Abstract
Objective: Analyze the interobserver reliability of a “clockface” method for describing the site and size of tympanic membrane perforations.
Method: Six junior doctors (ENT experience 0-3 months) and 6 ENT surgeons (ENT experience 4-26 years) were asked to estimate the position, percentage size, and “clockface” position of perforations in 30 images of tympanic membrane perforations. Four juniors repeated the exercise 2 weeks later to investigate test-retest reliability.
Results: Results were analyzed using intraclass correlation coefficients (95% confidence interval in brackets). With junior raters, perforation size percentage estimate gave 0.85 (0.77-0.92), clockhand method site of perforation (CM1) gave 0.91 (0.87-0.94), and clockhand method size of perforation (CM2) gave 0.82 (0.73-0.90). With ENT surgeons, perforation size percentage estimate gave 0.85 (0.77-0.92), CM1 gave 0.96 (0.94-0.99), and CM2 gave 0.88 (0.78-0.94). With all raters, perforation size percentage estimate gave 0.86 (0.78-0.92), CM1 gave 0.93 (0.90-0.95), and CM2 gave 0.84 (0.76-0.91). In test-retest reliability, using Pearson correlation coefficients, perforation size percentage estimate gave 0.94 (P < .001), CM1 gave 0.91(P < .001), and CM2 gave 0.92(P < .001).
Conclusion: The clockface method allows quick, detailed, and reliable recording of site and size of perforation at the time of clinical assessment. This may also become a valuable research and audit tool.
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