Trial design and setting
Google Trends was searched in April 2020 for Cholesteatoma and related
pathological diagnosis terms. Using these data, YouTube was then
searched in May 2020 for “Cholesteatoma”, “Ear Cholesteatoma”,
“Cholesteatoma Removal”, “Cholesteatoma Surgery” and “Cholesteatoma
Surgery Recovery”. The searches were undertaken by three different
authors using Google Chrome Version 83.0.4103.61. The cache of each
computer, search history and cookies of the browser were reset before
each search and the authors were not signed into their Google accounts.
The default reference filter was chosen as most users do not adjust
filters; a Virtual Private Network (VPN) was used with IP addresses
across Australia.
The search was limited to the top six English language videos for each
search term as determined by YouTube’s relevance algorithm. The website
results were displayed according to the default algorithm. To reproduce
user search strategies, as clips were viewed and the site offered
additional “up next” video suggestions, the top three suggested videos
were also scored. The initial search, subsequent screening, analysis,
and scoring of videos was performed independently by the three authors
(NP and NJ both otologists, and HC otology Fellow).