Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Sep;165(3):477-482.
doi: 10.1177/0194599820987131. Epub 2021 Feb 9.

Levels of Evidence in Rhinology and Skull Base Surgery Research

Jennifer A Silver  1 , Marco Mascarella  1 , George Tali  2 , Rickul Varshney  1 , Marc A Tewfik  1 , Bobby A Tajudeen  3 , Joseph S Schwartz  1
Affiliations
Review

Levels of Evidence in Rhinology and Skull Base Surgery Research

Jennifer A Silver et al. Otolaryngol Head Neck Surg. 2021 Sep.

Abstract

Objective: The purpose of this study was to evaluate the quality of evidence of rhinology and rhinologic skull base surgery (RSBS) research and its evolution over the past decade.

Study design: Review article.

Setting: We reviewed articles from 2007 to 2019 in 4 leading peer-reviewed otolaryngology journals and 3 rhinology-specific journals.

Methods: The articles were reviewed and levels of evidence were assigned using the Oxford Centre for Evidence-Based Medicine 2011 guidelines. High quality was defined as level of evidence 1 or 2.

Results: In total, 1835 articles were reviewed in this study spanning a 13-year period. Overall, the absolute number of RSBS publications increased significantly 22.6% per year, from 108 articles in 2007 to 481 in 2019 (P < .001; 95% CI, 7.9-37.2). In 2007, only 13 articles, or 15%, were high quality, and this grew to 146 articles, or 39%, in 2019. A 14.0% per year exponential increase in the number of high-quality publications was found to be statistically significant (P < .001; 95% CI, 7.2, 20.7). Overall, high-quality publications represented just 25.8% of RSBS articles overall. There was no significant difference in quality between rhinology-specific journals and general otolaryngology journals (χ2 = 3.1, P = .077).

Conclusion: The number of overall publications and of high-quality RSBS publications has significantly increased over the past decade. However, the proportion of high-quality studies continues to represent a minority of total RSBS research.

Keywords: endoscopic; evidence-based medicine; rhinology; skull base.

PubMed Disclaimer

Conflict of interest statement

Disclosures: Competing interests: None.

Sponsorships: None.

Funding source: None.

Figures

Figure 1.
Figure 1.
Systematic review literature review process.
Figure 2.
Figure 2.
Growth of articles and annual breakdown: exponential increase of total number of articles over study period. A 22.6% increase in overall number of articles published per year. Table with the breakdown of journal contributions of articles.
Figure 3.
Figure 3.
Proportion of high-quality articles: high-quality publication growth. Proportion of high-quality articles increased from 15.1% to 39.3% (blue). Absolute number increased from 13 to 146 (red). In total, 25.8% are high quality overall.
Figure 4.
Figure 4.
Rhinology vs skull base: high-quality articles within rhinology (red) and within general otolaryngology journals (blue), no significant difference between journal types (χ2 = 3.1, P = .077).
Figure 5.
Figure 5.
Rhinology vs skull base article growth: rhinology (red) vs skull base surgery (blue). In total, 1248 articles were focused on rhinologic diseases and 195 were focused on skull base pathologies. Total number of clinical articles (green).
See this image and copyright information in PMC

References

    1. Hoffmann T, Erueti C, Thorning S, Glasziou P. The scatter of research: cross sectional comparison of randomised trials and systematic reviews across specialties. BMJ. 2012;344:e3223. - PMC - PubMed
    1. Benninger MS. Quality of the voice literature: what is there and what is missing. JVoice. 2011;25(6):647-652. - PubMed
    1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312(7023):71-72. - PMC - PubMed
    1. Shin JJ, Rauch SD, Wasserman J, Coblens O, Randolph GW. Evidence-based medicine in otolaryngology, part 2: the current state of affairs. Otolaryngol Head Neck Surg. 2011;144(3):331-337. - PubMed
    1. Wasserman J, Wynn R, Bash T, Rosenfeld R. Levels of evidence in otolaryngology journals. Otolaryngol Head Neck Surg. 2005;134(5):717-723. - PubMed