Analysis of the Application of the Ladder Teaching Method Combined with Case Teaching in Otolaryngology Nursing Teaching

Objective:To analyze the feasibility of adopting a combined ladder and case teaching method in otolaryngology nursing teaching.Method:Nursing students in the otolaryngology department were selected.According to the admission time of nursing students,30 nursing students formed a control group(conventional nursing teaching),and 30 nursing students who were admitted later formed an observation group(ladder and case teaching method).The learning performance and teaching effectiveness of nursing students under different teaching methods were analyzed.Result:The academic performance and teaching effectiveness of the observation group were higher than those of the control group(P<0.05).Conclusion:The implementation of the ladder and case teaching method during the teaching of otolaryngology nursing significantly improved the student’s academic performance and teaching effectiveness.This method has great practical value.

The Department of Otolaryngology Head and Neck Surgery,PLA General Hospital (national key academic unit) The PLA Institute of Otolaryngology (PLA key laboratory for acoustic trauma) The PLA Medical College Department of Deafness Education Key Laboratory

Led by four generations of leadership from late Prof.JIANG Sichang(academician,Chinese Academy of Engineering),Prof.YANG Weiyan(Honorary President,Division of Otolaryngology Head and Neck Surgery,Chinese Medical Association),Prof.HAN Dongyi(President Elected,Division of Otolaryngology Head and Neck Surgery,Chinese Medical Association)to now Prof.YANG Shiming(President,Division of Otolaryngologists,

Confounding Effect in Clinical Research of Otolaryngology and Its Control

Confounding effect is a critical issue in clinical research of otolaryngology because it can distort the research's conclusion. In this review, we introduce the definition of confounding effect, the methods of verifying and controlling the effect. Confounding effect can be prevented by research's design, and adjusted by data analysis. Clinicians would be aware and cautious about confounding effect in their research. They would be able to set up a research's design in which appropriate methods have been applied to prevent this effect.They would know how to adjust confounding effect after data collection. It is important to remember that sometimes it is impossible to eliminate confounding effect completely, and statistical method is not a master key. Solid research knowledge and critical thinking of our brain are the most important in controlling confounding effect.

Department of Otolaryngology Head and Neck Surgery of Chinese PLA General Hospital (National Key Discipline)

Institute of Otolaryngology of Chinese PLA ( Key Laboratory for the Prevention of Acoustic Trauma,PLA)Key Laboratory of Hearing Impairment Science(Chinese PLA Medical School)Ministry of Education Led by four generations of leadership from late Prof. JIANG Sichang (academician, Chinese Academy of Engineering), Prof.YANG Weiyan (Honorary President, Division of Otolaryngology

Medical malpractice litigation involving otolaryngology residents and fellows:A case-based 30-year review

BACKGROUND Errors,misdiagnoses,and complications can occur while trainees are involved in patient care.Analysis of such events could reveal areas for improvement by residency and fellowship programs.AIM To examine lawsuits tried at the state and federal level involving otolaryngology trainees.METHODS The LexisNexis database,an online legal research database containing state and federal case records from across the United States,was retrospectively reviewed for malpractice cases involving otolaryngology residents or fellows from January 1,1990 to December 31,2020.Case data collected:Plaintiff/trainee/defendant characteristics,allegations,medical outcomes,and legal outcomes.RESULTS Over the study period,20 malpractice lawsuits involving otolaryngology trainees were identified.Plaintiffs raised numerous allegations including procedural error(n=12,25.5%),incorrect diagnosis and/or treatment(n=8,17.0%),and lack of knowledge of trainee involvement(n=6,12.8%).Nine cases(45%)had verdicts in favor of the plaintiff,whereas 5 cases(25%)had verdicts in favor of the defense.Six cases(30%)ended in a settlement.Awards to plaintiffs were heterogenous,with a median of$617,500(range$32K-17M)for settled cases and verdicts favoring plaintiffs.CONCLUSION The findings enclosed herein represent the first published analysis of trainee involvement in otolaryngology malpractice cases held at the state/federal level.Otolaryngology trainees can be involved in lawsuits for both procedural and nonprocedural events.This study highlights the importance of education specifically in the domains of procedural errors,informed consent,proper diagnosis/management,and clear communication within patient care teams.Training programs should incorporate these study findings into effective simulation courses and didactic sessions.Educating trainees about common pitfalls holds the promise of decreasing healthcare systems costs,reducing trainee burnout,and,most importantly,benefiting patients.

The Economics of Reorganizing Otolaryngology Out-Patient Services for COVID-19 Pandemic in Low- and Middle-Income Countries

The Coronavirus 2019 (COVID-19) pandemic has widespread implications for clinical practice of otolaryngologists in clinics and hospitals. With various reports of otolaryngology practitioners catching infection, a profound structural reorganization of ENT services in the clinic is mandatory for protecting both patients and healthcare workers. The present study focused on quantifying the cost involved in reorganizing the otolaryngology out-patient services in a third world country during the ongoing Covid-19 pandemic. Though the pandemic has increased the cost of running of an otolaryngology practice world over, the impact is huge in India as penetration of health insurance/social security is minimal. As out of pocket expenditure forms a significant proportion of healthcare spending by majority in India, any transfer of additional cost incurred because of Covid-19 pandemic to the patient will burn a bigger hole in their pocket.

Roadmap of Otolaryngology—Head and Neck Surgery Clinic in a Tertiary Center: A Prospective Cohort Study of 1178 Patients

Objectives: An Otolaryngology—Head and Neck Surgery clinic is an integral part of any modern tertiary center outpatient department. The objective of this article is to present our experience in developing a local electronic Makkah Otolaryngology—Head and Neck DATABASE (MO-HND) and provide a roadmap for the development of Otolaryngology—Head and Neck Surgery clinics in other tertiary centers. Methods: This is a prospective audit of all patients attending our clinic over 3 months period (July to September 2014). The data were recorded using our MO-HND. Results: A total of 1178 patients were included. The mean age was 27.7 ± 6.7 years. Participants included 586 males (49.7%) and 592 females (50.3%). There were 1139 (96.6%) Saudi and 39 (3.4%) non-Saudi patients. The specialist clinic undertook most of the workload (66%). The majority of surgery bookings (94%) were carried out through a consultant clinic. Of all participants, 80% were diagnosed with general ENT conditions, 21% underwent a procedure in the clinic, and 29% required further investigations. The surgical conversion rate was 16.3%. Conclusion: Electronic DATABASES have become important tools for improving medical services. Primary and secondary level medical centers and hospitals should increase their role in alleviating pressure from tertiary and quaternary level hospitals. In turn, a model concentrated on subspecialty clinics and services should be developed.

Evaluating implicit gender bias at Canadian otolaryngology meetings through use of professional title

Objectives:Increasing numbers of women enter medical school annually.The number of female physicians in leadership positions has been much slower to equalize.There are also well‐documented differences in the treatment of women as compared to men in professional settings.Female presenters are less likely to be introduced by their professional title(“Doctor”)for grand rounds and conferences,especially with a man performing the introduction.This study reviewed the Canadian Society of Otolaryngology–Head and Neck Surgery(CSOHNS)meetings from 2017 to 2020 to determine the proportion of presenters introduced by their professional title and whether this varied by gender.Methods:Recordings from CSOHNS meetings were reviewed and coded for introducer and presenter demographics,including leadership positions and gender.Chi‐squared tests of proportion and multivariate logistic regression was used to compare genders and identify factors associated with professional versus unprofessional forms of address.Results:No significant association was found between professional title use and introducer or presenter gender.Female presenters were introduced with professional title 69.6%of the time,while male presenters were introduced with professional title 67.6%of the time(P=0.69).Residents were introduced with a professional title with the most frequency(75.8%),while attending staff were introduced with a professional title with the least frequency(63.0%)(P=0.02).Conclusions:The lack of gender bias in speaker introductions at recent CSOHNS meetings demonstrates progress in achieving gender equity in medicine.Research efforts should continue to define additional forms of unconscious bias that may be contributing to gender inequity in leadership positions.

Gender analysis of the top classic papers in otolaryngology head and neck surgery

Objective:The aim of this study was to identify and analyze the gender breakdown of first authorship contributing to the most-cited papers in the field of otolaryngology,with a goal of identifying trends in gender representation in publishing.Methods:The top 150 most-cited papers were identified using the Science Citation Index of the Institute for Scientific Information.Among the first authors,gender,h-index,percentage of first,last,and corresponding authorship positions,total publications,and citations were analyzed.Results:The majority of papers were in the English language,from the United States,of clinical nature,and on otologic topics.Eighty-one percent of papers(n=122)had men who were first authors,although there was no difference inh-index score,authorship position,number of publications,citations,and average citations/year between men and women first authors.Upon subgroup analysis by decade(1950s-2010s),there was no difference in the number of articles by women first authors(P=0.11);however,there was a statistically significant increase in the percentage of women authors(P=0.001)in papers published later compared to those published earlier.Conclusions:While a promising number of women otolaryngologists are publishing high-powered articles,future initiatives to promote academic inclusivity of women should be considered.

Changes in otolaryngology application requirements and match outcomes:Are we doing any better?

Objectives:Otolaryngology-specific requirements were piloted to minimize applicant and program burdens.We investigated the impact of introducing and then removing these requirements on Match outcomes.Methods:2014-2021 National Resident Matching Program?data were examined.The primary outcome was the impact of Otolaryngology Resident Talent Assessment(ORTA;prematch 2017,postmatch 2019)and Program-Specific Paragraph(PSP;implemented 2016,optional 2018)on applicant numbers and match rates.Secondary survey analysis assessed candidate perceptions of PSP/ORTA.Results:Applicant numbers declined significantly during PSP/ORTA(18.9%;p=0.001).With the optional PSP and postmatch ORTA,applicant numbers increased significantly(39.0%;p=0.002).Examined individually,mandatory PSP was associated with a significant decline in applicants(p=0.007),whereas postmatch ORTA was associated with significant increases in applicants(p=0.010).ORTA and PSP negatively impacted the decision to apply to otolaryngology in 59.8%and 51.3%of applicants,respectively.Conversely,match rate success improved significantly from 74.8%to 91.2%during PSP/ORTA(p=0.014),followed by a significant decline to 73.1%after PSP was made optional and ORTA moved to postmatch(p=0.002).Conclusions:ORTA and PSP correlated with decreased applicant numbers and increased match rate success.As programs seek ways to remove barriers to applying to otolaryngology,the potential consequences of an increasing pool of unmatched candidates must also be considered.

Cost of open access publishing in otolaryngology‐head and neck surgery

Objective:Open access(OA)publishing makes research more accessible but is associated with steep article processing charges(APCs).The study objective was to characterize the APCs of OA publishing in otolaryngology‐head and neck surgery(OHNS)journals.Methods:We conducted a cross‐sectional analysis of published policies of 110 OHNS journals collated from three databases.The primary outcomes were the publishing model,APC for original research,and APC waiver policy.Results:We identified 110 OHNS journals(57 fully OA,47 hybrid,2 subscription‐only,4 unknown model).After excluding 12 journals(2 subscription‐only,4 unknown model,5 OA with unspecified APCs,and 1 OA that accepts publications only from society members),we analyzed 98 journals,23 of which did not charge APCs.Among 75 journals with nonzero APCs,the mean and median APCs were$2452 and$2900(interquartile range:$1082–3520).Twenty‐five journals(33.3%)offered APC subsidies for authors in low‐and middle‐income countries(LMICs)and/or on a case‐by‐case basis.Eighty‐five and 25 journals were based in high‐income countries(HICs)and LMICs,respectively.The mean APC was higher among HIC journals than LMIC journals($2606 vs.$958,p<0.001).Conclusion:APCs range from tens to thousands of dollars with limited waivers for authors in LMICs.

Laryngopharyngeal reflux disease:Updated examination of mechanisms,pathophysiology,treatment,and association with gastroesophageal reflux disease

Laryngopharyngeal reflux disease(LPRD)is an inflammatory condition in the laryngopharynx and upper aerodigestive tract mucosa caused by reflux of stomach contents beyond the esophagus.LPRD commonly presents with symptoms such as hoarseness,cough,sore throat,a feeling of throat obstruction,excessive throat mucus.This complex condition is thought to involve both reflux and reflex mechanisms,but a clear understanding of its molecular mechanisms is still lacking.Currently,there is no standardized diagnosis or treatment protocol.Therapeutic strategies for LPRD mainly include lifestyle modifications,proton pump inhibitors and endoscopic surgery.This paper seeks to provide a comprehensive overview of the existing literature regarding the mechanisms,pathophysiology and treatment of LPRD.We also provide an in-depth exploration of the association between LPRD and gastroesophageal reflux disease.

Shedding light in otolaryngology: A brief history on the surgical tools of visualization and access

Visualization and access. Historically, these have been the two major factors that have limited advancement in the field of Otolaryngology. No other surgical specialty deals with anatomical challenges quite like those presented by the structures of the head and neck. Otolaryngology is a field of dark cavities, complex and miniscule structures, and awkward angles. The aim of this article is to briefly explore how Otolaryngologists have historically met these challenges, with a specific focus on technological advancements in illumination, visualization, and access. From mirrors reflecting candlelight to fiberoptic illuminated scopes, from bamboo nasal speculums to Transoral Robotic Surgery (TORS), tracing the historical arc of these technologies highlights the innovative spirit that has come to define the field of Otolaryngology.

Surgical wound classification in otolaryngology:A state-of-the-art review

Objective:To describe the issues related to the assignment of surgical wound classification as it pertains to Otolaryngology—Head&Neck surgery,and to present a simple framework by which providers can assign wound classification.Data Sources:Literature review.Conclusion:Surgical wound classification in its current state is limited in its utility.It has recently been disregarded by major risk assessment models,likely due to inaccurate and inconsistent reporting by providers and operative staff.However,if data accuracy is improved,this metric may be useful to inform the risk of surgical site infection.In an era of quality-driven care and reimbursement,surgical wound classification may become an equally important indicator of quality.

Burnout and well-being in otolaryngology trainees:A systematic review

Objective:To comprehensively review the recent published literature to characterize current trends of burnout and well-being among otolaryngology trainees.Methods:Study design:systematic review and meta-analysis.A comprehensive literature review from 2000 to 2021 of studies related to otolaryngology resident burnout and well-being,as well as the general topic of well-being among surgical residents was completed.All included studies were summarized qualitatively.For the quantitative analysis,only articles reporting a Maslach burnout inventory(MBI),modified MBI or Mini-Z-Burnout assessment were included.Results:Twenty-five articles were included in the qualitative summary and nine articles in the quantitative analysis.In the qualitative summary,trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists.Total hours worked per week and female gender were associated with worsened well-being.Residency program strategies to improve trainee well-being include program-sponsored wellness activities,dedicated wellness champions,and assistance with clerical burden.Implementation of protected nonclinical time has been shown to decrease burnout and increase well-being among trainees.Moreover,formal trainee mentorship programs have also been shown to reduce trainee burnout and stress.In the quantitative analysis,rates of trainee burnout ranged from 29.7%to 86%with an overall trend towards reduced rates of burnout from 2006 to 2021.Utilizing a weighted average,the overall burnout among otolaryngology residents was 58.6%.Conclusions:Rates of burnout remain high among otolaryngology trainees.Implementing formal mentorship programs and providing protected time during regular work hours appear to be effective tools to improve resident well-being.

Enhanced recovery after surgery protocols for outpatient operations in otolaryngology:Review of literature

Objective:Enhanced recovery after surgery(ERAS)protocols are patient-centered,evidence-based pathways designed to reduce complications,promote recovery,and improve outcomes following surgery.These protocols have been successfully applied for the management of head and neck cancer,but relatively few studies have investigated the applicability of these pathways for other outpatient procedures in otolaryngology.Our goal was to perform a systematic review of available evidence reporting the utility of ERAS protocols for the management of patients undergoing outpatient otolaryngology operations.Methods:A systematic literature review was conducted using MEDLINE,EMBASE,SCOPUS,and gray literature.We identified studies that evaluated ERAS protocols among patients undergoing otologic,laryngeal,nasal/sinus,pediatric,and general otolaryngology operations.We assessed the outcomes and ERAS components across protocols as well as the study design and limitations.Results:A total of eight studies fulfilled the inclusion criteria and were included in the analysis.Types of procedures evaluated with ERAS protocols included tonsillectomy and adenoidectomy,functional endoscopic sinus surgery,tympanoplasty and mastoidectomy,and septoplasty.A reduction in postoperative length of stay and hospital costs was reported in two and three studies,respectively.Comparative studies between ERAS and control groups showed persistent improvement in pre-and postoperative anxiety and pain levels,without an increase in postoperative complications and readmission rates.Conclusions:A limited number of studies discuss implementation of ERAS protocols for outpatient operations in otolaryngology.These clinical pathways appear promising for these procedures as they may reduce length of stay,decrease costs,and improve pain and anxiety postoperatively.

Opioid prescribing patterns within otolaryngology

Objective:Determine current opioid prescribing patterns for adult procedures within an academic Otolaryngology-Head and Neck Surgery training program in order to establish a general guideline and more uniform approach to narcotic prescribing practices.Methods:The is a prospective,single-center pilot study.An online,anonymous survey was sent to all members of the Otolaryngology-Head and Neck Surgery training program at Medical University of South Carolina including residents,fellows,and attending surgeons,and advanced practice providers (APP).The survey consisted of questions including demographics,most commonly prescribed analgesic and the average number of opioid tablets prescribed postoperatively for eleven of the most common adult procedures within Otolaryngology.Results:Forty-two participants responded to the survey.Of the 42 respondents,20 were attending surgeons,11 junior level residents (year 1-3),6 senior level residents (year 4-5),and 5 A.P.P.s.The most commonly prescribed narcotic was hydrocodone-acetaminophen with 83.3% (35/42) of respondents prescribing this medication.Tonsillectomy or uvulopalatopharyngoplasty had the highest average number of tablets prescribed at 32.3 (Range:5 to 90).Neck dissection,parotidectomy,and thyroidectomy procedures all averaged over 20 tablets.Direct laryngoscopy opioid dose was the lowest at 4.8 tablets (range 0-20).Opioid prescriptions by surgery were broken down by provider class with only septoplasty showing a significant difference with attending physicians prescribing an average of 20 tablets vs 14.1 tablets for residents (P =0.034).Conclusion:We believe there remains an unacceptably high variability in current opioid prescribing patterns within otolaryngology especially within more painful procedures.Establishment of standardized post-operative narcotic guidelines is warranted.

A current render of pediatric otolaryngology in the United States

Introduction Complex pediatric otolaryngology can be generally regarded as a subspecialty within otolaryngology focusing on the care of children with complex diseases of the head and neck and aerodigestive tract, or in some cases more common diseases in this anatomical region in otherwise medically complex children. This concept of the specialty was succinctly articulated by Charles Bluestone in 1995 when he wrote pediatric otolaryngologists treat 'special problems or special children, or both'.1 Increasingly, this care is delivered by multi-disciplinary pediatric health care providers working at highly specialized tertiary care centers for children. This review will briefly cover the historical evolution of the specialty's origins, along with its current state of graduate medical education training and sub-certification efforts.

Pediatric otolaryngology-head and neck surgery in China: Present situation and future prospects

Evolution Pediatric otolaryngology–head and neck surgery (OHNS) is a young discipline in the 21st century. During its development, the discipline and its sub-areas were increasingly enriched and refined, and its name evolved from 'ear, nose and throat' to 'otorhinolaryngology' and then to 'otolaryngology–head and neck surgery' In the United States, the American Laryngological Association was established in 1878, and the American Academy of Ophthalmology and Otolaryngology was founded in 1903. However, no doctors specialized in pediatric OHNS until the 1940s.

Vestibular migraine in low-and lower-middle-income countries:A scoping review

Background:Vestibular migraine(VM)is a common cause of dizziness that is underrecognized,underdiagnosed,and challenging to effectively treat.The prevalence,appropriate diagnostic workup,and therapies for VM in low-and lower-middle-income countries(LLMICs)remain understudied.The objective of this scoping review is to evaluate the current state of VM research in LLMICs.Methods:PubMed,Embase,and Web of Science databases were searched to execute a scoping review of VM.Keywords“vestibular diseases”and“vertigo”were used in combination with terms referring to LLMICs as defined by the World Bank.Title and abstract screening,full-text review,and data collection were conducted by two authors independently.Results:Twenty-six studies were included in the scoping review.Most studies were cross-sectional(57.7%)or case studies/series(23.1%)and were conducted in urban settings only(92.3%).Geographic distribution of studies was skewed,with 65.4%of articles originating from India.The prevalence of VM among clinic patients ranged from 0.3%to 33.3%.VM most frequently presented as headache,nausea and vomiting,and photophobia.Radiographic imaging,audiometry,and electronystagmography/videonystagmography were the three most commonly utilized diagnostic modalities in the dizziness workup.The most studied pharmacotherapies included calcium channel blockers,followed by beta-blockers and antiepileptics.Case studies and series discussed less common VM pharmacotherapies,such as ayurvedic medicine.Conclusions:There is a need for more VM research in LLMICs,including innovative diagnostic approaches and therapies that can improve VM care globally.Equitable partnerships between LLMIC and highincome country researchers must expand vestibular research capacity and productivity in LLMICs.