Contents lists available at ScienceDirect
Journal of Oral and Maxillofacial Surgery, Medicine, and
Pathology
journal homepage: www.elsevier.com/locate/jomsmp
Original Research
Quality and Content of YouTube
TM
Videos Related to Sinus Lift Surgery
Tuğçe Paksoy
a,*, Selin Gaş
b,*
a Department of Periodontology, Faculty of Dentistry, Beykent University, Istanbul, Turkey
b Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Beykent University, Istanbul, Turkey
A R T I C L E I N F O Keywords: Internet Sinus Lift Social Media Video YouTube A B S T R A C T
Objective: In the interest of supplying medical information to YouTubeTM videos, this study aimed to assess the quality and content of the information provided that is related to sinus lift surgery.
Methods: In this cross-sectional study, YouTubeTM videos were searched using the search term “sinus lift sur-gery”. The first 140 videos were reviewed and analyzed by two independent researchers, after which 103 of them were included in the study. A 13-point scale was used to classify the videos by low- and high-content. Each video was evaluated on content quality using the video information and quality index (VIQI).
Results: Ninety-four (94.28%) and nine (8.72%) videos were included in the high-content and low-content groups, respectively. The high-content video group covered more topics than the low-content group, such as the definition of the procedure, its contraindications and advantages, and what to expect after the surgery (P < 0.05). The total VIQI scores of the high-score group were significantly higher than those of the low-score group. There was a positively strong correlation between total content score and VIQI (r = 0.777, P < 0.05). Conclusion: The quantity and quality of the YouTubeTM videos that feature sinus lift surgery are limited for professionals but may be sufficient for patients and non-specialist health care providers. Medical professionals, such as periodontists and oral surgeons, should play more of an active role in providing high-quality information by directing patients toward alternative sources that more clearly explain their surgeries.
1. Introduction
After posterior superior tooth extraction, bone loss and subsequent sinus pneumatization are common issues encountered in edentulous posterior maxillae where a sinus lift procedure is generally required for oral rehabilitation using dental implants [1]. Sinus lift procedures offer patients a solution when there is inadequate bone in the posterior maxillae. The success of sinus lift procedures depends on a thorough assessment of the patient’s medical history and condition, accurate evaluation of indications and contraindications, graft materials, and surgeon’s experience. Detailed patient education is also necessary to achieve successful treatment results and is especially important in sinus lift surgery.
With the Internet and social media, patients are able to find in-formation about sinus lift surgery procedures throughout every stage of their treatment; however, depending on the quality of the video con-tent, the patients may be either positively or negatively affected by the information presented. Since 2005, YouTubeTM has become very pop-ular and is the third most-visited website after GoogleTM and FacebookTM [2]. YouTubeTM is the preferred web resource where
people can gather information on medical issues, including sinus lift procedures. Because of the increasing interest in the medical informa-tion that YouTubeTM videos provide, the accuracy of the content be-comes increasingly more important. Several studies have evaluated the content of YouTubeTM videos [3–5] and the results provide clinicians with information for directing their patients to these videos during treatment.
The aim of the current study was to understand whether YouTubeTM videos on sinus lift surgery in particular are beneficial to patients, non- specialist health care providers and professionals by evaluating their quality.
2. Methods
“Google Trends” is an online search tool that organizes the most commonly used specific keywords, subjects, and phrases over a specific period and throughout several areas of the world. After a search for “sinus lift surgery” using this application, we found that the most commonly used terms were “sinus lift procedure” and “sinus lift sur-gery” (Google Trends, 2019). We then searched from 07:00 a.m. to 9:00
https://doi.org/10.1016/j.ajoms.2020.08.015
Received 18 April 2020; Received in revised form 21 August 2020; Accepted 31 August 2020
⁎Corresponding author at: Beykent University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Cumhuriyet Mah, Turgut Özal Bulvarı Beykent Üniversitesi Büyükçekmece, Külliyesi, 34500, Büyükçekmece, İstanbul, Turkey.
E-mail address: selingas@beykent.edu.tr (S. Gaş).
Available online 24 September 2020
2212-5558/ © 2020 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd All rights reserved.
p.m. on April 10, 2019, using the keywords “sinus lift surgery” and used “sort by relevance” as the default filter for the YouTubeTM search. The study population was composed of all YouTubeTM videos containing information on sinus lift surgery. The first 200 videos found using the search criteria were reviewed and assessed. According to studies, most of the YouTubeTM users will look at only the first three pages of a search result to gather information, and they usually scan only the first 30 videos [6,7].
2.1. Scanning the videos
The YouTubeTM videos found in the search were reviewed to de-termine whether they could be included in the study. The inclusion criteria were as follows: 1) videos in English and 2) videos related to the subject matter. The exclusion criteria were as follows: 1) videos not in English, 2) duplicate videos, 3) videos that not related to the subject, 4) irrelevant videos, or 5) conference/lecture videos primarily directed to a specialized audience (Fig. 1).
Two blinded researchers independently reviewed all videos for content. The number of views, duration in minutes, video’s upload date, number of likes/dislikes, number of comments, and country of origin were recorded for each video; however, to keep the assessments ob-jective, the researchers were not able to see the number of likes/dislikes or number of comments before finishing their reviews. Viewer inter-actions were calculated based on the interaction index (number of likes - number of dislikes / total number of views * 100%) and the viewing rate (number of views / number of days since upload x 100%).
We recorded the uploads of each video and categorized each source as healthcare professionals (oral surgeon, periodontist, dentist), hos-pital/university, commercial (dental manufacturing company or dental supply company), layperson, or other (e.g., television channels or news agencies). We also categorized the type of videos as either educational (i.e., those that provided information on sinus lift surgery and its in-dications, advantages, complications, prognosis, and management) or testimonial (i.e., those relating a personal experience with sinus lift surgery).
2.2. Video assessment
The YouTubeTM videos were assessed for the following content: (1) definition of sinus lift; (2) procedure of sinus lift; (3) indications; (4) contraindications; (5) advantages; (6) complications; (7) prognosis and survival; (8) cost; (9) dentistry specialties involved; and 10) post-operative recovery possibilities, such as pain, swelling, bruising, and bleeding. Each content item was given 1 point, for a possible total of 13 points, which was designated as the content score of the video. A score of 0–6 was designated as low content and defined as not at all useful for patients; 7–13 was designated as high content and defined as very useful for patients. To assess the overall quality and content of the vi-deos, we used the video information and quality index (VIQI), which comprises a 5-point Likert scale with 1 being poor quality and 5 being high quality. The video characteristics were then assessed for in-formation flow, accuracy, and quality (one point each for use of still images, animation, interview with individuals in the community, video captions, and a report summary); and the level of coherence between the video title and content (i.e., precision).
Disagreements between researchers on their analyses of a particular video were resolved by searching the literature and discussing the is-sues. No research and ethics committee approval was deemed necessary for the study.
2.3. Statistical analyses
SPSS ver. 22 (IBM Corp., Armonk, NY, USA) was used for statistical analyses of the data. We used the Shapiro-Wilk test to evaluate the distribution of the parameters, which were found to not show a normal distribution. The Mann-Whitney U test was used to compare the quantitative data as well as descriptive statistical methods (mean, standard deviation, median, frequency). We used the Chi-squared and Fisher-Freeman-Halton tests to compare qualitative data. A linear re-gression analysis was conducted for multivariate analysis. A Spearman Rho correlation analysis was conducted to investigate the correlations among the parameters. The significance was evaluated as P < 0.05. 3. Results
The first 140 videos were initially screened using the search term “sinus lift surgery”. Of the 140 videos screened, 37 were excluded from the study based on the above exclusion criteria (Fig. 1). All ratings were based on the remaining 103 videos.
The United States scored highest for video uploads (40.8%, n = 42), with India ranking second (14.6%, n = 15). Ten videos were uploaded by users from Italy (9.7%), nine from England (8.7%), five from Korea (4.9%), four from Germany (3.9%), three from both China and France (2.9%), and the remaining videos from Australia, Azerbaijan, Bulgaria, Israel, Lebanon Macedonia, Netherlands, Russia, Spain, Twain, Thailand, and Turkey (each 1%, n = 1).
Descriptive statistics of the YouTubeTM videos are provided in Table 1. Most videos (51.5%, n = 53) were uploaded by healthcare professionals; the rest were uploaded by commercial (39.8%, n = 41), layperson (4.9%, n = 5), and “other” (3.9%, n = 4). The mean length of the YouTubeTM videos on sinus lift surgery was 6:76 min (range: 0:53–47:18 min; median: 5:02). The mean number of views for these videos was 15,516.21 (range: 58–126,695) with a mean interaction index of 0.58 views/d (range: -0.25–4.41 views/d) and a mean viewing rate of 1,129.99 (range: 364.81–1,054.39). The overall mean of the number of “likes” was 45.54 (range: 0–615), while the overall mean number of “dislikes” was 4.58 (range: 0–47). The average age of the video was 1378.44 d (range: 50–3907 d). The vast majority of the video types analyzed were educational (96.1%, n = 99). The mean total content score of the YouTubeTM videos on sinus lift surgery was 3.56 (range. 1–10; median, 3) (Table 1).
Ninety-four (91.23%) and 9 (8.72%) videos were included in the
high-content and low-content score groups, respectively. The difference in download sources between the low- and high-content groups was not statistically significant (P > 0.05). The educational type (97.9%) was higher in the low-content group than in the high-content group (77.8%). The rate of testimonial content type for the high-content group (22.2%) was significantly higher than that of the low-content group (2.1%) (P < 0.05) (Table 2).
The YouTubeTM videos contained variable information on sinus lift
surgery for patients and health care professionals. The topics mentioned most often were procedures (n = 100, 97.1%), dentistry specialties involved (n = 80, 77.7%), and indications (n = 63, 61.2%). Those mentioned least were contraindications (n = 4, 3.9%), bleeding (n = 3, 2.9%), and cost (n = 1, 1%) (Table 2).
The high-content group mentioned more topics than the low-con-tent group, including definition of sinus lift (P < 0.05), contra-indications (P < 0.05), advantages (P < 0.05), prognosis and survival (P < 0.05), pain (P < 0.05), swelling (P < 0.05), bruising (P < 0.05), and bleeding (P < 0.05). There was no statistically significant differ-ence between the low- and high-content groups for procedure of sinus lift, indications, complications, cost, or dentistry specialties involved (P > 0.05) (Table 2).
There was no statistically significant difference in video character-istics between the low- and high-content groups (P > 0.05). The flow of information, information accuracy, quality, precision, and VIQI total scores of the high-content group were significantly higher than those of the low-content group (P < 0.05) (Table 3).
Spearman’s rho correlation analysis showed that there was a sta-tistically significant positive correlation between total content score and VIQI (r = 0.777, P < 0.05). In addition, there was a statistically significant positive low correlation between total content score and video duration (r = 0.255, P < 0.05). There was no statistically sig-nificant relationship between total content score and other demo-graphic characteristics (P > 0.05). There was a statistically significant positive correlation between VIQI and video duration (r = 0.249,
P < 0.05), number of views (r = 0.212, P < 0.05), number of
com-ments (r = 0.230, P < 0.05), number of likes (r = 0.263, P < 0.05), number of dislikes (r = 0.215, P < 0.05), and viewing rate (r = 0.223,
P < 0.05). There was no statistically significant relationship between
VIQI and other demographic characteristics (P > 0.05) (Table 4). 4. Discussion
The aim of our study was to evaluate the content and the quality of that content of YouTubeTM videos that were related to sinus lift surgery. There has been a strong increase in accessing medical and dentistry information using YouTubeTM because of its ease of use and free access [8].
The content of YouTubeTM videos related to different medical issues [9–12] and a few oral health issues [13–17] have been assessed. Al-though sinus lifting is a surgical procedure that is not known by patients and feared by physicians, it is a subject that has been widely researched on the internet and the subject of YouTubeTM videos for dental surgery was very curious. On the other hand, there has been no study that analyzed the quality of the information provided on YouTubeTM videos on sinus lift surgery. The exchange of video-based information has grown rapidly in recent years and has become an important resource [18]. Although social media, including YouTube™, may have a positive effect on those who use it to educate themselves, such as patients and health care professionals, these tools come with several risks, such as lack of accurate information and the availability of uncontrolled in-formation [19]; therefore, to improve the content of YouTubeTM videos covering health-related fields, video sources should be checked and video content should be evaluated in terms of the accuracy of their information [13,20].
Many sinus lift surgery patients and dental care professionals con-duct online searches to become better informed about the procedure and use social media, especially YouTubeTM, as a resource; however, the accuracy of the YouTubeTM information is suspect because video access is easy but standardizing the content of the uploaded videos is difficult [21]. Therefore, in our study there were many videos showing the surgical procedure, according to total-content video analysis, we observed that the number of high-content videos was very limited; and most uploaded videos contained low content. This suggests that the information in the YouTubeTM videos on sinus lift surgery was neither
Table 1
Descriptive Statistics of the YouTubeTM Videos.
Variables Minimum Maximum Mean Std. Dev Median
Video characteristics
No. of views 58 126695 15516.21 26000.58 2979 Duration in minutes 0:53 47:18 6:76 6:56 5:02 Days since upload 50 3907 1378.44 984.59 1167
No.of comments 0 43 3.99 7.90 1
No.of likes 0 615 45.54 93.11 14
No.of dislikes 0 47 4.58 8.26 1
Interaction index −0.25 4.41 0.58 0.83 0.31 Viewing rate 15.18 12167.81 1129.99 2022.65 365.69
Total content score 1 10 3.56 1.86 3
VIQI content assessment
Flow of information 2 5 3.19 0.79 3
Information accuracy 2 5 3.22 0.79 3
Quality 0 4 1.76 0.78 2
Precision 1 5 3.49 0.81 3
VIQI Total Score 7 18 11.67 2.61 11
n % Source of upload Healthcare professionals 53 51.5 Commercial 41 39.8 Layperson 5 4.9 Other 4 3.9 Video type Educational 99 96.1 Testimonial 4 3.9 Table 2
Distribution of YouTubeTM Video Demographics in High and Low-Content Video Groups.
Total Concent Score P
Low (n = 94) High (n = 9) Total (n = 103) n (%) n (%) n (%) Source of Upload Healthcare Professionals 47 (50%) 6 (66.7%) 53 (51.5%) 10.884 Commercial 38 (40.4%) 3 (33.3%) 41 (39.8%) Layperson 5 (5.3%) 0 (0%) 5 (4.9%) Other 4 (4.3%) 0 (0%) 4 (3.9%) Video Type Educational 92 (97.9%) 7 (77.8%) 99 (96.1%) 20.037* Testimonial 2 (2.1%) 2 (22.2%) 4 (3.9%) Content
Definition of Sinus Lift 33 (35.1%) 8 (88.9%) 41 (39.8%) 20.003*
Procedure of Sinus Lift 92 (97.9%) 8 (88.9%) 100 (97.1%) 20.242
Indications 56 (59.6%) 7 (77.8%) 63 (61.2%) 20.477
Contraindications 2 (2.1%) 2 (22.2%) 4 (3.9%) 20.037*
Advantages 4 (4.3%) 6 (66.7%) 10 (9.7%) 20.000*
Complications 9 (9.6%) 2 (22.2%) 11 (10.7%) 20.246
Prognosis and Survical 24 (25.5%) 8 (88.9%) 32 (31.1%) 20.000*
Cost 0 (0%) 1 (11.1%) 1 (1%) 20.087
Dental Specialties Involved 73 (77.7%) 7 (77.8%) 80 (77.7%) 21.000
Pain 2 (2.1%) 6 (66.7%) 8 (7.8%) 20.000*
Swelling 3 (3.2%) 6 (66.7%) 9 (8.7%) 20.000*
Bruising 0 (0%) 5 (55.6%) 5 (4.9%) 20.000*
Bleeding 0 (0%) 3 (33.3%) 3 (2.9%) 20.000* 1Fisher Freeman Halton Test2Fisher’s Exact Test *P < 0.05.
adequate nor an accurate resource for professionals. But the purpose of watching a video varies depending on the viewer and this information may be sufficient for patients and non-specialist health care providers when they are viewers.
Anyone can upload a YouTubeTM video. In our study, most videos (51.5%, n = 53) on sinus lift surgery were uploaded by healthcare professionals, and the majority of these were educational (n = 99, 96.1%), which indicated that the majority of the uploaded videos were directed toward dentists or dentistry specialist. This provides the ne-cessary information and guidance to patients who are interested in oral and maxillofacial surgeries on the surgical procedure and the dentistry specialists who conduct the procedure [5]. With this information, the occurrence of physician-related problems may decrease and patient satisfaction may increase. The sinus lift procedure was the common subject mentioned in all the videos reviewed. The most common topics mentioned in the low-content videos were the sinus lift procedure (97.9%), dentistry specialties involved (77.7%), and sinus lift indica-tions (59.6%); whereas, the high-content videos also comprised the definition of sinus lift (88.9%), sinus lift procedure (88.9%), prognosis and survival (88.9%), indications (77.8%), and dentistry specialist in-volved (77.8%). There was a statistically significant difference between
the high- and low-content scores with regard to post-operative condi-tions, such as pain, swelling, bruising, and bleeding (P < 0.001). In addition, low-content videos did not discuss cost. This procedure fol-lowed by dental implants is very expensive in Turkey for Turkish people and dental health insurance does not include the cost of dental im-plants. Patients often search the Internet for information on costs for the surgery and the implants. The study by Abukaraky et al. [5] has shown that only a minimal number of videos contain information on the cost for dental implants, which varies from country to country. Many pa-tients will travel to another country for dental implant surgery that is less expensive than that in their own country [5]. In general, tourists visit Turkey for these therapies because of their low cost and high success rate according to their countries. Information on patient care after sinus lift surgery and the situations that the patient might face during their recovery were not available in most of the videos, which is an indication that the videos are not intended for patients about these topics. Fortuna et al. [17] have investigated the quality and quantity of the information on burning mouth syndrome (BMS) on YouTubeTM videos and suggested that these videos are generally intended for pa-tients and the general population.
Because the Internet and social media are increasingly used in the medical and dental training areas by both clinicians, laypeople, and companies, studies are needed on the content and severity of these videos that encompass various health-related topics; however, the lack of standardization of these videos, including those comprising medical subjects, may result in poor and inaccurate content [22]. The results of the majority of dentistry studies agree that YouTubeTM videos contain scientifically inaccurate and often times misleading health-related in-formation that might harm patients’ health [4,5,16,17,23]. Un-fortunately, the majority of these videos have not been assessed for quality or accuracy with regard to health care information. One sys-tematic review has suggested that YouTube™ contains misleading in-formation, primarily anecdotal, that contradicts the reference standards [24].
All VIQI evaluation criteria were scored higher in the high-content video group than in the low-content video group. In contrast to the results of our study, Lena and Dindaroglu [4] have concluded that there is no difference in the total VIQI score between the high- and low- content video groups. Our study results differed from theirs because there were too many low-content videos in our study.
This study showed a strong positive correlation between total con-tent score and VIQI (r = 0.777, P < 0.05) and a low positive correlation between total content score and video duration (r = 0.255, P < 0.05).
Table 3
Comparison of Variables Between High- and Low-Content Videos.
Variables Total Concent Score P
low high
Mean ± SD Median Mean ± SD Median
Video characteristics
No. of views 15529.41 ± 26595.46 3137.5 15378.33 ± 19919.42 2441 0.726
Duration in minutes 6.92 ± 6.82 4.805 5.19 ± 2.55 5.52 0.744
Days since upload 1375.88 ± 976.75 1180.5 1405.11 ± 1126.23 1067 0.944
No.of comments 3.71 ± 7.61 1 6.89 ± 10.6 2 0.075
No.of likes 43.33 ± 93.05 13 68.67 ± 95.96 24 0.447
No.of dislikes 4.57 ± 8.32 1 4.67 ± 8.03 1 0.746
Interaction index 0.6 ± 0.85 0.304 0.49 ± 0.48 0.3432 0.587
Viewing rate 1054.39 ± 1765.52 364.81 1919.64 ± 3893.22 423.76 0.797
VIQI content assessment
Flow of information 3.07 ± 0.68 3 4.44 ± 0.88 5 0.000*
Information accuracy 3.09 ± 0.65 3 4.67 ± 0.71 5 0.000*
Quality 1.67 ± 0.74 2 2.67 ± 0.71 3 0.001*
Precision 3.38 ± 0.73 3 4.67 ± 0.71 5 0.000*
VIQI Total Score 11.21 ± 2.16 11 16.44 ± 2.07 17 0.000*
Mann Whitney U Test * P < 0.05.
Table 4
Correlation matrix between scores for total content score, VIQI, and YouTubeTM demographics.
Total Content Score VIQI Total
Total Content Score r 0.777
p 0.000*
No. of views r 0.068 0.212
p 0.496 0.032*
Duration in minutes r 0.255 0.249
p 0.009* 0.011*
Days since upload r −0.011 0.031
p 0.911 0.755 No.of comments r 0.144 0.230 p 0.148 0.019* No.of likes r 0.135 0.263 p 0.175 0.007* No.of dislikes r 0.079 0.215 p 0.428 0.029* Interaction index r 0.080 0.034 p 0.422 0.735 Viewing rate r 0.092 0.223 p 0.356 0.023*
In addition, there was a statistically significant positive correlation between VIQI and video duration (r = 0.249, P < 0.05), number of views (r = 0.212, P < 0.05), number of comments (r = 0.230,
P < 0.05), number of likes (r = 0.263, P < 0.05), number of dislikes (r
= 0.215, P < 0.05), and interaction index (r = 0.223, P < 0.05). Our results are similar to those of Lena and Dindaroglu [4]. In their study, there was a moderate correlation between VIQI and total content score (r = 0.442, P < 0.01) and there was a positive relationship between total content score and the variables of duration in minutes, VIQI, and number of dislikes. Contrast to our study, there was a negative re-lationship with the number of comments.
There were several limitations to our study. There were no validated assessment tools rating video-based resources [25]; therefore, our video evaluations were conducted by two independent researchers based on our checklist. This procedure is standard and used in several other publications in this area for dental treatments [26–28]. First, the study results may change according to the research words used to find the YouTubeTM video. That is, when different search terms are used, dif-ferent results may occur. In the present study, we conducted our search using only one search term—“sinus lift surgery”—to avoid confusion, which we considered to be the most likely search term a layperson would use in a search on the topic. Second, YouTubeTM content is highly dynamic, and uploaded videos are constantly changing; there-fore, results might vary based on the date and time of each search. As with similar studies, we used Google Trends and determined that the most commonly used search term was “sinus lift surgery”. Third, we analyzed only the videos that were in English and observed that these videos were uploaded by those in the United States at a very high rate. 5. Conclusions
YouTubeTM videos on sinus lift surgery were limited in data quantity and quality for professionals and may adequately provide the patient and non-specialist health care providers with information about sinus lift surgery. Medical professionals, such as periodontists and oral sur-geons, should play more of an active role in providing high-quality information by directing patients toward alternative sources that more clearly explain their surgeries.
6. Ethical Approval
No research and ethics committee approval was deemed necessary for the study.
Declaration of Competing Interest There is no conflict of interest. Acknowledgments
None declared. References
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