Exploring Diversity in North American Academic Pediatric Otolaryngology.

OBJECTIVE: Representation of women and minority groups is traditionally low in Otolaryngology-Head & Neck Surgery (OHNS). This cross-sectional study aims to assess the difference in gender and racial/ethnic representation within Academic North American pediatric OHNS. STUDY DESIGN: Cross-sectional study of North American pediatric OHNS faculty websites. SETTING: North America. METHODS: Canadian and American residency program registries were searched for accredited OHNS programs. Pediatric OHNS faculty were identified through program websites. Information regarding gender, race/ethnicity, time in practice, research productivity, academic title, and leadership positions was extracted from public profiles and Scopus. Demographic and academic data was also extracted for OHNS and pediatric OHNS department/division chairs. RESULTS: North American academic pediatric OHNS websites listed 516 surgeons, of whom 39.9% were women. Most surgeons were perceived as White (69.0%), followed by Asian (24.0%), Hispanic (3.7%), and Black (3.3%). Women surgeons had lower h-indices, less publications, and less citations than men (P < .001). Despite women surgeons having fewer years in practice (median 8.0 vs 13.0, P < .001), gender-differences in h-index persisted when controlling for years in practice (P < .05). Men surgeons had higher academic titles (P < .001), but there was no gender difference in leadership roles while accounting for years in practice (P = .559). White surgeons had higher academic titles than non-White surgeons (P = .018). There was no racial/ethnic difference in leadership roles (P = .392). CONCLUSION: Most pediatric OHNS surgeons are men and/or White. Significant gender-differences in research productivity and academic title exist, however surgeons of racial/ethnic minority have similar research productivity as their racial/ethnic majority counterparts.

Validation of a PHIS Esophageal Atresia and Tracheoesophageal Fistula Cohort in ICD-10.

OBJECTIVE: Validation of a contemporary International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) congenital esophageal atresia/tracheoesophageal atresia (EA/TEF) cohort in the Pediatric Health Information System (PHIS) database. STUDY DESIGN: Database study, validation. SETTING: Tertiary care center. METHODS: Search methods used to validate an ICD-9-CM EA/TEF cohort in PHIS were modified for ICD-10-CM. A retrospectively and prospectively maintained clinical database at a single high-volume EA/TEF center was used for comparison. Patients treated between October 1, 2015 and July 31, 2022 were included. Searches progressively narrowed the cohort by ICD-10-CM diagnosis codes, expansion to include incorrectly coded as 'iatrogenic, age less than 30 days, and use of at least 1 ICD-10-CM procedure code. Results of PHIS data and institution data were compared for accuracy. RESULTS: The most refined search of PHIS and the EA/TEF clinical database yielded 93 and 84 patients, respectively. The sensitivity was 99% and positive predictive value was 94%. A PHIS search using these methods and encompassing 49 children's hospitals yielded an EA/TEF cohort of 2479 patients. CONCLUSION: We present a validated search method in the PHIS database to identify a high-fidelity cohort of EA/TEF patients for multi-institutional study. We have demonstrated that a carefully maintained clinical database may be used to validate cohorts in PHIS. This cohort allows for improved practice variability and outcomes study of EA/TEF patients. Similar methods may be employed to generate other rare disease cohorts in PHIS. LEVEL OF EVIDENCE: Level 4.

Alternative Therapies for Ankyloglossia-Associated Breastfeeding Challenges: A Systematic Review.

Background: Ankyloglossia (AG) diagnoses are increasingly common, and management is not standardized. Nonsurgical alternative therapies are frequently recommended in conjunction with or instead of frenotomy, with uncertain evidence. Objective: To evaluate the efficacy of nonsurgical alternative therapies (chiropractic care, myofunctional therapy, and osteopathy) in improving breastfeeding for infants diagnosed with AG. Methods: PubMed, Embase, CINAHL, Scopus, Web of Science, Clinicaltrials.gov, and Google Scholar were searched (September-October 2023). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A librarian-designed search included the terms "Ankyloglossia," "Non-surgical," "myofunctional therapy," "chiropractic," "osteopathy," and related therapies, with no date restrictions. English language studies of infants <24 months with AG and alternative therapy were included. Risk-of-bias evaluation used Newcastle-Ottawa Scale (NOS). Results: Of 1,304 identified articles, four studies (2016-2022) met inclusion criteria (two cross-sectional, one case report, and one case series). All studies reported frenotomy in combination with alternative therapy yielded favorable outcomes for maternal pain, weight gain, feeding duration, and maintenance of latch. The risk of bias was moderate for two studies, low for the case series, and not calculated for the case report, which has an inherent high risk of bias. All studies lacked control or comparator groups preventing definitive conclusions about the role of alternative therapies in AG. Conclusion: Although some studies suggest the potential benefits of combining alternative therapies with surgery for AG-related breastfeeding issues, the lack of control groups renders the evidence inconclusive. Nonsurgical approaches alone currently lack sufficient evidence. As these alternative therapies gain popularity, rigorous research is crucial to determine their cost-effectiveness and role in managing AG.