Classification
VO data was reviewed by ENT Surgeons (with a previously established
>90% concordance) to obtain a middle ear diagnosis
(Browning classification) for all children20. VO files
with a visible TM perforation were then analysed by two medical
students, one with a paediatric audiology background. They were trained
by a senior ENT specialist on classifying perforation site and size. The
students received a random sample of the same 20 VO files to classify
independently. These classified files were then reviewed together with a
senior ENT specialist and senior audiologist where > 90%
diagnostic concordance was confirmed.
Perforations were classified as either <25%, 25-50%, 50-75%
or 75-100%. The site of perforations was classified depending on the
perforation size (Fig 1). Perforations deemed <25% were
classified by quadrants: AS: anterosuperior, AI: anteroinferior, PS:
posterosuperior, PI: posteroinferior. Perforations of size 25-50% were
divided into anterior, inferior, and posterior locations. For size
50-75% they were classified into anteroinferior or posteroinferior
locations. Perforations of 75-100% were classified as subtotal
perforations. Where perforations didn’t completely fit the exact
regions, the closest option was chosen. Where there was any ambiguity,
the VO images were reviewed by all four members of the team (the senior
ENT specialist, senior audiologist and two medical students) to obtain a
final classification.