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Objective: To investigate potential differences in new patient appointment wait times for otolaryngology care based on insurance types and explore factors influencing these wait times. Study Design: A cross‐sectional audit study, using a "mystery caller" approach, analyzed with a linear mixed Poisson model to adjust for confounding factors. Setting: A total of 612 physicians across 49 states and the District of Columbia, representing 6 otolaryngology subspecialties, were included. Methods: Otolaryngology physicians were contacted by mystery callers via telephone with scripted clinical vignettes as patients with either Medicaid or Blue Cross/Blue Shield (BCBS) insurance. Callers requested next available appointment. Wait times for new patient appointments were recorded and analyzed in R using a generalized linear mixed Poisson model. Results: A total of 1183 of 1224 calls reached a representative. Medicaid patients waited 5.73% longer (P <.001) compared to BCBS patients (IRR: 1.06; confidence interval [CI]: 1.03‐1.09; P <.001), with respective mean wait times of 36.8 days (SE ± 1.6) and 32.4 days (SE ± 1.6). Longer waiting times were also associated with physicians affiliated with universities (P =.001) and certain subspecialties, such as pediatric otolaryngology (P <.001) and neurotology (P =.008). Regional differences were also observed, with specific AAO‐HNS regions showing shorter wait times. The model achieved a conditional R‐squared value of 0.947. Conclusion: This study reveals disparities in wait times for otolaryngology care based on insurance type, with extended wait times for Medicaid beneficiaries. The findings highlight a potential access to care disparity, which begets the need for strategies that ensure equitable access to otolaryngology care and further research to understand the underlying reasons for these potential disparities. [ABSTRACT FROM AUTHOR]

Background: In patients with infectious diseases, remote consultation (RC) may be questionable compared with face-to-face office consultation (OC), not only because of the lack of physical examination but also because of the risk of overprescribing antibiotics (ATBs). Aim: To analyse ATB prescription in OC versus RC in a sample of French GPs. Design & setting: This is a retrospective observational cohort study in general practice in 2021. Anonymised data were collected from voluntary GPs. Method: The influence of the mode of consultation on ATB prescription was analysed using a χ² test. A secondary multivariate analysis investigated the factors influencing the use of OC or RC in patients who received at least one ATB. Results: In total, 35 503 consultations with an identifiable rating were included, corresponding to seven doctors' activities, practising with five locums and three residents. ATBs were prescribed in 10.41% of RCs and 6.77% of OCs (P<0.01). RC was associated with more frequent prescription of ATBs for respiratory and ear, nose, and throat (ENT) viral infections and urinary tract infections. For patients aged 20–40 years, ATB prescription was more associated with RC. Conclusion: RC is associated with a more frequent ATB prescription than OC, mostly for patients aged 20–40 years, who are most likely to use new technologies; and for urinary tract infections or respiratory and ENT viral infections. Further studies on RC outcomes should be conducted to better analyse the impact of RC on the prescribing of ATBs. [ABSTRACT FROM AUTHOR]

The inaugural total laryngectomy in history was conducted by Billroth in 1873. Nevertheless, significant enhancements to the technique were achieved through the contributions of Gluck, Sorensen, and various other surgeons. Throughout the twentieth century, advancements in anesthesia, infectious disease, hospital hygiene, antibiotic therapy, resuscitation, and the expertise of numerous laryngologists elevated total laryngectomy to a pivotal surgical intervention in head and neck surgery. The latter half of the twentieth century witnessed a paradigm shift with the emergence of organ preservation protocols. Total laryngectomy became the preferred choice for patients experiencing radiotherapy failure. However, the widespread use of laryngeal conservative treatments appears to be correlated with a decline inoverall survival rates in theUnited States and Europe. The evolutionof new minimally invasive surgical approaches in the twenty-first century may usher in a revolutionary era in the management of laryngeal carcinoma, offering the potential for improved survival and functional outcomes. [ABSTRACT FROM AUTHOR]

Background: Fronto-ethmoidal meningoencephalocele is an uncommon pathology. Most of the cases present a history of trauma or paranasal surgical intervention. Spontaneous development of such pathology is extremely rare. The aim of this case report was to demonstrate a rare appearance of spontaneous fronto-ethmoidal meningoencephalocele in an adult male with high-quality images in multiple modalities used in radiology. Case presentation: This case report demonstrates an extremely rare pathology of spontaneous development of fronto-ethmoidal meningoencephalocele in a 50-year-old male. The patient complained of swelling involving the nasal bridge, the left side of the nose, and the left cheek for more than 20 years, which was spontaneous without any trauma or surgical intervention. The patient underwent radiological investigations of ultrasonography, computed tomography of the paranasal sinus, and contrast-enhanced magnetic resonance imaging of the brain. The diagnosis of spontaneous development of left fronto-ethmoidal meningoencephalocele abutting the left orbit was made. No other complications of the brain tissue were noted. Conclusions: Knowledge about etiopathogenesis and various types of meningoencephalocele helps manage this pathology. [ABSTRACT FROM AUTHOR]

Objective: In our study, it is aimed to investigate the level of knowledge of family physicians working in primary health care organizations about Ear Nose and Throat (ENT) diseases, to examine how they manage frequently admitted ENT patients, to identify the problems they experience during examination and to examine the effect of the training given. Methods: Participants were first administered a 30-question pre-test created by the researcher based on the literature. Then, a collective training lasting 2 days and 1.5 hours per day was given by an ENT specialist from the researchers and a post-test was applied. Afterwards, the topics in which the researchers made the most mistakes or remained uninterpreted were recorded and a training program including these topics was created and training was given. Results: Of the 21 family physicians over 30 years of age, 2 (14,29%) were male and 18 (85,71%) were female. When the time of graduation from medical school of the family physicians in the study was analyzed, the number of family physicians with 5-10 years of medical school graduation was 4 (19,05%), 10 (47,62%) with 10-20 years of medical school graduation, and 7 (33,33%) with more than 20 years of medical school graduation. All of the family physicians who participated in the study think that ENT education is important for primary care medicine. Conclusions: ENT diseases are common in primary care. In order for family physicians to manage their patients more comfortably, we believe that rotations in the field of ENT diseases in the postgraduate period would be appropriate. [ABSTRACT FROM AUTHOR]

Background: To investigate the perception of young European otolaryngologists (OTOs), i.e., head and neck surgeons, toward transoral robotic surgery (TORS). Methods: Members of the Young Confederation of European Otorhinolaryngology-Head and Neck Surgery and Young Otolaryngologists of International Federation of Otorhinolaryngological Societies were surveyed about TORS perception and practice. Results: The survey was completed by 120 young OTOS (26%). The most important barriers to TORS were robot availability (73%), cost (69%), and lack of training (37%). The participants believed that the main benefits include better surgical filed view (64%), shorter hospital stay (62%), and better postoperative outcomes (61%) than the conventional approach. Head and neck surgeons considered cT1-T2 oropharyngeal cancers (94%), resection of base of tongue for sleep apnea (86%), or primary unknown cancer (76%) as the most appropriate indications. A total of 67% of TORS surgeons assessed themselves as adequately trained in TORS. Conclusions: Young European OTOs report positive perception, adoption, and knowledge of TORS. The cost-related unavailability and the lack of training or access are reported to be the most important barriers for the spread of TORS. [ABSTRACT FROM AUTHOR]

Summary: Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same‐day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre‐operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time‐series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre‐intervention and 52 of 619 (8.4%) cases post‐intervention. The cancellation rate decreased by 2.7% (95%CI 1.6–3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1–0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21–61 [0–288]) pre‐intervention to 31 (20–51 [1–250]) post‐intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post‐intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre‐intervention to 4.5% post‐intervention (p = 0.03). An anaesthetist‐driven, clinical informatics‐based bundle intervention decreases same‐day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery. [ABSTRACT FROM AUTHOR]

Objectives: During the COVID-19 pandemic, various non-pharmaceutical interventions such as individual hygiene practices like hand washing, social distancing, and mandates for the use of masks in public spaces were implemented to reduce the spread of the disease. Otitis media (OM) is a common infectious disease. How the changed environment due to the COVID-19 pandemic has influenced the prevalence of infectious diseases like OM is not known. This study aimed to investigate how OM prevalence and trends changed during COVID-19 in Korea. Methods: OM patient data from 2017 to 2021 were extracted from the Health Insurance Review and Assessment Service database. Patients diagnosed with disease code H66 (suppurative and unspecified otitis media) were selected for analysis. Data on OM prevalence, gender, region, medical institution, and number of ventilating-tube prescriptions were analyzed. All age groups were included, and ages were categorized into 5-year ranges Results: The number of patients diagnosed with the OM disease code decreased continuously from 2017 to 2021 (1 598 205, 1 560 178, 1 520 948, 983 701, and 734 901). The average OM prevalence per 1000 persons decreased by 45.0% from 30.2 in 2017 to 2019 to 16.6 in 2020 to 2021. The change of OM prevalence was greater for the 0 to 5 age group than other age groups. The decrease in average prevalence per 1000 persons was greatest in the 0 to 5 age group (48.6% decrease from 358.2 in 2017-2019 to 184.1 in 2020-2021). The impact of environmental changes on ventilation-tube insertion was smaller than on OM prevalence. The average number of ventilating-tube insertions decreased by 28.1% from 27 311 in 2017 to 2019 to 19 650 in 2020 to 2021. Conclusions: OM prevalence decreased by 45.0%, and the number of ventilating-tube insertions decreased by 28.1% in Korea during COVID-19. [ABSTRACT FROM AUTHOR]

Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children's curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic caused major disruptions to healthcare services in 2020, delaying cancer diagnosis and treatment. While early-stage thyroid cancer often progresses slowly, it is crucial to determine whether treatment delays associated with the pandemic have impacted the clinical presentation and management of advanced-stage thyroid cancer. The purpose of our study was to determine the impact of the early COVID-19 pandemic on thyroid cancer presentation and treatment times. Utilizing the National Cancer Database, chi-squared tests and regression analyses were performed to compare patient demographic and clinical characteristics over time for 56,011 patients diagnosed with primary thyroid cancer who were treated at the Commission on Cancer-accredited sites in 2019 and 2020. We found that thyroid cancer diagnoses decreased between 2019 and 2020, with the biggest drop among patients with cT1 disease relative to other T stages. We also found that patients diagnosed with thyroid cancer in 2020 had similar treatment times to patients diagnosed in 2019, as measured by both the time between diagnosis and start of treatment and the time between surgery and start of radioactive iodine therapy. Overall, our study suggests that resources during the pandemic were allocated to patients with advanced thyroid disease, despite a decrease in diagnoses. [ABSTRACT FROM AUTHOR]

The demand for ear, nose, and throat (ENT) care significantly contributes to the workload in outpatient departments (OPDs) worldwide, including Thailand. However, the epidemiology of ENT diseases in Thai OPDs has not been thoroughly reported. Therefore, this study aimed to assess and describe the epidemiology of these conditions among patients attending the ENT clinic at Thung Song Hospital, marking the first epidemiological report of southern Thailand. This retrospective, descriptive study spanned four years and observed the number of ENT patients. The comprehensive dataset revealed a total of 34,848 ENT visits and 12,712 new cases within the ENT clinic's OPD, averaging 3,178 case instances annually. Notably, over a quarter of the patients were classified as elderly, aged 60 years or older. Of significance, the prevalence of ENT diseases among females exceeded that of males by more than 15% each year. Specific age groups revealed distinct prevalent conditions: otitis externa was most common among children, benign tumors prevailed in adults, and sensorineural hearing loss was prominent among the elderly. This study endeavor aims to deepen the understanding of the epidemiology of these diseases. Such investigations could guide the refinement of healthcare approaches targeting ENT-related ailments. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has led to a major public health crisis. Residents entered the frontline in triaging and treating COVID-19 patients, working overtime to meet the growing demand. Surgical practice and educational activities were restricted, thus affecting resident training. There was also a great risk to their mental health. Our study aims to assess the academic impact and quality of life including mental health status among year I, year II and year III otorhinolaryngology residents during the pandemic. A cross-sectional study was conducted among postgraduates and junior residents working in otorhinolaryngology departments in institutions across South India in October 2020. Quality of life, severity of anxiety and depression, and academic impact were assessed using the WHOQOL-BREF, GAD-7, PHQ-8 and Academic impact questionnaires respectively via Google Forms. A total of 303 responses were obtained. Inpatient and outpatient clinical activity were affected irrespective of the year of training. Surgical training was also affected especially among the final-year residents (year III) with a mean score of 4.42. The maximum median WHOQOL-BREF score of 14.66 was found in the social domain and 13.33 in the psychological and social domains in men and women respectively. The majority (43%) of 114 men had mild anxiety, while among women, a slight preponderance (33.9%) of severe anxiety was noted. Most of the residents (75% of men and 66.6% of women) had no symptoms suggestive of depressive disorder, however, 19.3% of the men and 29.6% of the women were found to have major depression. The impact of the pandemic on resident training and mental health has been immense. The study outcome may help residents comprehend and perceive the extent of the same, and explore methods to be equipped and overcome similar circumstances in the future. [ABSTRACT FROM AUTHOR]

Diagnostic accuracy is vital in otorhinolaryngology for effective patient care, yet diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists can occur. However, studies investigating such mismatches in low-resource healthcare environments are limited. This study aims to analyze diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. A publicly available dataset assessing diagnostic outcomes from non-otorhinolaryngology clinicians and ENT specialists was analyzed. The dataset included demographic characteristics, referral diagnoses, and final ENT specialist diagnoses. Descriptive statistics and appropriate statistical tests were employed to assess the prevalence of diagnostic mismatches and associated factors. The analysis comprised 1544 cases. The prevalence of diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists was 67.4%. Certain specific ENT diseases demonstrated higher frequencies of diagnostic mismatches. Factors such as mismatch in the diagnosis and compliance of patient were found to influence the occurrence of diagnostic mismatches. This study highlights the presence of diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. The prevalence of these mismatches underscores the need for improved diagnostic practices in such settings. Factors contributing to diagnostic mismatches should be further explored to develop strategies for enhancing diagnostic accuracy and reducing diagnostic errors in otorhinolaryngology. [ABSTRACT FROM AUTHOR]

Key points: Chatbot Generative Pre‐trained Transformer (ChatGPT)‐4 indicated more than twice additional examinations than practitioners in the management of clinical cases in rhinology.The consistency between ChatGPT‐4 and practitioner in the indication of additional examinations may significantly vary from one examination to another.The ChatGPT‐4 proposed a plausible and correct primary diagnosis in 62.5% cases, while pertinent and necessary additional examinations and therapeutic regimen were indicated in 7.5%–30.0% and 7.5%–32.5% of cases, respectively.The stability of ChatGPT‐4 responses is moderate‐to‐high. The performance of ChatGPT‐4 was not influenced by the human‐reported level of difficulty of clinical cases. [ABSTRACT FROM AUTHOR]

Background: Driving capacity is affected by vestibular disorders and the medications used to treat them. Driving is not considered during medical consultations, with 92 per cent of patients attending a centre for dizziness not discussing it with the doctor. Objective: To investigate if medical record prompts facilitate dizziness and driving conversations in ENT balance clinics. Methods: A questionnaire was designed to reflect the current standards of practice and advice given regarding driving and dizziness during balance clinic consultations. Results: Medical record prompts facilitated the improved frequency and recording of shared decision-making conversations about driving and dizziness in 98 per cent of consultations. Conclusion: This study highlights the benefits of medical record prompts for documented and accurate shared decision-making conversations surrounding dizziness, vertigo, vestibular conditions and driving. This potentially improves safety for all road users, and protects the patient and clinician in the event of road traffic accidents and medico-legal investigations. [ABSTRACT FROM AUTHOR]

Objective: To examine the newly established role of a primary contact physiotherapist in an ENT clinic, in an Australian cohort and context, over two phases of development. Methods: A retrospective cohort study was conducted with data collected from a medical record audit. Over the study duration, the primary contact physiotherapist completed initial appointments with patients; follow-up appointments were subsequently conducted by medical staff. Results: There was a 46 per cent reduction in patients with suggested vestibulopathy requiring an ENT medical review. This reduction could hypothetically increase to 71 per cent with follow-up primary contact physiotherapist appointments. Improvements in the service delivery model and a primary contact physiotherapist arranging diagnostic assessments could improve waitlist times and facilitate better utilisation of medical staff time. Conclusion: The primary contact physiotherapist can help in the management of patients with suspected vestibulopathy on an ENT waitlist. This is achieved through: a reduction of patients requiring ENT review, improvements to waitlist time and improved utilisation of medical specialists' time. [ABSTRACT FROM AUTHOR]

Objective: Vestibular migraine is a newly recognised and debilitating condition. This article aims to provide an overview of what is known of vestibular migraine, delineating its diagnostic criteria and presenting some initial management strategies to aid ENT professionals in delivering optimal care when patients first present to the otolaryngology clinic. Method: Although traditionally underdiagnosed, there are now clearly defined diagnostic criteria to aid accurate diagnosis of vestibular migraine. Results: A detailed history and clinical examination are the cornerstone of the diagnostic process, but supportive evidence is required from appropriate audio-vestibular tests and imaging. Conclusion: This is a unique condition that commonly initially presents to ENT. This article provides a summary of diagnostic and management strategies to facilitate early diagnosis and first-line treatment that can be employed in general ENT settings, which may be particularly useful given the limited availability of specialist audio-vestibular medicine and neuro-otology services. [ABSTRACT FROM AUTHOR]

Background: Cocaine is one of the most used recreational drugs. Whilst medical uses exist, chronic recreational nasal use of cocaine is associated with progressive destruction of the osseocartilaginous structures of the nose, sinuses and palate – termed cocaine-induced midline destructive lesions. Case report: A 43-year-old male with a history of chronic cocaine use, presented with conductive hearing loss and unilateral middle-ear effusion. Examination under anaesthesia revealed a completely stenosed left Eustachian tube orifice with intra-nasal adhesions. The adhesions were divided and the hearing loss was treated conservatively with hearing aids. Whilst intra-nasal cocaine-induced midline destructive lesions are a well-described condition, this is the first known report of Eustachian tube stenosis associated with cocaine use. Conclusion: This unique report highlights the importance of thorough history-taking, rhinological and otological examination, and audiometric testing when assessing patients with a history of chronic cocaine use. This paper demonstrates the complexity of managing hearing loss in such cases, with multiple conservative and surgical options available. [ABSTRACT FROM AUTHOR]

Objectives: There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs. Method: Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians. Results: The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts. Conclusion: All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience. [ABSTRACT FROM AUTHOR]

Objective: Tonic tensor tympani syndrome is found in a subset of tinnitus patients who experience intra-aural and peri-aural symptoms, in addition to their tinnitus, in the absence of clinically detectable pathology. As the syndrome has not been widely reported, this study aims to determine its prevalence and evaluate the effectiveness of current management. Methods: The tinnitus management clinic records of patients over the past six years were assessed to identify tonic tensor tympani syndrome patients and track their progress based on patient-reported Tinnitus Handicap Index scores. Patients with reversible ear pathology and temporomandibular joint disorder were excluded. Results: It was found that 13 per cent of the tinnitus management patients fulfilled the criteria for tonic tensor tympani syndrome and 94 per cent of those who returned for follow up showed an improvement in their Tinnitus Handicap Index grades. Conclusion: This study suggests that tonic tensor tympani syndrome is a significant problem among tinnitus patients and current tinnitus management strategies contribute effectively to helping such patients habituate to their symptoms. [ABSTRACT FROM AUTHOR]

Objectives: To describe findings from an otolaryngology-specific needs assessment tool in Zimbabwe. Methods: Surveys were developed and shared with Low-Middle Income Country (LMIC) hosting institutions in Zimbabwe and to High-Income Country surgical trip participants (HIC). Respondents were otolaryngologists identified online and through professional networks who had participated in a surgical trip. Results: The most common procedures Zimbabwe otolaryngologists reported treating were adenotonsillectomy (85.7%), chronic rhinosinusitis (71.4%), chronic otitis (57.1%), and head and neck tumor intervention (57.1%). The most common untreatable conditions that host physicians wanted to treat were skull base surgery (71.4%), flap reconstructions (57.1%), and laryngotracheal reconstruction (57.1%). The largest discrepancy between host desires and visiting team offerings were flap reconstruction (57.1%), nasal bone deformities (37.1%), and laryngotracheal reconstruction (17.1%). Perceptions of shortterm surgical trips (STST) were recorded for host and visiting teams, and important differences between the public and private sectors of care in Zimbabwe were also identified. Conclusion: The surveys utilized in this study served as a bidirectional needs assessment of the requirements and care goals of host institutions and visiting teams in Zimbabwe. Differences between public and private sectors of care, particularly regarding infrastructure, resources, and surgical goals, were revealed, and the results can be utilized as part of efforts to maximize efforts within global surgical partnerships. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to ascertain the prevalence of left-handedness (LH) among otolaryngology--head and neck surgery (ORLHN) practitioners, investigate dexterity's impact on LH trainees, and identify common patterns in their training to improve the training experience. Methods: A web-based survey was distributed anonymously via email to members of the Saudi Otorhinolaryngology Society. The survey targeted ORLHN attending consultants, board-certified registrars, and current residents. It consisted of three sections: the first focused on the experience of attending consultants in training LH individuals, the second investigated common maneuvers employed by rhinologists, and the third explored the experiences and impacts reported by LH trainees. Results: The study included 174 participants, and found a 13.2% LH prevalence among them. Rhinologists showed disparities, with 50% advising trainees to stand on the left side of the bed and use their left hand for the scope, whereas the other half asked otherwise. Additionally, 94.4% of the participants had not encountered any courses specifically tailored for LH trainees. Among LH trainees, 57% and 41% reported difficulties in learning and performing side-specific procedures such as functional endoscopic sinus surgery and endoscopic septoplasty, respectively, often attempting to switch to their nondominant hand, and feeling disadvantaged due to their laterality. Conclusions: Left-handedness presents challenges for both LH trainees and their trainers in surgical specialties, particularly in ORLHN, in which specific positioning and instruments are crucial to gain access to the desired surgical field. Despite these challenges, there is insufficient support for LH individuals. We recommend encouraging LH trainees to openly disclose and discuss their left-handedness, provide them with mentors, establish standardized operating room setups and techniques, supply appropriate instruments, and demonstrate flexibility in accommodating their needs. Level of evidence: Level 5. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease 2019 accelerated the use of virtual visits within health care. We examined the utility of telemedicine for conducting visits in a tertiary head and neck practice. Methods: A retrospective study was conducted on patients presenting via video to a tertiary-level head and neck clinic between January 2020 and December 2020. Patient demographics were collected in addition to visit indication, diagnostic imaging/tests at the time of visit, and post-visit plan. Visits were deemed successful if evaluation by video was sufficient in determining a clinical plan and did not require deferment of recommendations for subsequent in-person consult visits and/or work-up (labs, imaging). Logistic regression was performed to identify variables that served as significant predictors of successful video visits. Results: A total of 124 video visits were reviewed. Video visits were successful for the initial evaluation 88.7% of the time (n = 110). Computerized tomographic scans were the most available diagnostic test, available for 54% of patients (n = 67), followed by biopsy report 30.6% (n = 38). Visit indication had a statistically significant effect on whether a treatment plan could be made (p = 0.024). For new patients with parotid masses (n = 42), definitive treatment plans could be made 97.6% of the time (n = 41). Patients presenting with an indication of thyroid mass (odds ratio: 0.19 (confidence interval: 0.00072–0.50), p = 0.018) and other neck mass (odds ratio: 0.035 (confidence interval: 0.0014, 0.90), p = 0.043) were at significantly lesser odds than parotid patients to have a successful video visit. Discussion: In this study, virtual visits were successful for a high percentage of head and neck visits, particularly among patients seeking evaluation for parotid-related concerns. [ABSTRACT FROM AUTHOR]

Background: Epistaxis is a common condition in daily clinical practice and is presented either in emergency units or outpatient otolaryngology clinic. There is no relevant local study regarding its prevalence and clinical profile. Objectives: To estimate the prevalence and demographic and clinical profile of patients with epistaxis. Materials and methods: We prospectively reviewed the patients with epistaxis during the year 2021. Detailed information regarding every subject’s demographic and clinical aspects was registered and analyzed. Results: Of the 6645 patients visiting the private clinic, 344 (5.2%) had epistaxis. The highest proportion of patients was registered in June (12.5%). There were 53.5% males, 48.3% from the age group 11–18 years, and 80.02% lived inside the city. Around 60% were presented within 1–2 days from the bleeding onset. Unilateral epistaxis was seen in 74.4% of the cases (143 from the right and 113 from the left side). The majority of bleeding was from the anterior part (97.1%) and with mild form (96.5%). About 80% of the subjects had recurrent attacks of epistaxis. Early presentation (1–2 days) was seen more in the age group > 50 years (9/12), bleeding from the posterior part (10/10), severe epistaxis (11/12), patients with the first attack of bleeding (77%), and with idiopathic (19.77%) cause (P-value < 0.05). The majority of the cases (84.3%) were treated conservatively. Conclusion: The prevalence of epistaxis was 5.2%. June registered the highest cases of bleeding. The age group of 11–18 years and males were mostly affected. The age, site, severity, cause, and patient with the first attack were significantly affected the presentation time. Conservative treatment was effective in the majority of cases. [ABSTRACT FROM AUTHOR]

Objectives: Surgical fires, particularly within Otolaryngology, remain a surprisingly frequent and devastating complication of laser‐related surgery in the oropharynx and airway; Current estimates suggest anywhere from 200 to 600 surgical fires per year in the United States, with 20%–30% of these occurring as a complication of laser surgery and 90%–95% of these occurring in the head and neck region. Unfortunately, the complications of laser surgery in the airway may include respiratory failure, airway burns with stenosis, and may result in mortality. The most commonly utilized endotracheal tube for protection against inadvertent laser strikes, the Laser‐Shield II tube (Medtronic), was removed from the commercial marketplace in 2016 after cases of airway fires were reported as a result of feature deficiencies in the product (FDA MAUDE Database review). Since the demise of the Laser‐Shield II tube, alternatives such as the Mallinckrodt laser tube and handmade reinforced tubes have been utilized, although shortcomings in design and features have made these options less appealing to practicing Otolaryngologists. Creating a laser‐safe endotracheal tube is critical for safe upper airway surgery. This paper evaluates new technologies, materials, and technical innovations in endotracheal tubes that may advance patient safety in laser‐assisted Otolaryngology procedures. Study Type: This paper evaluates new technologies, materials, and technical innovations in endotracheal tubes that may advance patient safety in laser‐assisted Otolaryngology procedures. Methods: First, this article reviews the background of laser surgery in Otolaryngology and the consequent risk of surgical fire with resultant development of laser‐resistant endotracheal tubes and commercial availability. Next, a review of claims and national database review of product failures related to previous laser‐resistant endotracheal tubes is performed through the FDA MAUDE database. This includes an evaluation of cases: review of techniques in laser airway surgery including spontaneous ventilation, decreased O2 concentration, currently available endotracheal tubes including "handmade" fixes for perceived safety risks, and determination of failure points for previous laser‐resistant endotracheal tubes. Third, the paper reviews the requested features of an "ideal" laser‐resistant endotracheal tube. Finally, the paper reviews failure testing from an initial, unsuccessful attempt at material development and the consequent development of alternative technologies that address failure points from previous endotracheal tubes and addresses requested features with a detailed analysis of FDA‐approval required testing. Extensive lab testing of the new tube predicts a significant reduction of risk in vivo with inability to perforate the shaft or cuff of the tubes under standard working conditions. Results: While no iteration of a laser‐resistant endotracheal tube is entirely laser safe, advances in technology can improve the safety profile of these devices. The new tube contains a double cuff, a soft and flexible shaft to minimize laryngeal insertion trauma, a smooth external surface, a tight‐to‐shaft balloon, and methylene blue dye in the cuff to alert the user to inadvertent penetration. These characteristics were the most requested by laryngologists in the development of a new laser‐resistant tube. The newest endotracheal tube brings the features most requested by Otolaryngologists in a laser‐resistant tube, and improves the safety profile over previous tubes. Conclusion: Development of a new endotracheal tube represents an advancement in safety for the Otolaryngologist in laser airway surgery. Understanding the previous history and the science behind surgical fire formation is essential in advancing safety for patients in the future. Level of Evidence: N/A Laryngoscope, 134:S1–S12, 2024 [ABSTRACT FROM AUTHOR]

Objective: To review the published literature on decisional regret in adult patients undergoing operative otolaryngology procedures. The primary outcome was decisional regret scale (DRS) scores. DRS scores of 0 indicate no regret, 1–25 mild regret, and >25 moderate to strong/severe regret. Data Sources: A comprehensive librarian‐designed strategy was used to search MEDLINE, Embase, and CINAHL from inception to September 2023. Review Methods: Inclusion criteria consisted of English‐language studies of adult patients who underwent operative otolaryngology treatments and reported DRS scores. Data was extracted by two independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta‐analyses Extension for Scoping Reviews (PRISMA‐ScR) guidelines were followed. Oxford Centre's Levels of Evidence were used for quality assessment. Results: In total, 6306 studies were screened by two independent reviewers; 13 studies were included after full‐text analysis. Subspecialties comprised: Head and neck (10), endocrine (1), general (1), and rhinology (1). The DRS results of the included studies spanned a mean range of 10.1–23.9 or a median range of 0–20.0. There was a trend toward more decisional regret after large head and neck procedures or when patients underwent multiple treatment modalities. Depression, anxiety, and patient‐reported quality of life measures were all correlated with decisional regret. Oxford Centre's Levels of Evidence ranged from 2 to 4. Conclusion: This is the first comprehensive review of decisional regret in otolaryngology. The majority of patients had no or mild (DRS <25) decisional regret after otolaryngology treatments. Future research on pre‐operative counseling and shared decision‐making to further minimize patient decisional regret is warranted. Level of Evidence: N/A Laryngoscope, 134:2562–2567, 2024 [ABSTRACT FROM AUTHOR]

Objectives: To systematically review the literature regarding previously described peritonsillar abscess (PTA) drainage simulation. Data Sources: PubMed, Scopus, Web of Science, Ovid, and Cochrane. Review Methods: A search of the abovementioned databases was performed in August 2022 using the terms "peritonsillar abscess/quinsy," "incision/drainage/aspiration," and "simulation." No time restrictions were applied. We included studies that clearly described how their PTA models were built and underwent validation from experts and/or evaluation from trainees. Articles describing a model only without any evaluation and reports in languages other than English were excluded. Results: Our search initially yielded 80 articles after duplicate removal, 10 of which met our criteria and were included. Two studies trained participants on both needle aspiration and incision and drainage (I&D), four studies on I&D only, and four on needle aspiration only. 87.5% to 100% of junior residents reported minimal exposure to PTA prior to simulation. Five studies provided some form of validation to their models. The value of the simulators to train participants on skills received better appreciation than their anatomical fidelity. The perceived confidence level of trainees in managing PTA, which was assessed in 7 studies, substantially improved after training. Conclusion: PTA simulation improves the confidence of trainees to perform PTA drainage. There is, however, a lack of standardization and evidence regarding transfer validity among PTA simulators. The development of a standardized PTA simulator could allow for more widespread use and increase resident comfort with this procedure in a pre‐clinical setting. Level of Evidence: NA Laryngoscope, 134:2495–2501, 2024 [ABSTRACT FROM AUTHOR]

Schwannoma and angiosarcoma are rare occurrences. Angiosarcoma's occurrence in a preexisting schwannoma is a very rare event with only fifteen cases reported in the literature. We report the sixteenth case of angiosarcoma arising in a schwannoma, a 30-year-old male patient with a long-standing (15 years) history of right neck lump. The lump measured around 10x7 cm at the time of presentation and all cranial nerves were intact. We performed a fiberoptic laryngoscopy and a computed tomography scan of the head and neck with contrast. Our provisional diagnosis was a parapharyngeal space neoplasm, most likely a salivary gland malignancy. The tumor was excised surgically. On histopathology it contained two distinct tissue architectures representing a schwannoma and epithelioid angiosarcoma, also confirmed on immunohistochemistry. Literature review of these limited cases implicates a poor prognosis of the disease. The pathogenesis is uncertain, but the theories put forward suggest chronic vascular stasis or vascular endothelial proliferation as possible etiologies. The main takeaway of our report is to consider the potential of malignancy in long standing cases of schwannomas. Prompt surgical treatment should be offered, and the patient and their family be counselled for postoperative adjuvant treatment for better prognosis. [ABSTRACT FROM AUTHOR]

Objective: Large language models (LLMs) are used in various fields for their ability to produce human-like text. They are particularly useful in medical education, aiding clinical management skills and exam preparation for residents. To evaluate and compare the performance of ChatGPT (GPT-4), Gemini, and Bing with each other and with otorhinolaryngology residents in answering in-service training exam questions and provide insights into the usefulness of these models in medical education and healthcare. Methods: Eight otorhinolaryngology in-service training exams were used for comparison. 316 questions were prepared from the Resident Training Textbook of the Turkish Society of Otorhinolaryngology Head and Neck Surgery. These questions were presented to the three artificial intelligence models. The exam results were evaluated to determine the accuracy of both models and residents. Results: GPT-4 achieved the highest accuracy among the LLMs at 54.75% (GPT-4 vs. Gemini p=0.002, GPT-4 vs. Bing p<0.001), followed by Gemini at 40.50% and Bing at 37.00% (Gemini vs. Bing p=0.327). However, senior residents outperformed all LLMs and other residents with an accuracy rate of 75.5% (p<0.001). The LLMs could only compete with junior residents. GPT- 4 and Gemini performed similarly to juniors, whose accuracy level was 46.90% (p=0.058 and p=0.120, respectively). However, juniors still outperformed Bing (p=0.019). Conclusion: The LLMs currently have limitations in achieving the same medical accuracy as senior and mid-level residents. However, they outperform in specific subspecialties, indicating the potential usefulness in certain medical fields. [ABSTRACT FROM AUTHOR]

Objective: Muscle tension dysphonia (MTD) is a functional voice condition that causes irregular and imbalanced laryngeal and paralaryngeal muscle activation. Our study aimed to examine the acoustic characteristics of patients with MTD and reveal the differences between genders. Methods: The study retrospectively reviewed the acoustic examination findings from the files of patients diagnosed with MTD during evaluations in the laryngology outpatient clinic at a tertiary reference hospital between 2015 and 2022. The parameters assessed in prolonged vowel phonation analysis were fundamental frequency (F0), jitter, shimmer, noise-to-harmonic-to-ratio, and soft phonation index; in the counting task analysis, they were intensity, frequency, and semitone. Gender differences in acoustic measurements obtained during prolonged vowel phonation and counting tasks were also examined. Results: The study included 80 individuals diagnosed with MTD. Although all parameters in the acoustic analysis of/a/ phonation were increased, differences were statistically significant only in the F0 and jitter parameters between females and males (p≤0.05). In the analysis of the counting task, the mean and minimum F0 parameters were significantly higher in females than in males (p=0.000). The mean dB level was decreased, particularly in the counting task, but the results for the intensity parameter did not differ significantly between genders (p>0.05). Conclusion: The values in the acoustic voice analysis parameters of patients with MTD were determined. These acoustic parameters are thought to guide the clinician in evaluating voice and determining voice therapy goals for MTD patients. [ABSTRACT FROM AUTHOR]

Objective: This study aims to present a series of patients with disseminated rhinosporidosis with diagnostic and therapeutic features. Methods: A retrospective study was conducted in a tertiary health care centre in South India from 2007 to 2020 with disseminated rhinosporidiosis. Twelve patients with multiple sites of involvement like the nose, nasopharynx, oropharynx, larynx, lacrimal sac and skin were included in the study. All patients underwent surgical excision, followed by peroral dapsone for one year. Results: The age group was around 30-55 years, with male predominance (11:1). Pond bathing history was present in 50% (n=6). The most common site of lesion was the nose (100%), oropharynx (83.3%), skin (75%), larynx (50%) and less commonly, nasopharynx (41.6%) and lacrimal sac (25%). One patient underwent surgery four times (8.3%), followed by thrice and twice by five (41.6%) and six (50%) patients, respectively. On two years of follow-up, two patients (16.6%) had a recurrence in the nose and larynx whereas eight patients (66.6%) had no recurrence and two patients (16.6%) were lost to follow-up. Conclusion: This original article highlights the rare occurrence of disseminated rhinosporidiosis, the possibility of which should be kept in mind, mainly when two or more sites are involved. The most significant number of disseminated rhinosporidiosis cases in the literature is reported here. Dissemination with the cutaneous and multisite disease is rarely reported and poses difficulty in management. Early diagnosis and intervention prevent the dissemination of spores into various parts of the body. [ABSTRACT FROM AUTHOR]

Background: Outpatient waiting list figures have substantially increased over the last 3 years due to the effects of a global pandemic and cyber-hacking crisis. Multidisciplinary initiatives are essential to try to reduce the burden on overwhelmed medical and surgical specialties. Objective: The purpose of the study is as follows: (1) to demonstrate the potential for a problem-specific clinic to help ease the burden on an overwhelmed specialty and identify high-risk patients who may benefit from earlier surgical intervention and (2) to provide supervised clinical training to our clinical nurse specialist. Methods: A retrospective audit of outpatient referrals awaiting an appointment was conducted, and a new outpatient clinic was formed for patients referred with tonsil issues with or without additional complaints. Results: Two hundred ninety-five patients with an average waiting time of 14.4 months were offered an outpatient appointment over 5 months. Sixty-four percent (n = 189) attended their appointments, and 59.3% (n = 112) of these were listed for surgery. One hundred fifty-eight patients were able to be discharged back to the care of their general practitioners. Discussion/conclusion: This outpatient clinic identified a large number of patients waiting significant periods of time for an outpatient appointment and allowed a definitive clinical decision to be made with most patients being either discharged or listed for surgery. Initiatives such as this offer the possibility of reducing the burden of long waiting times on individual institutions. [ABSTRACT FROM AUTHOR]

INTRODUCTION. The methodology of quality of life research has justified the need to develop a new direction of interdisciplinary research. The research aimed to study the impact of main ear-nose-throat diseases on quality of life parameters and the level of anxiety in adolescents of pre-conscription age. MATERIALS AND METHODS. The study was conducted from 2014 to 2020. The sample consisted of 720 adolescents of pre-conscription age from 15-to 17 years old. The cross-sectional survey was conducted in 4 randomly selected secondary schools of Yerevan. Out of the total participants included in the 351 had ear-nose-throat pathology and 369 did not. The dependence of the PedsQLTM 4.0 questionnaire domains on external factors was assessed. Reliability of the questionnaire was assessed using Cronbach's a-coefficient. The Taylor Manifest Anxiety Scale was designed to measure anxiety. RESULTS. The prevalence of ear-nose-throat diseases among young men of pre-conscription age (15,16 and 17 years old) was 48.8±1.9%. The rate was significantly higher in the group of 17-year-old adolescents compared to 15-year-old adolescents. Throat diseases ranked first in prevalence. All the indicators of quality of life of pre-conscription youth with ear-nosethroat diseases were lower compared to the group without ear-nose-throat diseases. Chronic inflammatory diseases of the nasal cavity and paranasal sinuses had the most negative impact on self-esteem. It was found that the expressed and very high anxiety was significantly higher in the group of persons with ear-nose-throat diseases compared to practically healthy people. CONCLUSION. In pre-conscription youth with ear-nose-throat -diseases a lower level of the domains of quality of life was registered in comparison with the group of practically healthy people. Chronic diseases of the nasal cavity and paranasal sinuses had the most negative impact on the quality of life. Adolescents with ear-nose-throat diseases more often show increased anxiety compared to the practically healthy ones. [ABSTRACT FROM AUTHOR]

Objective: To study the performance of Chatbot Generative Pretrained Transformer‐4 (ChatGPT‐4) in the management of cases in otolaryngology–head and neck surgery. Study Design: Prospective case series. Setting: Multicenter University Hospitals. Methods: History, clinical, physical, and additional examinations of adult outpatients consulting in otolaryngology departments of CHU Saint‐Pierre and Dour Medical Center were presented to ChatGPT‐4, which was interrogated for differential diagnoses, management, and treatment(s). According to specialty, the ChatGPT‐4 responses were assessed by 2 distinct, blinded board‐certified otolaryngologists with the Artificial Intelligence Performance Instrument. Results: One hundred cases were presented to ChatGPT‐4. ChaGPT‐4 indicated a mean of 3.34 (95% confidence interval [CI]: 3.09, 3.59) additional examinations per patient versus 2.10 (95% CI: 1.76, 2.34; P =.001) for the practitioners. There was strong consistency (k > 0.600) between otolaryngologists and ChatGPT‐4 for the indication of upper aerodigestive tract endoscopy, positron emission tomography and computed tomography, audiometry, tympanometry, and psychophysical evaluations. Primary diagnosis was correctly performed by ChatGPT‐4 in 38% to 86% of cases depending on subspecialty. Additional examinations indicated by ChatGPT‐4 were pertinent and necessary in 8% to 31% of cases, while the treatment regimen was pertinent in 12% to 44% of cases. The performance of ChatGPT‐4 was not influenced by the human‐reported level of difficulty of clinical cases. Conclusion: ChatGPT‐4 may be a promising adjunctive tool in otolaryngology, providing extensive documentation about additional examinations, primary and differential diagnoses, and treatments. The ChatGPT‐4 is more effective in providing a primary diagnosis, and less effective in the selection of additional examinations and treatments. [ABSTRACT FROM AUTHOR]

Objectives: Social media has enabled discussion of relevant topics within otolaryngology. With increasing academic discourse occurring on virtual platforms, it is important to examine who is influencing these discussions. This study thus aims to: (1) identify the top Twitter influencers in otolaryngology and (2) assess the relationship between Twitter influence and academic impact. Study Design: Cross‐sectional analysis. Setting: Twitter. Methods: The Right Relevance program was used to identify and rank the top 75 Twitter influencers, excluding organizations, according to the search terms "otolaryngology," "head and neck surgery," "ear nose throat," "rhinology," "head and neck," "laryngology," "facial plastics," and "otology." Demographic data and h‐index were collected for each influencer. Correlational analyzes were performed to assess the relationships between Twitter rank and geographic location, sex, subspecialty, and h‐index. Results: The majority of the top 75 influencers were otolaryngologists (87%), female (68%), and located in the United States (61%). General otolaryngology (n = 20, 31%) was more well‐represented than any individual subspecialty including facial plastics (n = 10, 15%), rhinology (n = 10, 15%), and neurotology (n = 9, 14%). There was a significant relationship between Twitter rank and h‐index (Spearman ρ value of –0.32; 95% confidence interval: –0.51 to –0.01; P =.006). Twitter rank was not significantly correlated with subspecialty, sex, or geographic location (P >.05). Conclusion: The majority of Twitter influencers within otolaryngology were otolaryngologists, female, and located in the United States. Social media influence is positively associated with academic impact among otolaryngologists. [ABSTRACT FROM AUTHOR]

Objective: To investigate medical student research productivity by institutions associated with otolaryngology residency programs and identify correlates of productivity. Study Design: Retrospective review. Setting: N/A. Methods: A systematic search for articles indexed on PubMed published by 116 programs from January 1, 2016 to February 28, 2021 was conducted. Primary outcomes were number of faculty publications, first‐author medical student publications and medical students from each institution. Secondary outcomes included geographic region, number of otolaryngology faculty members, and program rankings. Results: Nationally, the mean number of faculty per institution was 21.7 at the time of search. Over a 5‐year period, there was a mean 98.7 total publications and 15.8 medical student first‐author publications per institution consisting of a mean of 10.03 distinct medical students. One‐way analysis of variance showed no statistically significant difference in medical student productivity (P =.09) or department size (P =.12) between regions. Number of medical student first‐author publications positively correlated to number of faculty (R =.43, P <.05) and number of faculty publications (R =.63, P <.05). The top 30 programs ranked by United States News & World Report or National Institute of Health for funding had a statistically significantly greater mean number of medical student first‐author publications and distinct medical student first authors than all other programs (P <.05). Conclusion: Greater numbers of faculty members likely provide more mentorship and opportunities that allow medical students to engage in projects that lead to first‐author publications. These findings allow institutions to reflect on efforts in medical student engagement and provide data to students for career planning. [ABSTRACT FROM AUTHOR]

ChatGPT is a new artificial intelligence‐powered language model of chatbot able to help otolaryngologists in clinical practice and research. We investigated the ability of ChatGPT‐4 in the editing of a manuscript in otolaryngology. Four papers were written by a nonnative English otolaryngologist and edited by a professional editing service. ChatGPT‐4 was used to detect and correct errors in manuscripts. From the 171 errors in the manuscripts, ChatGPT‐4 detected 86 errors (50.3%) including vocabulary (N = 36), determiner (N = 27), preposition (N = 24), capitalization (N = 20), and number (N = 11). ChatGPT‐4 proposed appropriate corrections for 72 (83.7%) errors, while some errors were poorly detected (eg, capitalization [5%] and vocabulary [44.4%] errors. ChatGPT‐4 claimed to change something that was already there in 82 cases. ChatGPT demonstrated usefulness in identifying some types of errors but not all. Nonnative English researchers should be aware of the current limits of ChatGPT‐4 in the proofreading of manuscripts. [ABSTRACT FROM AUTHOR]

Ear- and hearing-related conditions pose a significant global health burden, yet public health policy surrounding ear and hearing care (EHC) in low- and middle-income countries is poorly understood. The present study aims to characterize the inclusion of EHC in national health policy by analysing national health policies, strategies and plans in English, French, Spanish, Portuguese and Arabic. Three EHC keywords were searched, including ear*, hear* and deaf*. The terms human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis and malaria were included as comparison keywords as these conditions have historically garnered political priority in global health. Of the 194 World Health Organization Member States, there were 100 national policies that met the inclusion criteria of document availability, searchable format, language and absence of an associated national EHC strategy. These documents mentioned EHC keywords significantly less than comparison terms, with mention of hearing in 15 documents, ears in 11 documents and deafness in 3 documents. There was a mention of HIV/AIDS in 92 documents, tuberculosis in 88 documents and malaria in 70 documents. Documents in low- and middle-income countries included significantly fewer mentions of EHC terms than those of high-income countries. We conclude that ear and hearing conditions pose a significant burden of disease but are severely underrepresented in national health policy, especially in low- and middle-income countries.

PURPOSE OF REVIEW: To highlight the need for comprehensive resource lists to provide baseline care of otolaryngologic conditions; to present a proposed list of essential equipment and services that may be applied toward surgical systems research, policymaking, and charitable efforts in global otolaryngology-head and neck surgery. RECENT FINDINGS: To provide effective and high-quality surgical care across care settings, there must be a global standard for equipment and ancillary services necessary to provide baseline care. Though there have been efforts to devise resource standards via equipment lists and appraisal tools, these have been limited in scope to general surgery, emergency care, and a few other subspecialty surgical contexts. Recent efforts have brought attention to the significant burden imposed by otolaryngologic conditions such as hearing loss, otitis media, head and neck cancer, head and neck trauma, and upper airway foreign bodies. Yet, there has not been a comprehensive list of resources necessary to provide baseline care for common otolaryngologic conditions. SUMMARY: Through an internal survey of its members, the Global Otolaryngology-Head and Neck Surgery Initiative has compiled a list of essential equipment and services to provide baseline care of otolaryngologic conditions. Our efforts aimed to address common otolaryngologic conditions that have been previously identified as high-priority with respect to prevalence and burden of disease. This expert-driven list of essential resources functions as an initial framework to be adapted for internal quality assessment, implementation research, health policy development, and economic priority-setting.

BACKGROUND: The COVID-19 pandemic has made facial masks an essential part of daily life. While protective facial masks are crucial to help the spread of viral infections, they are common causes of facial skin breakdown, acne, and superficial injuries. Masks with elastic ear loops are also particularly likely to cause ear pressure injuries. CASE REPORT: Herein, we present a case of a patient experiencing homelessness found to have significant postauricular wounds due to prolonged mask use in the context of the Covid-19 pandemic. These injuries led to bilateral erosion of the helix with partial avulsion of the ear and mask ear loops eroding into cartilage. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We describe a rare complication of mask use and highlight the difficulties the COVID pandemic has made in providing adequate care for chronic head and neck wounds amongst the homeless population. While PPE remains an important part of decreasing the risk of the spread of infections, it is important to recognize the vulnerabilities of the homeless population during the COVID pandemic and how best to care for novel auricular wounds.

Happy Holidays! The Philippine Society of Otolaryngology-Head and Neck Surgery (PSO HNS) Board of Trustees congratulates the Editorial Board of the Philippine Journal of Otolaryngology – Head and Neck Surgery (PJO-HNS), headed by Dr. Jose Florencio Lapeña, Jr., on the publication of this issue. Dr. Lapeña has been the editor-in-chief of the PJO-HNS for the past 18 years, and it has grown in scope and stature under his leadership. It is through the PJO-HNS that we achieve some of the objectives codified in our articles of incorporation. These articles state that the primary purpose of the PSO-HNS is to engage in the promotion of the welfare, training, and scientific advancement of ORL-HNS in the Philippines, particularly (among many other objectives), to develop programs to promote the exchange of scientific information among members, and to encourage, support and institute publication of scientific ORL-HNS literature for national and international consumption. This year, we will be proposing a new Vision for the PSO-HNS: To be a globally recognized society in ORL-HNS, driving innovation, collaboration, and excellence through an engaged community of Fellows and stakeholders by 2027. Part of the reason for the change was to facilitate recall of the vision statement. We want every Fellow of the Society to remember the vision so that individually and corporately, we can put this vision at the forefront of our plans and projects to ensure success. Part of the proposed Mission of the PSO-HNS is advancing innovation in ENT care by promoting research and development. The PJO-HNS will play an important role in achieving global recognition for the society by continuing its tradition of innovation and excellence in vetting, improving and publishing research papers from all over the world. Knowing our Vision and Mission is but the start of continuing our growth as a Society. To be truly relevant, we must look at the current situation of our nation and identify ways to improve the lot of the Filipino people, not just in terms of ENT care, but in all aspects of life that we can touch. The Society has increasingly focused on advocacies such as care for the environment, cancer consciousness, hearing health, road safety and the like. We have supported movements and statements for social justice, government accountability and PhilHealth reform. Let us continue to use our strength as a Society towards a better Philippines. I would like to share with you my life verse for this year. From the letter of Paul to the Galatians: “Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up.” Let us continue doing good for each Fellow, for the PSO-HNS as a whole, and for the Filipino people who need our care. His Blessings!

Abstract Introduction In pediatric tonsillectomy management, the consistent tracking of surgical outcomes and adherence to guidelines are vital. This study explores how a surgical dashboard can serve as a tool in research analysis, translating AAO‐HNSF guidelines into measurable performance improvements. Methods Using a prospective registry from three pediatric hospitals, a Tableau dashboard was constructed to graphically visualize key demographic and postoperative outcomes (including intensive care unit [ICU] utilization, 30‐day emergency department (ED) visits, and postoperative bleed rates) in children undergoing tonsillectomy from 2020 to 2024. From the dashboard data, a retrospective cohort study analyzing 6767 tonsillectomies was conducted from January 2, 2020, to June 20, 2023. Patients were categorized into low‐risk, OSA‐only (by ICD‐10 codes), and high‐risk groups based on comorbidities. Logistic regression identified factors influencing ED revisits and unplanned nursing calls. Three quality initiatives were assessed: preoperative school absence notes, perioperative dexamethasone recording, and post‐tonsillectomy parental education. Results A total of 2122 (31%) were low‐risk, 2648 (39%) were OSA‐only, and 1997 (30%) high risk. Risk factors that increased the likelihood of ED visits were high‐risk comorbidities (OR = 1.46; 95% CI = 1.24–1.74; p

Background: Women entering surgical residencies must determine which programs best fit their career and family goals. The purpose of this study was to determine if breastfeeding policies are available on otolaryngology residency program websites. Methods: A total of 122 publicly available otolaryngology residency program websites were reviewed for the presence of a breastfeeding policy and lactation information. The percentage of residents and faculty that are women in each program as well as the program’s region, size, and affiliation with a top 50 hospital for ear, nose, and throat care were determined. Frequencies and nonparametric analyses were calculated when appropriate. Results: None of the otolaryngology residency programs had a breastfeeding policy posted directly on their website. A link to a Graduate Medical Education (GME) website that contained a breastfeeding policy was present on 20 (16.4%) program websites, and 31 websites (25.4%) had information about lactation facilities on the GME website or another page that could be found through the search bar; 17 (23.0%) of the large residency programs contained the link to the GME website, whereas only 3 (6.25%) of the small programs did (p = 0.015). Residency programs that were affiliated with a top 50 hospital for ear, nose, and throat care were more likely to have a link to the GME website with a breastfeeding policy than those not affiliated (13 [29.5%] vs. 7 [8.9%], respectively; p = 0.003). Conclusion: Otolaryngology residency programs do not provide breastfeeding policies directly on their websites.

Unilateral vocal cord paralysis (UVCP) is a growing area of research in pediatrics as it spans across many specialties including otolaryngology, cardiology, general surgery, respirology, and speech language pathology. Iatrogenic injury is the most common cause of UVCP, however there is a wide range of data reporting the prevalence, symptom burden, and best treatment practice for this condition. The literature included systematic reviews and meta-analyses, retrospective studies and limited prospective studies. Overall, the literature lacked consistency in the diagnosis, treatment, and long-term outcomes of patients with UVCP. Many articles conflated bilateral vocal cord paralysis (BVCP) with UVCP and had limited data on the natural history of the condition. There was no consensus on objective and subjective measurements to evaluate the condition or best indications for requiring surgical intervention. Thyroplasty, injection medialization (IM) and recurrent laryngeal nerve reinnervation (RLNR) were the reported surgical interventions used to treat UVCP, however there was limited data on short and long-term surgical outcomes in children. More research is needed to determine the true prevalence, natural history, indications for surgical intervention and long-term outcomes for pediatric patients with this condition.

Key points: Social determinants of health link to worse quality of life in pediatric chronic rhinosinusitis.The area deprivation index (ADI) may serve to predict health disparities in these patients. [ABSTRACT FROM AUTHOR]

Key points: The surgeon's hand dominance impacts ergonomics in endoscopic endonasal surgery.Left‐handed trainees experience difficulty learning certain surgical techniques.OR adjustments optimize ergonomics for left‐handed trainees without compromising others. [ABSTRACT FROM AUTHOR]

Otolaryngology residency training, along with the world of online medical education, has been continuously evolving and refining methods to educate and produce competent otolaryngologists. Numerous resources have been developed to assist otolaryngology residents in enhancing their clinical training. Although these resources greatly enhance clinical training, the growing volume of material presents a challenge within the constrained schedule of otolaryngology residents. This challenge is compounded by the variability in quality among resources which lack standardization or validation. Recently, the American Academy of Otolaryngology–Head and Neck Surgery Foundation has proposed a unified otolaryngology curriculum designed to address these issues. This curriculum aims to incorporate high‐quality educational materials, evidence‐based adult learning principles, accessible learning sources, and diverse instructional methods within a structured program. Such a curriculum promises a significant positive impact, mirroring successes observed in various other surgical specialties. [ABSTRACT FROM AUTHOR]

Objective: This case report presents a unique manifestation of Mucocutaneous Leishmaniasis (MCL) in a 56-year-old woman with chronic nasal symptoms. Initially diagnosed with chronic sinusitis and septal perforation, the patient's history of a childhood sandfly bite and subsequent episodes of Leishmaniasis, revealed after nasal surgery, provided crucial information for accurate diagnosis. Methods: A retrospective review was conducted on this patient's electronic medical record. Results: The patient's life-long struggle with nasal obstruction, congestion, and a septal perforation initially masked the underlying MCL. Sinus surgery and persistent symptoms further complicated the diagnostic process. Only after postoperative complications, including grainy skin texture extending into the nasal passages, did the patient recall the sandfly bite, prompting reevaluation and diagnosis of MCL. The case highlights the challenges of diagnosing MCL due to its varied presentation and potential mimicry of other chronic nasal conditions. It emphasizes the importance of thorough patient history-taking, especially when symptoms are atypical or persistent. Additionally, the report underscores the potential for unexpected postoperative complications in MCL patients and the need for vigilance in recognizing and assessing them. Conclusion: This case contributes to the understanding of MCL's diverse clinical presentation and the importance of early diagnosis and multidisciplinary management for prompt intervention and improved outcomes. [ABSTRACT FROM AUTHOR]