Gender distribution of Top Doctors in otolaryngology-head and neck surgery.

INTRODUCTION: Our study seeks to understand the profiles of otolaryngologists selected by Castle Connolly's Top Doctor list and how this compares to the entire field of otolaryngology. METHODS: Top Doctor lists published in Castle Connolly affiliated magazines were analyzed for Otolaryngology, Otolaryngology/Facial Plastic Surgery, or Pediatric Otolaryngology physicians. Only lists published in 2021 or representing the 2021 Top Doctor lists were analyzed. Of the total 39 partnered magazines, 27 met our criteria. Information on the physician was analyzed from the Castle Connolly website and included: gender, education, faculty position, years as a Top Doctor, and certifications of each physician. RESULTS: 879 doctors, 742 (84%) men and 137 women (16%), were included in our analysis. 509 physicians completed a fellowship, 85 (62%) women and 424 (57%) men. The fellowship type varied significantly between gender (p = .002). 122 (14%) Top Doctors completed facial and plastic reconstructive surgery and 111 (91%) were men. Of the women Top Doctors completing a fellowship, 29 (34%) completed a fellowship in pediatric otolaryngology. A logistic regression found that men have an increased odds of being on the Top Doctors list for more years than females (OR: 1.36, p < .001). CONCLUSION: The percentage of women named as Top Doctors was less than the proportion of women in otolaryngology. This may be attributed to gender differences we found in fellowship type and certification. Further research into the role of otolaryngology subspecialties in selection of Top Doctors is needed to better understand gender differences.

How Pediatric Sleep Disordered Breathing Impacts Parental Fatigue.

OBJECTIVE: Previous research has indicated that sleep disordered breathing (SDB) can lead to a decreased quality of life in children and their families as compared to children who do not have SDB. The purpose of this study was to examine fatigue levels in parents who had young children who were impacted by sleep symptoms as determined by the OSA-18 scale. STUDY DESIGN: Survey. SETTING: Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. METHODS: Fatigue levels for parents of children with OSA-18 ≥ 60 were assessed using the Fatigue Severity Scale and the Chalder Fatigue Scale. Consecutive parents with at least one child between the ages of 1 and 10 were recruited. Parents scored their youngest child on the OSA-18 scale. RESULTS: Of the 261 respondents included, 37 parents had a child with an OSA-18 score ≥60. The majority, 211 (82.1%), of participants reported 2 caregivers in the household while 30 (11.7%) had 1 caregiver in the household. Parents of children with OSA-18 ≥60 had a significantly higher mean fatigue score, 16.5 ± 5.8, compared to their counterparts, 11.9 ± 5.2, on the Chalder Fatigue Scale (P < .001). Similar results were reported for the total score on the Fatigue Severity Scale, 34.7 ± 10.8 compared to 28.9 ± 12.0 (P = .004). CONCLUSION: Parents of children with OSA-18 score ≥60 are significantly more fatigued than parents of children with lower scores. Recognition of this is important for the health care community as it impacts not just the child with OSA but also their family.

Tracheotomy in children older than two years: Analysis of discharge trends from 2015 to 2020.

OBJECTIVE: In light of increasingly complex patients being discharged with tracheostomies, we aimed to evaluate discharge trends over time in pediatric tracheotomy patients. We hypothesized that there would be delays in discharge from increased focus on preparing families for at-home care of critically ill pediatric patients. MATERIALS AND METHODS: We conducted a cross-sectional analysis of pediatric patients who underwent tracheotomy (Current Procedural Terminology code 31600) between 2015 and 2020 using the American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS NSQIP-P). Univariate and multivariate regression analyses were performed to assess patient demographics, comorbidities, perioperative factors, postoperative complications, and discharge information. Data were analyzed using Stata 15. RESULTS: A total of 1552 patients were identified. There were 868 (56 %) males and 684 (44 %) females with a mean age of 7.3 ± 5.7 years. At least one comorbidity was seen in 1282 (83 %) patients, with 907 (58 %) having impaired cognitive status or developmental delay. Thirty-six (2.3 %) patients experienced mortality within 30 days, while 710 (46 %) were still in the hospital at 30 days. The odds of remaining in the hospital after 30 days were positively correlated with the year (p=.001). Other factors associated with an increased likelihood of remaining in the hospital after 30 days included younger patient age (p <.001), any complication (p <.001), and a higher American Society of Anesthesiologists classification (p <.001). CONCLUSION: As years have progressed, fewer children were discharged from the hospital after 30 days following tracheotomy. Further research may identify socioeconomic factors contributing to the increasing length of hospital stays associated with a need for tracheotomy.

Age-related outcomes after pediatric branchial cleft cyst excision via NSQIP-P.

OBJECTIVE: Branchial cleft cysts present at varying ages; sometimes excision is delayed because of concern about operating in small children. Our goal was to determine if outcomes and complications differed among pediatric age groups. STUDY DESIGN: Retrospective, cross-sectional. SETTING: American College of Surgeons' National Surgical Quality Improvement Pediatric database. METHODS: Patients who underwent a branchial cleft cyst excision between 2016 and 2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database. Patients with CPT code 42,815: 'excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx' as their primary procedure were included. Variables of interest included patient demographics, comorbidities, pre-operative risk factors and complications. RESULTS: 2267 patients with median age of 3.9 (IQR: 7.4, range: 0.04-17.9) years were included. The most common pre-operative risk factors were 149 (7 %) patients with prematurity, 136 (6 %) with developmental delay, 135 (6 %) with congenital malformation, and 128 (6 %) with open wound or wound infection. 68 (3 %) patients experienced at least one post-operative complication, with 73 post-operative complications documented in total. Surgical site infections were the most common complications with 49 (67.1 %) superficial infections, 11 (15.1 %) deep infections, and 4 (5.5 %) organ/space infections. Surgical site infections were the most common reason for related readmission. Duration of anesthesia and operative time increased significantly as patient age increased (p < .001 for both). There was no significant correlation between age and complication incidence. CONCLUSION: Branchial cleft cyst excision is a relatively safe operation with a low complication rate, even in young pediatric populations.

A Rare Case of Pediatric Oropharyngeal Schwannoma.

This is a case of a male child who presented with a progressively enlarging oropharyngeal mass, hyponasal voice, and symptoms of obstructive sleep apnea. Computed tomography imaging of the head and neck revealed a well-circumscribed low-density area of polypoid morphology arising from the left lateral pharyngeal wall, filling most of the posterior oropharynx and extending to a pedicle at the lateral nasopharynx. Histopathological evaluation following surgical excision revealed Antoni A tissue and S100 immunoreactivity. The presentation and diagnosis of benign schwannoma neoplasms are discussed.

Parental Knowledge of Obstructive Sleep Apnea Symptoms and Tonsillectomy in Children.

OBJECTIVE: Obstructive sleep apnea (OSA) is present in approximately 2% to 5% of children; however, only 15% of parents are reported to be knowledgeable about OSA in children. Sleep apnea in children can lead to cardiopulmonary disease, abnormal weight gain, failure to thrive, or learning difficulties. The purpose of our study is to assess parental knowledge of pediatric OSA to identify any knowledge gaps. STUDY DESIGN: Survey. SETTING: Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. METHODS: In June of 2021, parents of pediatric (0-18 years) otolaryngology patients completed a survey on their knowledge of OSA. Parents were asked to rank their concern about OSA and identify symptoms of OSA. Parental demographic data collected included gender, age, race, and educational level. Respondents were asked if their child had undergone a sleep study or tonsillectomy. RESULTS: Of the 246 parents included, 77 (31.4%) parents had a child who had a tonsillectomy, 40 (16.3%) had a child who had a sleep study done, and 25 (10.2%) had a child with both done. For recognizing the symptoms of pediatric OSA the mean was 6.3 (95% CI 5.8-6.8) out of 13 total. Symptoms least likely recognized were nocturnal enuresis and hyperactivity, 65 (27%) and 91 (37%) of parents correctly identifying these symptoms, respectively. Greater concern about OSA correlated with greater cumulative knowledge score (P < .001). Parents whose child had undergone a tonsillectomy were more likely to be concerned about OSA in children compared to non-tonsillectomy parents (P = .003), and sleep study parents were also more likely to be concerned about OSA than non-sleep study parents (P = .045). CONCLUSION: Parents who attended a pediatric otolaryngology clinic have knowledge gaps about pediatric sleep.

Impact of COVID-19 Pandemic on Expenses of Medical Students Applying to Otolaryngology Residency Programs.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has led to many changes in the residency application process. The purpose of this study was to determine the impact of these changes on the cost of applying to otolaryngology residency programs.  Materials and Methods: A retrospective, cross-sectional analysis was conducted using the Texas Seeking Transparency in Application to Residency (Texas STAR) Dashboard database to determine the differences in residency application costs from 2019 to 2022. Applicant information and cost data including application fees, interview expenses, away rotation expenses, total expenses, and geographic regions were collected. Median expenses and interquartile ranges were reported for each year and geographic region. Non-parametric comparisons were conducted. RESULTS: Data from 499 otolaryngology applicants were collected from the Texas STAR database. The total expenses, interview expenses, and away rotation expenses of applicants from 2019 to 2022 were significantly decreased (p < 0.001) in all regions of the United States with the greatest decrease between 2020 and 2021. Application fees (p = 0.005) were not significantly different among regions of the United States throughout the time period studied. CONCLUSION: The COVID-19 pandemic significantly decreased the total expenses of applying to otolaryngology residencies including away rotation and interview expenses.

Age and indication for pediatric septoplasty in the NSQIP-P database.

INTRODUCTION: Pediatric septoplasty has been a historically controversial topic in the field of otolaryngology. Past recommendations avoided reconstruction during development because of the potential for growth changes after intervention that may require later revision surgery. Recent studies have considered early operation to avoid further growth complications, pointing at changing trends in the field. METHODS: A retrospective study was conducted using the ACS NSQIP-P database to identify patients under 18 years of age who underwent a septoplasty between 2012 and 2019. Cases were identified using CPT code 30520 for 'septoplasty' and grouped by primary procedure as follows: cleft lip repair, sinus surgery, rhinoplasty/reconstruction/other, and septoplasty as primary procedure. Variables of interest included patient demographics, comorbidities, perioperative risk factors and complications. RESULTS: 2290 patients were included with a mean age of 14.2 years at time of surgery. Patients undergoing cleft lip repair were significantly younger than patients in the other procedure groups (mean age 9.3 years, p < .001), with 28% of the patients under 1 year of age. The most common comorbidity was congenital malformation (20.0%) followed by asthma (10.2%). Significantly longer total length of hospital stay was associated with younger age (p < .001), female gender (p = .007), and perioperative comorbidities (p < .001). 8 (0.3%) patients were readmitted within 30 days for reasons related to the primary septoplasty surgery and 15 patients (0.7%) had related reoperations within 30 days. CONCLUSION: Septoplasty is currently being performed on children of all ages. Children undergoing cleft lip repair account for the youngest demographic of pediatric septoplasty patients. General complications such as readmission and length of stay are more common in younger children undergoing septoplasty, however the number of readmissions and reoperations is relatively low. Further study is needed to describe the association between pediatric septoplasty and long term health outcomes.

Effectiveness of Amniotic Fluid Injection in the Treatment of Trigger Finger: A Pilot Study.

Purpose: To assess the efficacy and safety of amniotic fluid therapy injections in patients with mild to moderate trigger finger. Methods: All participants received 1 mL of amniotic fluid injected into the tendon sheath of the affected tendon. Pretreatment and posttreatment data were collected for triggering frequency, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, and numerical pain rating scale scores. Results: Of 111 digits from 96 patients, 51% experienced clinically notable improvement and did not receive an alternative treatment. Average length of follow-up was 11 months. From baseline to end of follow-up, average pain score (0-10) decreased from 5.19 to 1.19 (P < .001), median triggering per day decreased from 5 to 0 (P < .001), and median DASH score (1-100) decreased from 20 to 6.03 (P < .001). There was a 50% success rate in patients with diabetes and a 52.6% success rate in digits diagnosed with concomitant Dupuytren contracture in the same hand. Conclusions: Amniotic fluid therapy injections may offer a biologic alternative for conservative treatment of trigger finger, particularly for patients with diabetes. Decreased pain, decreased triggering, and improved DASH scores offer preliminary evidence supporting the use of amniotic injections for stenosing tenosynovitis. Type of study/level of evidence: Therapeutic IV.