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Hypothesis: Treatment modalities administered by Otolaryngologists vary based on patient volume and years of experience., Objective: It was our goal to evaluate the current trends in treatment modalities administered by Otolaryngologists based on patient volume and years of experience., Methods: An electronic questionnaire was distributed to all General Otolaryngologists and fellowship-trained Neurotologist members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Respondents were separated into groups by patients per year (<10, 10-29, 30-49, 50-99, or >100 patients) and years in practice (0-5, 6-10, 11-15, 16-20, or >20 yrs)., Results: Eight hundred and sixty members replied for a response rate of 14.5% for generalists and 35% for neurotologists. Patient volume was found to have a positive association with perceived benefit of lifestyle and diet modification, and use of intratympanic steroids, intratympanic gentamycin, oral steroids, benzodiazepines, acetazolamide, endolymphatic sac procedures, vestibular nerve section, and surgical labyrinthectomy. Only endolymphatic sac procedures were found to have a significant positive association with a physician's length in practice. The only negative association was between intratympanic steroids and a physician's length in practice., Conclusion: Physicians who see more MD patients annually are more likely to use these treatment modalities: diet and lifestyle modification, intratympanic steroids, intratympanic gentamycin, surgical labyrinthectomy, vestibular nerve section, acetazolamide, alprazolam, lorazepam, dexamethasone, and prednisone. Physicians with a longer length of time in practice are more likely to use only endolymphatic sac procedures, and they are less likely to use intratympanic steroids.

Objective: Due to the microscopic nature of otologic surgery, photographic image quality suffers from an inherent inability to maintain all the planes of surgery in focus under binocular microscopy. Our goal was to perform simple editing techniques to create improved imaging for educational and research purposes in the field of Otology and Neurotology., Patients/design: The study was a proof of concept performed with series of cases including patients undergoing transmastoid and transcanal otologic surgery over time period of December 1, 2018 to March 1, 2019 at an academic medical center. The Zeiss OPMI Pentero 800 operating microscope was used with a camera capturing 2.1 megapixel, 1098 × 1080 resolution images., Intervention: We created a systematic protocol for capturing images of multiple focal lengths during each surgery. With the image-editing technique of focus-stacking, multiple images of varying focal length, were spliced together to produce high-quality and high-fidelity composite images rendered using the Adobe Photoshop (San Jose, CA)., Outcomes: Subjective comparisons of pre and post photo-edited photographs., Results: Composite, focus-stacked images with comparison to unedited microscopic pictures are reviewed in the manuscript., Conclusion: We describe a simple and objectively practical method for improving the quality of medical imaging in the field of Otology/Neurotology. To achieve this enhanced image quality, a relatively expeditious and reliable photographic protocol can be used for image capturing and editing, requiring little to no additional training for a physician in the field.

Technology is integral to the diverse diagnostics and interventions of Otolaryngology. Historically, major advances in this field derive from advances of associated technologies. Challenges of visualization and surgical access are increasingly overcome by integrating endoscopic, electronic, and robotic instruments. Otolaryngology is often limited to urban areas and large academic centers, making it difficult to allocate care and resources to many underserved populations. The widespread use of technology has important implications in regards to global access to this field as telemedicine is most effectively applied to specialties that are heavily reliant on data and visuals that may be electronically disseminated., (Copyright © 2018 Elsevier Inc. All rights reserved.)