Discussion
To our knowledge, this is the first in-depth study objectively assessing
the quality and reliability of video information pertaining to
cholesteatoma on YouTube. There were on average 55,292 views per video
included in this study with videos having an average of 271 likes and
only 22 dislikes.
In otolaryngology, YouTube content has been investigated for the
educational value of videos about pediatric tonsillectomy, middle ear
ventilation tubes, rhinoplasty and thyroid cancer
(8, 14-16).
Sorenson (16) found there was a low
educational quality for YouTube videos describing pediatric
adenotonsillectomy with even lower quality scores in videos from patient
uploaded testimonial-type content. These findings were mirrored by
Strychowsky et al (15), with study
findings revealing physician-uploaded content being of a better
educational quality than patient experience, surgical technique and news
media videos. The findings of the current study confirm that videos
uploaded by patients are of a lower educational value when compared to
videos from academic sources.
The DISCERN tool was developed in 1999 in order to critically appraise
the reliability and validity of published health information
(7) and the DISCERN instrument has since
been used generically in assessing YouTube sources in several studies
(8, 9,
14).
In addition to the DISCERN tool, the senior authors developed a disease
specific Essential and Ideal Video Completeness Criteria (EIVC criteria)
to represent the necessary video contents required in order to inform
patients of all the elements of cholesteatoma and its management. Novel
scoring systems have previously been developed to address the
intricacies of disease factors being assessed such as Strychowsky et al
who developed a usefulness checklist for validity of YouTube health
information videos regarding pediatric
tonsillectomy(15).
The overall educational quality of the videos examined was poor using
both the DISCERN and EIVC Criteria. The DISCERN scores in this study
showed a good reliability between raters and there was moderate
correlation between raters in the EIVC criteria. The results show that a
video’s view count, length and like tally did not correlate with the
DISCERN or EIVC criteria however, the more dislikes a video had, the
lower the DISCERN or EIVC score.
In a systematic review addressing the health care information on
YouTube, Madathil (4) et al found that
although YouTube had the potential to be a great source of patient
education, it was potentially also at significant risk of bias and
misinformation. It was been recommended that professional organizations
and government agencies (17) take more of
an active role in uploading approved videos which are more likely to
meet the criteria and guidelines required. Given the poor educational
content found in this study, as well as other past otolaryngology
studies (8,
15, 16),
the authors advocate for otolaryngology and otology societies working
with patients in order to upload high quality patient education videos
onto YouTube which surgeons can direct patients to view for more
accurate information.
With regards to the limitations of this study, firstly it was limited to
the English Language and only the top 6 search results were examined.
The authors felt that this would generally match what the average
patient would search for, but of course, many may search for more
information. The geographical location of the YouTube user also affects
the search findings and as such, our study may not be representative of
the quality of videos found in other regions. The DISCERN instrument was
originally created to assess written material and as such, has not been
properly validated for use in the video educational material.
Furthermore, the essential and ideal video completeness criteria is an
unvalidated instrument based on replicating similar models of disease
assessment used to analyze video educational content.