Use of IOOG Classification to Categorize Middle Ear Surgery in Children: Evaluation After 5 Months of Use in 119 Consecutive Pediatric Middle Ear Surgeries

Introduction: SAMEO-ATO classification is an international consensual tool published in 2018. In order to evaluate the ease of use and reliability of this classification in pediatric otologic surgery, a retrospective study was conducted in our tertiary referral center. Method: We began to use IOOG classification in September 2018, after a 15-day testing period. In this monocentric retrospective study, we reviewed the classification and the operative charts of all the pediatric middle ear surgeries after the first 5 months of use. Each classification was carefully re-checked by a junior and senior surgeon. In parallel, all the surgeons involved received a questionnaire to evaluate the ease of use, with a score from 1 (very difficult) to 5 (very easy). Results: From September 2018 to February 2019, the tool was used for 119 pediatric surgeries, involving 13 surgeons. The indications for surgery were tympanic membrane perforations (28/119, 23.5%), retraction pockets (36/119, 30.3%), cholesteatoma first procedures (13/119, 10.9%), cholesteatoma revision procedures (41/119, 34.5%) and temporal bone fracture (1/119, 0.8%). All surgical procedures performed could be classified with the ATO-SAMEO classification. We found misclassification in 29/119 cases (24%), 79% of which concerning ATO items. Of the 8 SAMEO-ATO categories in 119 surgeries, the error rate was 4.5% (49/952). Surgeons reported a mean score of use of 4 (quite easy). Conclusion: The easy-to-use SAMEO-ATO classification is well suited for pediatric otology and to the categorization of surgical procedures. However, in a multi-user context, misclassifications were observed in up to a quarter of cases during the first months of use. Carefully anticipated explanations and guidelines given to surgeons should ensure an optimal quality of rating.

Automated summary

This retrospective study evaluated the ease of use and reliability of the SAMEO-ATO classification in pediatric otologic surgery. The results showed that there were misclassifications in approximately 25% of cases during the first 5 months of use, with the majority of errors in the ATO items. Surgeons reported that the classification was quite easy to use.