Skip to main content Accessibility help

Glue ear: how good is the information on the World Wide Web?

  • L Ritchie (a1), C Tornari (a2), P M Patel (a2) and R Lakhani (a2)



This paper objectively evaluates current information available to the general public related to glue ear on the World Wide Web.


The term ‘glue ear’ was typed into the 3 most frequently used internet search engines – Google, Bing and Yahoo – and the first 20 links were analysed. The first 400 words of each page were used to calculate the Flesch–Kincaid readability score. Each website was subsequently graded using the Discern instrument, which gauges quality and content of literature.


The websites, and received the highest overall scores. These reflected top scores in either readability or Discern instrument assessment, but not both. Readability and Discern scores increased with the presence of a marketing or advertising incentive. The website had the highest Discern score and third highest readability score.


There is huge variation in the quality of information available to patients on the internet. Some websites may be accessible to a wide range of reading ages but have poor quality content, and vice versa. Clinicians should be aware of indicators of quality, and use validated instruments to assess and recommend literature.


Corresponding author

Address for correspondence: Miss Lulu Ritchie, ENT Department, St Mary's Hospital, Praed Street, London W2 1NY, UK E-mail:


Hide All
1Simpson, SA, Thomas, CL, van der Linden, MK, Macmillan, H, van der Wouden, JC, Butler, C. Identification of children in the first four years of life for early treatment for otitis media with effusion. Cochrane Database Syst Rev 2007;(1):CD004163
2Joosten, EA, DeFuentes-Merillas, L, de Weert, GH, Sensky, T, van der Staak, CP, de Jong, CA. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom 2008;77:219–26
3Zhang, NJ, Terry, A, McHorney, CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Ann Pharmacother 2014;48:741–51
4Office for National Statistics. Internet Access - Households and Individuals, 2013. In: [5 November 2015]
5National Literacy Trust. Literacy: State of the Nation – A picture of literacy in the UK today, 2012. In: [5 November 2015]
6Naval Technical Training Command. Research Branch Report 8–75: Derivation of new readability formulas (Automated Readability Index, Fog Count and Flesch Reading Ease Formula) for Navy enlisted personnel, 1975. In: [5 November 2015]
7Charnock, D, Shepperd, S, Needham, G, Gann, R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 1999;53:105–11
8eBizMBA Guide. Top 15 Most Popular Search Engines 2013. In: [26 November 2013]
9Ademiluyi, G, Rees, CE, Sheard, CE. Evaluating the reliability and validity of three tools to assess the quality of health information on the internet. Patient Educ Couns 2003;50:151–5
10Landis, JR, Koch, GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–74
11Kuk, G. Digital divide and quality of electronic service delivery in UK local government. Government Information Quarterly 2003;20:353–63
12US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National Action Plan to Improve Health Literacy. Washington, DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2010
13Hasnain-Wynia, R, Wolf MS. Promoting health care equity: is health literacy a missing link? Health Serv Res 2010;45:897903
14Goslin, RA, Elhassan, HA. Evaluating internet health resources in ear, nose, and throat surgery. Laryngoscope 2013;123:1626–31
15McKearney, TC, McKearney, RM. The quality and accuracy of internet information on the subject of ear tubes. Int J Pediatr Otorhinolaryngol 2013;77:894–7
16Swartz, EN. The readability of paediatric patient information materials: are families satisfied with our handouts and brochures? Paediatr Child Health 2010;15:509–13
17Crocco, AG, Villasis-Keever, M, Jadad, AR. Analysis of cases of harm associated with use of health information on the internet. JAMA 2002;287:2869–71
18Larner, AJ. Searching the Internet for medical information: frequency over time and by age and gender in an outpatient population in the UK. J Telemed Telecare 2006;12:186–8
19Eysenbach, G, Köhler, C. How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. BMJ 2002;324:573–7


Glue ear: how good is the information on the World Wide Web?

  • L Ritchie (a1), C Tornari (a2), P M Patel (a2) and R Lakhani (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed