Skip to main content
SpringerLink
Log in

Rating surgical field quality in endoscopic ear surgery: proposal and validation of the “Modena Bleeding Score”

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To develop and validate a bleeding score that could be applied in endoscopic ear surgery (EEarS).

Methods

A prospective validation study was performed. A new bleeding score, called “Modena Bleeding Score” (MBS), was created by the authors. It provides five grades for rating the surgical field during EEarS procedures (from grade 1—no bleeding to grade 5—bleeding that prevents every surgical procedure except those dedicated to bleeding control). A preliminary “face validity” was performed by 18 ENT specialists to assess possible misunderstandings in interpreting the scale. Then, 15 videos of endoscopic ear surgery procedures, each divided into three parts (t0, t1, and t2), were subsequently evaluated by 15 specialists, using MBS. The videos were randomly selected and assigned. Intra-rater reliability and inter-rater reliability were calculated. The clinical validity of the instrument was calculated using a referent standard (i.e., four ENT experts whose ratings were compared to those obtained by the former sample).

Results

The face validity showed a good consensus about the clarity and comprehension of the scale; both intra and inter-rater reliability demonstrated good performance (intra-rater reliability ranged from 0.741 to 0.991 and inter-rater reliability was 0.790); clinical validity also showed positive values, ranging from 0.75 to 0.93.

Conclusions

MBS has proved to be an effective method to rate surgical field during EEarS, with good-to-excellent performances. Its use would possibly help comparisons of groups in clinical trials or comparisons between studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Qiao H, Chen J, Li W et al (2016) Intranasal atomised dexmedetomidine optimises surgical field visualisation with decreased blood loss during endoscopic sinus surgery: a randomized study. Rhinology 54:38–44

    Article  PubMed  CAS  Google Scholar 

  2. Wormald PJ, van Renen G, Perks J et al (2005) The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol 19:514–520

    Article  PubMed  Google Scholar 

  3. Halderman AA, Sindwani R, Woodard TD (2015) Hemorrhagic Complications of Endoscopic Sinus Surgery. Otolaryngol Clin North Am 48:783–793

    Article  PubMed  Google Scholar 

  4. Kelly EA, Gollapudy S, Riess ML, Woehlck HJ, Loehrl TA, Poetker DM (2013) Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia. Int Forum Allergy Rhinol 3(6):474–481

    Article  PubMed  Google Scholar 

  5. Boezaart AP, van der Merwe J, Coetzee A (1995) Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 42:373–376

    Article  PubMed  CAS  Google Scholar 

  6. Athanasiadis T, Beule A, Embate J, Steinmeier E, Field J, Wormald PJ (2008) Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study. Laryngoscope 118(2):314–319

    Article  PubMed  Google Scholar 

  7. Bujang MA, Baharum N (2017) Guidelines of the minimum sample size requirements for Cohen’s Kappa. EBPH. https://doi.org/10.2427/12267

    Article  Google Scholar 

  8. Gisev N, Bell JS, Chen TF (2013) Interrater agreement and interrater reliability: key concepts, approaches, and applications. Res Soc Adm Pharm 9(3):330–338

    Article  Google Scholar 

  9. Cichetti Dv (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6(4):284–290

    Article  Google Scholar 

  10. Cohen JA (1960) Coefficient of agreement for nominal scales. Educ Psychol Meas. https://doi.org/10.1177/001316446002000104

    Article  Google Scholar 

  11. Sajedi P, Rahimian A, Khalili G (2016) Comparative evaluation between two methods of induced hypotension with infusion of remifentanil and labetalol during sinus endoscopy. J Res Pharm Pract 5(4):264–271

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Govindaraj S, Adappa ND, Kennedy DW (2010) Endoscopic sinus surgery: evolution and tehcnical innovations. J Laryngol Otol 124(3):242–250

    Article  PubMed  CAS  Google Scholar 

  13. Beule AG, Wilhelmi F, Kühnel TS, Hansen E, Lackner KJ, Hosemann W (2007) Propofol versus sevoflurane: bleeding in endoscopic sinus surgery. Otolaryngol Head Neck Surg 136(1):45–50

    Article  PubMed  Google Scholar 

  14. Eberhart LH, Folz BJ, Wulf H, Geldner G (2003) Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope 113(8):1369–1373

    Article  PubMed  CAS  Google Scholar 

  15. Ahn HJ, Chung SK, Dhong HJ, Kim HY, Ahn JH, Lee SM, Hahm TS, Kim JK (2007) Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery. Br J Anesth 100(1):50–54

    Article  CAS  Google Scholar 

  16. McGuire DB (1984) The measurement of clinical pain. Nurs Res 33(3):152–156

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy

    Matteo Alicandri-Ciufelli, Davide Mariano, Giulia Molinari, Marco Bonali & Livio Presutti

  2. Neurosurgery Department, New Civil Hospital Sant’Agostino-Estense, Stradello Baggiovara 53, 41126, Baggiovara, MO, Italy

    Matteo Alicandri-Ciufelli

  3. Human Resources, Department of Mental Health, Local Health Agency Reggio Emilia, Reggio Emilia, Italy

    Luca Pingani

  4. Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Bern, Switzerland

    Lukas Anschuetz

  5. Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy

    Daniele Marchioni

  6. Psychiatry Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy

    Gian Maria Galeazzi

Authors
  1. Matteo Alicandri-Ciufelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luca Pingani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Davide Mariano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lukas Anschuetz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giulia Molinari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniele Marchioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marco Bonali
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gian Maria Galeazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Livio Presutti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giulia Molinari.

Ethics declarations

Conflict of interest

All the authors have nothing to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alicandri-Ciufelli, M., Pingani, L., Mariano, D. et al. Rating surgical field quality in endoscopic ear surgery: proposal and validation of the “Modena Bleeding Score”. Eur Arch Otorhinolaryngol 276, 383–388 (2019). https://doi.org/10.1007/s00405-018-05268-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-05268-6

Keywords

Search

Navigation