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- Turkish validity and reliability of Eustachian tube dysfunction questionnaire-7.
A total of 40 individuals older than 18 years old admitted to outpatient clinic of otorhinolaryngology between August and December and were diagnosed with ETD were enrolled for the ETD group. Forty healthy, age and sex-matched adults were included as a control group. It was proven with medical examination and audiological methods that the control group did not have ETD. Inclusion criteria for the control group were listed as answering all scale questions, not having any acute or chronic sinonasal pathology, any acute or chronic otitis media, tinnitus, hearing loss or obstructive sleep apnea during ENT examination.
Afterwards, patient data sheet related to demographic features and ETDQ-7 forms were applied to all control group. Routine ENT examination was performed to the individuals. After that, tympanometric analysis and Williams test were conducted Interacoustics AZ 26 clinical impedance audiometer, Assens, Denmark. Results obtained from Williams test were recorded for each ear as P1, P2 and P3. Based on symptoms of ETD, this Likert-type scale consisted of seven questions, with a response of "1" indicating no problem and "7" indicating a severe problem.
When an overall score got higher, it was considered to be an increase in the severity of the disease.
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In ETDQ-7 patients were asked if they had pressure, pain in the ears, a feeling of clogged or muffled hearing, ear symptoms during sinusitis or common cold, crackling sounds or tinnitus in one or both ears over the previous one month period. The lowest total score was 7 while highest was 49 in this scale. Internationally accepted steps defined in related methods were used during language adaptation of the scale. Thereafter, the accordance between two languages was checked by a linguist.
Finally, the scale which was translated into Turkish was translated into English again by a bilingual academician. Ultimately, no meaning loss was detected among scale wording. Considering expert opinions, a final state for the scale was determined. Later on, as a pilot study, five patients were requested to fill out Turkish versions of the scale and asked if there were any cognitive dissonance to be corrected.
Heeding their opinions, all obscure sentences in Turkish version of ETDQ-7 were enhanced to achieve comprehensibility. Then, the scale was applied to all participants.
The data were evaluated with SPSS Conformity of the data to normal distribution was estimated with the Kolmogorov-Smirnov test. Correlations between test-retest results were obtained with Pearson correlation analysis. Number, percentage, mean and Standard Deviation SD were listed as descriptive data.
Floor-ceiling effect, test-retest method, item-total score correlation and Cronbach's alpha coefficient as an internal consistency analysis were used in reliability analyses. For statistical significance level, p -value was accepted to be less than 0.
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Twenty five The mean age of the control group was Cronbach's alpha coefficient was equal to 0. As seen from Table 1 , none of the Cronbach alphas were greater than 0. There was no statistically significant difference detected while comparing first and last evaluation scores of the scale items in test-retest reliability except Item 2 Table 3.
There are substantial scales that are used routinely in the field of otorhinolaryngology. McCoul et al. Although they prepared this scale with nine items initially, two of the questions were omitted owing to achieving a higher Cronbach's alpha with seven items and ETDQ-7 was finalized accordingly. Moreover, during internal consistency analysis Cronbach's alpha coefficient was found as 0. As Cronbach alpha coefficient approaches one, internal consistency reliability increases.
Being a 7-item scale and its ease of application are ETDQ-7's most important advantages. In , its German validity and reliability study was done by Schroder et al. Liu et al. Participants had difficulty in scoring Item 4 "Increase in ear symptoms when you have a cold or sinusitis" if they did not encounter these diseases over the last month during pilot study.
Neither a note nor a criticism was detected in original scale or in validity and reliability edition of the scale. Thus, as authors, it is agreed to annotate a footnote under the related scale about this inquiry. For the Turkish version of the scale a footnote stating "if you do not complain about both diseases for the last month, please mark 1 Not a problem " was added. The lowest mean score was detected for item 2 3. Those items we suggest being interpreted carefully. These results showed similarities with analyses of McCoul et al. It is possibly because many patients do not define earache in chronic ETD.
In the studies conducted by Park et al. In our study, the test-retest reliability for overall test score was found as 0. Similarly, test-retest reliability was declared as 0.
Moreover, in our study, test-retest correlation value was detected to vary between 0. These results lead us to the fact that even if every item in the scale is answered by the same patient at different times, responses show consistency. Questions showed consistency over time both for total scale and for item. Moreover, none of cases in control group had total scale scores greater than For all patients with ETD, total scale scores were observed to be greater than These results might be interpreted such that while this scale is a valid discrimination between people with and without ETD, it also states that this scale is particular to ETD.
In conclusion, a high-level of validity and reliability was determined in consequence of statistical analyses for Turkish version of Eustachian tube dysfunction questionnare This scale is recommended for screening of ETD and evaluating severity of the disease. Turkish validity and reliability of Eustachian tube dysfunction questionnaire Braz J Otorhinolaryngol.