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Telemedicine use among otolaryngologists-head and neck surgeons and facial plastic and reconstructive surgeons has accelerated as a result of the COVID-19 pandemic. Yet, it is unclear what impact the increased adoption of telehealth will have on the doctor-patient relationship, patients' perceptions of individual practices, and the likelihood of patients proceeding with the next steps toward surgery. While an understanding of these complex questions is imperative for all otolaryngologists, it is extremely important for facial plastic surgeons who focus on elective procedures, particularly cosmetic/aesthetic operations. The use of telemedicine has the potential to reduce bias among patients seeking facial plastic surgery, especially cosmetic procedures. As reports of this phenomenon are anecdotal thus far, we recommend further study into the specific criteria that patients consider when selecting a facial plastic surgeon.

Objectives: As the volume of research publications in the field of otolaryngology has increased, so has the need to qualify articles through bibliometric analyses to identify the most important and impactful work in the field. Herein, we aim to identify the 100 most disruptive articles in ENT over a 60‐year period and examine how disruption index (DI) compares with other bibliometrics in identifying impactful works in the field. Methods: In this cross‐sectional bibliometric analysis, articles published between 1954 and 2014 in commonly referenced otolaryngology‐head and neck surgery (OHNS) journals were queried in PubMed. Publications were characterized by DI, journal, subspecialty discipline, and status as an impactful article in the field as determined by other bibliometrics such as citation count, the "Sleeping Beauty Index," and those derived by the modified Delphi process. Results: Of the 122,094 articles queried, 67,561 (55.3%) had available citation count as well as disruption score data, meeting inclusion criteria. The most represented subspecialty disciplines within the top 100 most disruptive articles were Otology/Neurotology (28%), General (Comprehensive) (27%), Head and Neck Surgery (12%), and Laryngology (11%). Fifty percent of articles identified as Sleeping Beauties and impactful via modified Delphi approach had scores in the top 86th percentile. Conclusion: DI in otolaryngology can be appreciated as an added dimension to existing indices and can unearth seminal research, which serve as early foundations of evidence‐based management in the field of OHNS today. Level of Evidence: NA Laryngoscope, 134:629–636, 2024 [ABSTRACT FROM AUTHOR]

Objectives: The aim was to describe incidence and reimbursement trends of surgical repair of facial fractures among the Medicare population. Methods: The annual procedure data from the Centers for Medicare and Medicaid Service National Part B Data File from 2000 to 2019 were queried. Results: The total number of surgically corrected facial fractures increased from 10,148 in 2000 to 19,631 in 2019 in a linear pattern (r = 0.924). Specifically, nasal bone/septum fracture repairs increased the most by 200.6% (n = 4682 to n = 14,075), whereas operations for TMJ dislocations, malar/zygoma fractures, and alveolar ridge/mandibular fractures decreased by 27.9%, 12.3%, and 3.2%, respectively, between 2000 and 2019. Correspondingly, the total Medicare reimbursement rose from $2,574,317 in 2000 to $4,129,448 in 2019 (r = 0.895). However, the mean reimbursement for all procedures decreased from $376.63 to $210.35 (44.1% fall) over the same time after adjusting for inflation, with this trend holding for individual fracture types as well. Conclusions: Given the population's increasing age, there has been a significant increase in the number of surgical repairs of facial fractures in Medicare patients between 2000 and 2019. However, this is largely driven by an increase in nasal bone/septum closed reductions, with stagnant and, in some cases, declining incidence among other fracture repairs. The reason is unclear and may be related to an increase in nonoperative management or poor outcomes. Nevertheless, like other subfields within otolaryngology and medicine at large, payments have lagged far behind, which may play some role. Level of Evidence: 3 Laryngoscope, 134:659–665, 2024 [ABSTRACT FROM AUTHOR]

With the increasing consolidation of physician practices, private equity (PE) firms have been playing a growing role in healthcare delivery and recently began entering the otolaryngology‐head and neck surgery space. To date, no studies have examined the extent of PE investment in otolaryngology. We assessed trends and geographic distribution of US otolaryngology practices acquired by PE using Pitchbook (Seattle, WA), a comprehensive market database. From 2015 to 2021, 23 otolaryngology practices were acquired by PE. The number of PE acquisitions increased over time: 1 practice was acquired in 2015 versus 4 practices in 2019 versus 8 practices in 2021. Nearly half (43.5%, n = 10) of acquired practices were in the South Atlantic region. The median number of otolaryngologists at these practices was 5 (interquartile range: 3‐7). As PE investment in otolaryngology continues to grow, further research is needed to assess its impact on clinical decision‐making, healthcare costs, physician job satisfaction, clinical efficiency, and patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the 2020 to 2021 Otolaryngology residency application cycle in the context of recent trends. Study Design: Retrospective data analysis. Setting: Disruptions caused by the COVID-19 pandemic may significantly alter trends among residency applicants, especially in highly competitive and/or smaller specialties. Methods: Applicant and residency statistics from Electronic Residency Application Service (ERAS) and National Residency Matching Program (NRMP) were extracted from the 2016 to 2021 and 2011 to 2021, respectively. Trends in Otolaryngology-Head and Neck Surgery (OHNS) were compared to peer specialties (PS) including Dermatology, Neurological Surgery, Orthopedic Surgery, and Integrated Pathway for Plastic and Reconstructive Surgery (PRS). The ratio of the number of applicants per positions (APP) was used to reflect the degree of competition. Results: Between 2011 and 2021, the number of OHNS programs and positions expanded less than those of PS and General Surgery. The increase in the APP ratio was significantly greater for OHNS compared to those Dermatology, Orthopedic Surgery, General Surgery and all PGY1 residency positions for both US MD and all applicants (P <.01 for each). OHNS expansion of US MD (P =.046), but not all applicants (P =.169), outgrew that of Neurosurgery. Conclusion: The 2020 to 2021 cycle affected by the COVID-19 pandemic saw a continuation of the recent trend in the expanding OHNS applicant pool. OHNS remains one of the specialties with the highest APP ratio and has observed a significant growth compared to PS since 2018. Understanding and anticipating trends in residency application cycles is critical for designing processes to optimize the best fit between applicants and programs. [ABSTRACT FROM AUTHOR]

Objective: To perform a literature review on burnout prevalence, factors that affect burnout and well‐being, and solutions to address burnout in otolaryngology–head and neck surgery (OTO‐HNS) residents and residents in other surgical specialties. Data Sources: Ovid Medline, Embase, and article reference lists. Review Methods: A literature search was performed to identify articles on resident burnout, distress, wellness, well‐being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years. Conclusions: Moderate to high burnout has been reported in 35% to 86% of OTO‐HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO‐HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well‐being across specialties. Implications for Practice: Addressing burnout, which is prevalent in OTO‐HNS residents, is critical to improving patient care and physician well‐being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well‐being. [ABSTRACT FROM AUTHOR]