.01/50 (± 11.3) (p = 0.035). The score in each group, and the difference between both groups, increased with resident seniority. The MERSQI score of our study was 14.5/18.

CONCLUSION

This study highlights the educational value of videos to help memorise complex 3D anatomy such as in the tympanic cavity.

Analysis of the Quality of Parotidectomy Videos on YouTube Using the IVORY-Grading-System

OBJECTIVE

The aim of this study was to evaluate the quality and the educational content of YouTube videos showing parotidectomy.

METHODS

We searched for videos displaying parotidectomy on YouTube. To rate parotidectomy videos, we introduced the "Instructional Videos in Otorhinolaryngology by YO-IFOS (IVORY)-grading-system (GS)" derived from the IVORY Guidelines, which pose established consensus recommendations for the production of educational surgical videos in otolaryngology. The videos were rated using the IVORY-GS, and the total score was tested for statistical association with views, likes, likes/dislikes-ratio, age, and length of the videos for validation of the IVORY-GS.

RESULTS

Overall, 50 parotidectomy videos were identified. Sixty-eight (68%) of the videos showed a superficial parotidectomy. The mean IVORY-GS total score was 24.9 (out of a maximum of 44 points). Video education quality was rated as moderate in 22% and high in 4%. There was a statistically significant correlation between the total score and the number of views (p = 0.03), the total score and the number of likes (p < 0.01), and the total score and the likes/dislikes ratio (p < 0.01). A higher total score was a significant predictor of more likes (p = 0.01) and a higher likes/dislikes ratio (p < 0.01).

CONCLUSION

Our modification of the IVORY Guidelines is otolaryngology-specific, suitable, and recommended to evaluate parotidectomy videos. To date, most videos are of poor educational quality. Future efforts in otolaryngology surgical video education could focus on the establishment of an online video platform.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:2631-2637, 2023.

Social Media Utilization in Otolaryngology: A Scoping Review

OBJECTIVE

Social media (SM) is an increasingly popular medium for the medical community to engage with patients, trainees, and colleagues. This review aimed to identify reported uses of SM in otolaryngology-head and neck surgery (OHNS), assess the quality of evidence supporting these uses, and identify gaps in the literature. With the relative lack of regulatory guidelines for the development of SM content, we hypothesized that the quality of content available on SM would be highly variable.

DATA SOURCES AND METHODS

A scoping review was performed of English-language peer-reviewed studies published to date discussing SM use in any form within OHNS. Three reviewers independently screened all abstracts. Two reviewers independently extracted data of interest from the full text of articles identified from the preliminary abstract screen.

RESULTS

171 studies were included, with 94 (54.9%) studies published between 2020 and 2022. 104 (60.8%) studies were conducted in the US. 135 (78.9%) used cross-sectional or survey-based methodology; only 7 (4.1%) were controlled studies. SM was most commonly employed for professional networking (n = 37 [21%]), and within subspecialties of otology (n = 38 [22%]) and rhinology/allergy (n = 25 [15%]). Facebook was most frequently used for study recruitment (n = 23 [13.5%]), YouTube for patient education (n = 15 [14.6%]), and Twitter for professional networking (n = 16 [9.4%]).

CONCLUSION

SM use within OHNS is increasing rapidly, with applications including patient education, professional networking, and study recruitment. Despite myriad articles, there remains a paucity of well-controlled studies. As SM becomes integrated into healthcare, particularly for applications directly impacting patient care, higher levels of evidence are needed to understand its true impact. Laryngoscope, 133:2447-2456, 2023.

Ethical and Legal Considerations for Recording in the Operating Room: A Systematic Review

INTRODUCTION

The integration of high-resolution video into surgical practice has fostered widespread interest in capturing surgical video recordings for the purposes of patient care, medical training, quality improvement, and documentation. The capture, analysis, and storing of such recordings inherently impact operating room (OR) activities and introduce potential harms to patients as well as members of the surgical team, which can be analyzed from both ethical and legal perspectives.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic literature search of PubMed was conducted. The citations of included articles were then reviewed to find any articles not captured by our initial search.

RESULTS

62 Articles were included in the review (52 from PubMed search and 10 from citation review). Prevalent key issues in the literature at present include privacy, consent, ownership, legal use and discoverability, editing, data security, and recording's impact on the surgical team.

CONCLUSIONS

This review aims to spark proactive discussions of the ethical and legal implications of recording in the OR, which will guide transformation as the medical field adapts to new and innovative technologies without compromising its ideals or patient care.

Intraoperative video recording in otolaryngology for surgical education: evolution and considerations

BACKGROUND

Otolaryngology is a surgical speciality well suited for the application of intraoperative video recording as an educational tool considering the number procedures within the speciality that utilize digital technology. Intraoperative recording has been utilized in endoscopic surgeries and in evaluating technique in mastoidectomy, myringotomy and grommet insertion. The impact of intra-operative video recording in otolaryngology education is vast in creating access to surgical videos for preparation outside the operating room to individualized coaching and assessment. The purpose of this project is to highlight the role of intraoperative video recording in otolaryngology training and elucidate the challenges and considerations associated with implementation.

METHODS

Related publications between 1999 to 2022 were reviewed from PubMed and Embase databases utilizing search terms "intraoperative videography," "video recording surgery," "otolaryngology," and "surgical education." 109 articles were screened independently by HB and SK, by title and abstract then full text review. 28 articles from the original search and 6 from the secondary reference review were included.

RESULTS

The application of intraoperative video recording is evident in otolaryngology surgeries including endoscopic sinus surgery, laryngeal surgery, and other endoscopic procedures. There have been significant advancements in recording tools, including devices that can capture the surgeon's perspective. The considerations and challenges identified with utilizing this educational tool were categorized into different themes including ethics/consent, regulation, liability, data, technology, and human resources.

CONCLUSION

Intra-operative video recording has been demonstrated to have significant impact within otolaryngology education. It is critical to elucidate the challenges and considerations involved to utilize this educational tool effectively. Future directives will see video-based performance analytics providing comparative metrics to encourage precise coaching of surgical residents.