Search

Objective: The EuroQol 5‐Dimension (EQ‐5D) is a general health survey that is quick to administer, widely used, and directly convertible to health utility values (HUV). We aim to describe the five‐year EQ‐5D outcomes among patients who undergo surgical treatment for chronic rhinosinusitis (CRS). Study Design: Prospective observational cohort study. Methods: Patients with CRS completed the EQ‐5D questionnaire preoperatively and annually for five years following endoscopic sinus surgery. Paired t‐tests and McNemar's tests were used to compare preoperative and postoperative scores. Mixed‐effects modeling was used for multivariate analysis. Results: Among 1296 patients enrolled in our study, 812 (74.7%) completed the postoperative survey at one year and 336 (38.9%) completed it at five years. There was a significant and sustained reduction of patients reporting pain/discomfort (74.9% vs. 58.0%, p < 0.001) and anxiety/depression (49.6% vs. 38.1%, p = 0.01) out to five years. Frequency of problems reported in the usual activity domain decreased at one year and was sustained through year four (30.6% vs 19.7%, p = 0.003). After multivariable modeling, female gender (p = 0.02), prior sinus surgery (p = 0.01), tobacco use (p = 0.038), headaches (p = 0.013), allergies (p = 0.001), diabetes (p = 0.022), hypertension (p = 0.036), higher preoperative SNOT‐22 score (p < 0.001), and a lower preoperative Lund‐Mackay score (p < 0.001) were associated with significantly worse EQ‐5D HUV over time. Similarly, a worse EQ‐5D Visual Analog Scale (VAS) over time was associated with allergies (p = 0.03), diabetes (p < 0.001), hypertension (p = 0.04), higher preoperative SNOT‐22 score (p < 0.001), and prior sinus surgery (p < 0.001). Conclusion: Patients with chronic rhinosinusitis experience significant sustained improvements in health‐related quality of life up to five years after ESS as measured by the EQ‐5D instrument. Level of Evidence: Level 2 Laryngoscope, 134:2592–2601, 2024 [ABSTRACT FROM AUTHOR]

Objectives: The COVID‐19 pandemic affected the epidemiology of several diseases. This study aims to compare the incidence of surgically treated odontogenic sinusitis (ODS) before and during the COVID‐19 pandemic and identify unique features. Methods: A retrospective chart review of patients who underwent at least maxillary antrostomy at a tertiary referral center was performed. The patients were divided into two cohorts: "pre‐COVID" (March 2018 to February 2020) and "COVID" (March 2020 to February 2022). Data on demographics, comorbidities, and treatment interventions were collected and analyzed. Results: Of the 734 patients who underwent maxillary antrostomy, 370 (50.4%) were operated on during the COVID period, with a mean age of 53.1 ± 15.7 years. ODS was found as the etiology of 22 (6%) and 45 (12.2%) of the pre‐COVID and COVID cases, respectively (p = 0.006). Although no difference was found in the incidence of diabetes (p = 0.9) or obesity (p = 0.7) between groups, a trend toward higher incidence of immunosuppression was found in the pre‐COVID patients (18.2% vs. 0%, p = 0.06). A higher incidence of sphenoid sinus involvement (31.8% vs. 8.9%, p < 0.05) was identified in the pre‐COVID group; however, no differences in ethmoid (86.4% vs. 86.7%, p = 0.999) or frontal sinus involvement (54.5% vs. 37.8%, p = 0.3) were found between the groups. Conclusion: There was an increase in the incidence of ODS during the first 2 years of the COVID‐19 pandemic compared to the 2 years prior. Similar clinical characteristics were found in both groups. Future studies focusing on specific etiologies to explain ODS preponderance may help determine optimal treatment and prevention strategies. Level of Evidence: 3 Laryngoscope, 134:1597–1602, 2024 [ABSTRACT FROM AUTHOR]

This article evaluates the availability of key information on independent rhinology/skull base surgery fellowship websites compared to the American Rhinologic Society (ARS) website. The study found that out of 37 identified programs, 34 had program-created fellowship websites. On average, program-created websites fulfilled 49.4% of the criteria, while the ARS website fulfilled 58.1%. Important information such as case volume, sample case logs, and graduate placements were inconsistently provided on both types of websites. The article suggests that including these criteria could help applicants make more informed decisions when applying for a fellowship in rhinology/skull base surgery. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, discusses a rare case of a solitary fibrous tumor in the nasal cavity. Solitary fibrous tumors are uncommon neoplasms that can arise in various parts of the body, including the head and neck region. Although these tumors are slow-growing, they can potentially spread and invade nearby structures, leading to life-threatening complications. The article highlights the importance of early identification and surgical resection in managing these tumors. The case presented in the article describes the successful removal of the tumor through endoscopic surgical resection after embolization. The article emphasizes the need for prompt diagnosis and treatment due to the potential risks associated with these tumors. [Extracted from the article]

Objective: To identify the impact of gender on the clinical outcomes of endoscopic sinus surgery (ESS) through the comparison of quality of life measures in female and male patients who undergo surgical treatment for chronic rhinosinusitis (CRS). Study Design: Prospective observational cohort study. Methods: Patients with CRS completed the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and EuroQol 5‐Dimension Survey (EQ‐5D) preoperatively and annually for 5 years following ESS. Health utility values (HUV) were calculated from EQ‐5D scores. Comparisons of cohort characteristics were performed with chi‐square and t‐tests. A multivariable linear mixed effects model evaluated changes in SNOT‐22 and HUV over time by gender. Results: Among the 1268 patients (54% female) enrolled, 789 and 343 completed postoperative surveys at one and 5 years, respectively. Preoperatively, females experienced more severe symptoms: mean SNOT‐22 score (51.1 ± 20.9 female vs. 44.7 ± 20.0 male, p < 0.001) and HUV (0.80 ± 0.14 female vs. 0.84 ± 0.11 male, p < 0.001). These gender differences were resolved by year one postoperatively (SNOT‐22: p = 0.083; HUV: p = 0.465). Two years after surgery, however, females reported more severe symptoms (SNOT‐22: 25.6 ± 20.7 female vs. 21.5 ± 17.4 male, p = 0.005; HUV: 0.88 ± 0.12 female vs. 0.90 ± 0.11 male, p = 0.018), a difference that persisted at year five. These gender‐related differences remained after adjusting for age, race, ethnicity, nasal polyps, history of prior ESS, and smoking status (p < 0.001). Within‐subject improvement was comparable between genders (SNOT‐22: p = 0.869; HUV: p = 0.611). Conclusion: Females with CRS reported more severe symptoms both before and 5 years after surgery compared to their male counterparts. Understanding the mechanism behind these gender‐related differences is important for optimizing CRS treatment. Level of Evidence: 2 Laryngoscope, 133:3319–3326, 2023 [ABSTRACT FROM AUTHOR]

Objective: Competency‐based surgical education requires practical assessments and meaningful benchmarks. In otolaryngology, key indicator procedure (KIP) minima are indicators of surgical exposure during training, yet it remains unknown how many times trainees must be evaluated on KIPs to ensure operative competence. Herein, we used Bayesian mixed effects models to compute predicted performance expectations for KIPs. Methods: From November 2017 to September 2021, a smartphone application (SIMPL OR) was used by attendings at five otolaryngology training programs to rate resident operative performance after each case on a five‐level scale. Bayesian mixed effects models were used to estimate the probability that postgraduate year (PGY) 3, 4, or 5 trainees would earn a "practice‐ready" (PR) rating on a subsequent evaluation based on their previously earned PR ratings for each KIP. Probabilities of earning a subsequent PR rating were examined for interpretability, and cross‐validation was used to assess predictive validity. Results: A total of 842 assessments of KIPs were submitted by 72 attendings for 92 residents PGY 2–5. The predictive model had an average Area Under the Receiver Operating Curve of 0.77. The number of prior PR ratings that senior residents needed to attain a 95% probability of earning a PR rating on a subsequent evaluation was estimated for each KIP. For example, for mastoidectomies, PGY4 residents needed to earn 10 PR ratings whereas PGY5 residents needed 4 PR ratings on average to have a 95% probability of attaining a PR rating on a subsequent evaluation. Conclusion: Predictive modeling can inform assessment benchmarks for competency‐based surgical education. Level of Evidence: NA Laryngoscope, 133:3341–3345, 2023 [ABSTRACT FROM AUTHOR]

Objectives: To examine the otolaryngology residency selection process, including past experiences based on the medical literature and survey analysis of our present practices to generate recommendations for future selection system design. Methods: A mixed‐methods study, including a scoping review and a cross‐sectional survey, was completed. Four databases were assessed for articles on otolaryngology residency selection published from January 1, 2016 through December 31, 2020. A 36‐question survey was developed and distributed to 114 otolaryngology program directors. Descriptive and thematic analysis was performed. Results: Ultimately, 67 of 168 articles underwent data abstraction and assessment. Three themes surfaced during the analysis: effectiveness, efficiency, and equity. Regarding the survey, there were 62 participants (54.4% response rate). The three most important goals for the selection process were: (1) to fit the program culture, (2) to make good colleagues, and (3) to contribute to the program's diversity. The three biggest 'pain points' were as follows: (1) Large volume of applications, (2) Lack of reliable information about personal characteristics, and (3) Lack of reliable information about a genuine interest in the program. Conclusions: Within this study, the depth and breadth of the literature on otolaryngology residency selection have been synthesized. Additionally, baseline data on selection practices within our specialty has been captured. With an informed understanding of our past and present, we can look to the future. Built upon the principles of person‐environment fit theory, our proposed framework can guide research and policy discussions regarding the design of selection systems in otolaryngology, as we work to achieve more effective, efficient, and equitable outcomes. Level of evidence: N/A Laryngoscope, 133:2929–2941, 2023 [ABSTRACT FROM AUTHOR]

Objective: To determine how augmented reality (AR) has been applied to the field of otology/neurotology, examine trends and gaps in research, and provide an assessment of the future potential of this technology within surgical practice and education. Data Sources: PubMed, EMBASE, and Cochrane Library were assessed from their inceptions through October 2022. A manual bibliography search was also conducted. Review Methods: A scoping review was conducted and reported according to PRISMA‐ScR guidelines. Data from studies describing the application of AR to the field of otology/neurotology were evaluated, according to a priori inclusion/exclusion criteria. Exclusion criteria included non‐English language articles, abstracts, letters/commentaries, conference papers, and review articles. Results: Eighteen articles covering a diverse range of AR platforms were included. Publication dates spanned from 2007 to 2022 and the rate of publication increased over this time. Six of 18 studies were case series in human patients although the remaining were proof of concepts in cadaveric/artificial/animal models. The most common application of AR was for surgical navigation (14 of 18 studies). Computed tomography was the most common source of input data. Few studies noted potential applications to surgical training. Conclusion: Interest in the application of AR to otology/neurotology is growing based on the number of recent publications that use a broad range of hardware, software, and AR platforms. Large gaps in research such as the need for submillimeter registration error must be addressed prior to adoption in the operating room and for educational purposes. Level of Evidence: N/A Laryngoscope, 133:1786–1795, 2023 [ABSTRACT FROM AUTHOR]

Objective: Primary chronic rhinosinusitis (CRS) is typically a diffuse process and the extent of endoscopic sinus surgery (ESS) performed for medically recalcitrant CRS is impacted by many factors. However, some third‐party payors have implemented policies to authorize coverage for ESS in a sinus‐by‐sinus manner based on a minimal measurement of millimeters of mucosal thickening or sinus opacification in the corresponding sinus that is being surgically addressed. Our objective was to determine whether such policies are based on scientific evidence that in patients with medically recalcitrant CRS, a minimum measurement of mucosal thickening or sinus opacification is a predictor of CRS in that sinus or improved outcomes after ESS on a sinus‐by‐sinus basis. Data Sources: Medline, Embase, Scopus, and Web of Science databases, from inception through May 2022. Review Methods: A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines were followed. Results: We identified 6070 abstracts which were screened and from which 112 studies ultimately underwent a full‐text review. From these studies, we found that none investigated (or provided evidence of) whether any minimal degree of radiographic mucosal thickening or sinus opacification predicted CRS or better outcomes after ESS in a sinus‐specific manner. Conclusion: We were unable to find evidence supporting a minimum millimeter measurement of mucosal thickening or sinus opacification as predictors of CRS or better post‐ESS outcomes in a sinus‐specific manner in patients with medically recalcitrant CRS. The extent of ESS for CRS should be determined through personalized medical decision‐making that considers all patient‐specific factors. [ABSTRACT FROM AUTHOR]

Competency‐based medical education (CBME) is an outcomes‐focused approach to educating medical professionals that will be central to future efforts to improve resident training in otolaryngology. The transition to CBME for otolaryngology in the United States will require the development of specialty‐specific assessments and benchmarks, the financial and administrative support for implementation, the professional development of faculty and learners, and the cooperation of all major stakeholders in graduate medical education. In this article, we describe the need for evidence‐based innovation in surgical training, the history of CBME in the United States, and the progress towards defining "entrustable professional activities" as the building blocks of assessments for CBME. We explore what such a paradigm shift in surgical education could mean for academic otolaryngologists by examining innovative educational practices in other surgical specialties and discussing foreseeable challenges in implementation for the American healthcare system. [ABSTRACT FROM AUTHOR]

A paired surgical educator curriculum on adult learning was designed for residents and faculty at a large otolaryngology residency program. In its first year of implementation, 12 core faculty and 20 residents attending the workshops, with positive feedback from all participants and measurable improvements in their understanding of basic terms in adult cognitive learning theory. The curriculum enabled faculty and residents to practice applying educational theories to their every day clinical teaching activities and is adaptable for use in other surgical training programs. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Pathophysiology-targeting treatments exist for aspirin-exacerbated respiratory disease (AERD) through aspirin desensitization and biologics, such as dupilumab. With increasing attention paid to these treatments, which may be associated with significant side effects and/or cost, there is little description of chronic rhinosinusitis with nasal polyps (CRSwNP) response to treatment with intranasal corticosteroids and saline irrigations in AERD. Objective: To determine the effect of intranasal budesonide irrigations for the treatment of CRSwNP in AERD. Methods: This is an observational study of 14 AERD patients presenting to a rhinology clinic for CRS who were treated with twice daily high volume, low pressure irrigations with 240 mL of saline to which a 0.5 mg/2 mL respule of budesonide was added. All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) at enrollment and at follow up 1 to 6 months later. Polyp scores were also calculated at each time point. Results: SNOT-22 scores ranged from 26 to 98 (median: 40.5) at enrollment and 3 to 85 (median: 38.5) at follow-up. Polyp scores ranged from 2 to 6 (median: 4) at enrollment at 0 to 6 (median: 2) at follow-up. Over the treatment period, change in SNOT-22 score ranged from −38 to 16 (median: −18) and change in polyp score ranged from −2 to 0 (median: −0.5). Approximately 57% of participants experienced at least 1 minimal clinically important difference in SNOT-22 score and 21% of participants had a SNOT-22 score <20 at follow-up. Conclusion: Medical management with intranasal corticosteroids and saline irrigations alone leads to significant improvement in sinonasal symptomatology in a subset of AERD. [ABSTRACT FROM AUTHOR]

Objectives: A paucity of literature exists about childbearing during otolaryngology residency. Pregnancy is a common part of many physician life cycles, but the timing of residency and the rigors of surgical training amplify the challenges. This study was designed to understand the experiences of childbearing otolaryngology residents and support them during this major life event. Unique challenges include long training, shortage of role models, combination surgical and clinical work, and higher rates of infertility. Study Design: Qualitative research. IRB exempt. Setting: United States. Methods: To capture modern perspectives, 16 current and former otolaryngology residents that experienced pregnancy and childbirth during residency in all four geographic regions of the United States in the past 10 years were recruited to participate in individual structured qualitative interviews. Results: Although there was significant training program and personal anxiety reported by childbearing otolaryngology residents, many surgeons experienced healthy pregnancies and postpartum recoveries with minimal disruption to clinical productivity and minimal disruption to their training programs. Multiple recurring themes were identified among the participants spanning the entire childbearing process: increased incidence of pregnancy complications and preterm labor, pregnancy stigma from leadership and coresidents, scheduling logistics regarding call and parental leave, and challenging transitions back to clinical work while navigating breastfeeding and childcare. Conclusion: There are actional recommendations that programs can address to make childbearing during residency accessible and acceptable. Understanding these challenges is an important step to encouraging childbearing residents to prosper in academic otolaryngology, increasing the diversity at the highest levels of the field. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: There is concern that current otolaryngology residents may not receive adequate surgical training. We aimed to characterize residents' surgical experiences at 5 academic centers performing the 14 key indicator procedures (KIPs) outlined by the Accreditation Council for Graduate Medical Education. Study Design: Prospective study. Setting: Five otolaryngology training programs. Methods: Data were gathered from December 2019 to December 2020 with a smartphone application from the Society for Improving Medical Professional Learning. After each operation, residents and faculty rated trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale. Results: Residents and attendings (n = 92 and 78, respectively) logged 2984 evaluations. Attending ratings of resident autonomy and performance increased with training level (P <.001). Resident self-assessments of autonomy and performance were lower than paired attending assessments (P <.001). Among attending evaluations of KIPs performed by senior residents (postgraduate year 4 or 5), 55% of cases were performed with meaningful autonomy (passive help or supervision only). Similarly, attendings rated 55% of these cases as a practice-ready or exceptional performance. Senior residents had meaningful autonomy for ≥50% of cases for most KIPs, with the exception of flaps and grafts (40%), pediatric/adult airway (39%), and stapedectomy/ossiculoplasty (33%). Similarly, senior residents received practice-ready or exceptional performance ratings for ≥50% of cases across all KIPs other than pediatric/adult airway (42%) and stapedectomy/ossiculoplasty (33%). Conclusion: In this multicenter study, resident surgical autonomy and performance varied across otolaryngology KIPs. The development of nationwide benchmarks will help programs and residents set educational goals. Level of evidence: 2. [ABSTRACT FROM AUTHOR]

Objective: To evaluate strategies to increase racial and ethnic diversity in the surgical workforce among trainees and faculty across surgical specialties. Data Sources: Embase, OVID/Medline, and Web of Science Core Collection. Review Methods: A review of US-based, peer-reviewed articles examining the effect of targeted strategies on racial and ethnic diversity in the surgical workforce was conducted from 2000 to 2020 with the PRISMA checklist and STROBE tool. Studies without an outlined strategy and associated outcomes were excluded. Eleven studies met inclusion criteria and were completed in general surgery, orthopaedic surgery, and otolaryngology–head and neck surgery. Conclusions: Efforts to increase exposure to surgery through internship programs and required clerkships with efforts to improve mentorship were common (6 of 11 [54.5%] and 3 of 11 [27.3%] studies, respectively). Three (27.3%) studies aimed to diversify the recruitment and selection process for the residency match and faculty hiring, and 2 (18.2%) aimed to increase representation among trainees, faculty, and leadership through holistic review processes paired with departmental commitment. Outcome metrics included surgical residency applications for individuals underrepresented in medicine, interview and match rates, faculty hiring, measures of a successful academic surgical career, and leadership representation. All strategies were successful in increasing diversity in the surgical workforce. Implications for Practice: A convincing yet limited body of literature exists to describe strategies and outcomes that address racial and ethnic diversity in the surgical workforce. While future inquiry is needed to move this field of interest forward, the evidence presented provides a framework for surgical residency programs/departments to develop approaches to increase racial and ethnic diversity. [ABSTRACT FROM AUTHOR]

Objective: Surgical education is changing in an era of new regulations and evolving training cultures. We sought to understand the factors that affect operative experiences during otolaryngology residency. Methods: From December 2019 to December 2020, five otolaryngology training programs used the SIMPL OR smartphone application to evaluate residents after each operation. Residents and attendings rated the trainee's autonomy on a 4‐level Zwisch scale, performance on a 5‐level scale, and case complexity on a 3‐level scale. We examined associations between ratings of autonomy and performance with variables including postgraduate year (PGY), case complexity, gender, week of the academic year (AY), and whether multiple procedures were logged. Results: 78 attendings and 92 residents logged 2984 evaluations. PGY level and week of the AY were positively associated with attending ratings of autonomy and performance (PGY3 vs. PGY2: B = 0.63, p <.001 for autonomy and B = 1.05, p <.001 for performance; week of the AY: B = 0.013, p =.002 for autonomy; B = 0.025, p <.001 for performance). Multiple procedures logged and increasing case complexity were negatively associated with attending ratings (multiple procedures: B = −0.19, p =.04 for autonomy and B = −0.48, p <.001 for performance; hardest vs. easiest 1/3 of cases: B = −1.01, p <.001 for autonomy and B = −0.59, p <.001 for performance). Attending and trainee genders were not associated with attending ratings of autonomy or performance. Conclusion: Resident autonomy and performance were positively associated with PGY level and week of the academic year, and negatively associated with case complexity and multiple procedures. These findings highlight the need to align training level with case complexity to promote quality operative experiences. Level of Evidence: 2. [ABSTRACT FROM AUTHOR]

Objective: To investigate the demographics of CORE grant recipients (Centralized Otolaryngology Research Efforts) over the last decade and evaluate disparity among recipients as compared with otolaryngology overall. To assess whether procurement of a grant predicts pursuit of an academic career. Study Design: Analysis of grant recipients' bibliometrics. Setting: Academic medical center. Methods: The list of recipients of grants from 2010 to 2019 was obtained from the website of the American Academy of Otolaryngology–Head and Neck Surgery. Demographics of recipients were collected through an internet search, including gender, race, residency program, and h -index. Recipients from 2010 were searched to determine current academic faculty rank. Univariate and multivariate analyses were used to compare these factors with otolaryngology overall. Results: The distribution of gender among recipients over the last decade remained nearly constant, with no significant difference versus residents in otolaryngology (P >.05). However, there were significantly more female recipients when adjusted for gender differences in the field overall (P <.01). Asians were relatively overrepresented, while Black and Hispanic residents were underrepresented (P <.01). Many recipients (52.6%) trained at institutions recognized as the best training programs with reputations for quality research output. The h -index of recipients decreased over the last decade (P <.01). The h -index of duplicate winners was significantly higher than those of nonduplicate winners (P <.01). After adjusting for gender and rank, recipients were significantly more likely to hold academic positions (P <.01). Conclusion: CORE grants are favorably distributed as related to gender and racial disparities, and recipients frequently go on to achieve high levels of academic success. [ABSTRACT FROM AUTHOR]

Objectives  This article examines a national cohort of patients with nasopharyngeal adenoid cystic carcinoma (ACC) for incidence, skull base invasion, overall survival, and treatment paradigms. Design, Setting, and Participants  Retrospective national population-based study using Surveillance, Epidemiology, and End Results program data of patients with ACC of the nasopharynx (NACC) and skull base between 2004 and 2016. Main Outcomes and Measures  Primary outcomes included 5-year overall survival and odds of radiation treatment. Statistical analysis was performed using STATA 15.0 (STATACorp). p -Values < 0.05 were considered statistically significant. Results  Of the 2,385 cases of ACC, 70 cases were classified as NACC. Twenty-one percent (15) involved invasion of the skull base or posterior pharyngeal wall, and 42% (30) were either stage 3 or stage 4. The 5-year overall survival for patients with NACC without skull base invasion was 67% which dropped to 40% with invasion into the skull base. Radiation was used as the primary form of therapy for 62% of NACC and 73% of NACC invading into skull base. Odds of receiving radiation therapy and 5-year survival were not affected by socioeconomic status or density of providers. Conclusion  NACC is rare in incidence and was most commonly treated with radiation therapy when advanced in stage. Prognosis was dependent on invasion through posterior pharyngeal wall and skull base. Provider density and socioeconomic status did not affect odds of radiation or overall survival for NACC. [ABSTRACT FROM AUTHOR]