Impact of Medical Student Research Fellowships on Otolaryngology Match Outcomes.

OBJECTIVES/HYPOTHESIS: While many students participate in research years or fellowships prior to entering the otolaryngology-head and neck surgery (OHNS) match, the effects of these fellowships on match outcomes remains unclear. This study aimed to assess the impact of research fellowships on odds of matching into OHNS. STUDY DESIGN: Cross-sectional analysis. METHODS: Applications from first-time, US allopathic seniors between the 2014-2015 and the 2019-2020 application cycles were reviewed. Data were abstracted from Electronic Residency Application Service applications and match results determined using the National Residency Matching Program database and online public sources. The relationship between research fellowships and matching was analyzed using multivariate logistic regression. RESULTS: Of the 1775 applicants included, nearly 16% (n = 275) participated in research fellowships and 84.1% matched (n = 1492). Research fellows were no more likely to match into OHNS than non-research fellows (86.9% vs. 83.5%, unadjusted odds ratio [OR] 1.31, P = .161), even when adjusting for applicant characteristics (predicted probability [PP]: 88.8% vs. 85.8%, adjusted OR 1.31, P = .210). For applicants from top 25 medical schools, however, research fellowships were associated with higher odds of matching (PP: 96.5% vs. 90.0%, adjusted OR 3.07, P = .017). In addition, completing a fellowship was associated with significantly greater odds of matching into a top 25 OHNS residency program (PP: 58.6% vs. 30.5%, adjusted OR 3.24, P < .001). CONCLUSION: Fellowships may be beneficial for select applicants, though for most, they are not associated with improved odds of matching. These findings provide context for OHNS residency candidates considering research fellowships and should be carefully weighed against other potential advantages and disadvantages of fellowships. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E2506-E2512, 2021.

Comparison of Socioeconomic and Demographic Factors in Patients with Chronic Rhinosinusitis and Allergic Fungal Rhinosinusitis.

OBJECTIVE: The primary objective of this study is to evaluate the differences in socioeconomic, demographic, and disease severity factors between patients with chronic rhinosinusitis (CRS) and those with allergic fungal rhinosinusitis (AFRS). STUDY DESIGN: A retrospective cohort analysis was performed. SETTING: The study was conducted at the hospital of the University of North Carolina at Chapel Hill. SUBJECTS AND METHODS: A total of 186 patients were included (93 AFRS, 93 CRS with and without nasal polyps). Socio- economic and demographic data were obtained from the North Carolina State Data Center. Indicators of disease severity were measured by Lund-Mackay scores, serum immunoglobulin E (IgE) levels, diagnosis of asthma and/or allergic rhinitis, and the number of surgeries and computed tomography scans performed. Associations were analyzed with Fisher's exact, Wilcoxon rank sum, and Pearson's correlations tests. RESULTS: Compared with patients with AFRS, patients in both CRS groups were predominantly white (P < .0001), were older at the time of diagnosis (P < .0001), had higher county-based income per capita (P = .004), had lower quantitative serum IgE level (P < .001), and had lower Lund-Mackay scores (P < .0001). No associations between disease severity, socioeconomic status, and demographic factors were found within the CRS groups. CONCLUSION: Within our cohort of patients residing in North Carolina, those with CRS have higher income, more access to primary care, and lower markers of disease severity than those with AFRS. These data continue to support the notion that AFRS merits classification as a distinct subtype of CRS.

Markers of disease severity and socioeconomic factors in allergic fungal rhinosinusitis.

BACKGROUND: Allergic fungal rhinosinusitis (AFRS) is a refractory subtype of chronic rhinosinusitis. There is a paucity of data investigating the association of epidemiologic markers of disease severity. The primary objective of this study is to evaluate components of disease severity with socioeconomic status and health care access. METHODS: A retrospective analysis was performed on patients diagnosed with AFRS by Bent and Kuhn criteria from 2000 to 2013. Severity of disease was measured by orbitocranial involvement, bone erosion, Lund-Mackay score, serum immunoglobulin E (IgE), and mold hypersensitivity. The North Carolina State Data Center provided county-specific socioeconomic and demographic data. Fisher's exact test, Wilcoxon rank sum test, Pearson correlations, and multivariable linear regression models were used to explore associations between variables. RESULTS: Of 93 patients, 58% were African American and 39% Caucasian with a male:female ratio of 1.4:1 and average age at presentation of 29 years. Race, age, insurance status, and gender were not associated with severity of disease. Bone erosion was correlated with residence in counties with lower income per capita (p = 0.01). Patients with orbitocranial involvement resided in more rural counties (p = 0.01) with less primary care providers per capita (p = 0.02). Residence in counties with older or poorer quality housing was associated with a higher prevalence of bone erosion (p = 0.02). CONCLUSION: Within our cohort of patients residing in North Carolina, markers of disease severity (bone erosion and orbitocranial involvement) in AFRS were associated with lower income, rural counties, poor housing quality, and less health care access.

Comparative analysis of cost of endoscopic endonasal minimally invasive and sublabial-transseptal approaches to the pituitary.

BACKGROUND: Two surgical approaches to the pituitary are commonly used: the sublabial-transseptal (SLTS) approach using microscopy and the endonasal endoscopic minimally invasive (MIPS) approach. Although outcomes are similar for both procedures, MIPS has become increasingly prevalent over the last 15 years. Limited cost analysis data comparing the 2 alternatives are available. METHODS: A retrospective analysis of cost and volume data was performed using data from the published literature and University of North Carolina at Chapel Hill (UNC) Hospitals. A sensitivity analysis of the parameters was used to evaluate the uncertainty in parameter estimates. RESULTS: The total cost in real dollars ranges from $11,438 to $12,513 and $18,095 to $21,005 per patient per procedure for MIPS and SLTS, respectively, with a cost difference ranging between $5582 and $9567 per patient per procedure. The sensitivity analysis indicates that the total cost for MIPS is most sensitive to: (1) average length of stay, (2) nursing costs, and (3) number of total complications, whereas the total cost for SLTS is most sensitive to: (1) average length of stay, (2) nursing cost, and (3) operating time. MIPS is less costly than SLTS between 94% and 98% of the time. CONCLUSION: The results indicate that MIPS is less costly than SLTS at a large academic center. Future research should compare the outcomes and quality of life (QoL) associated with the 2 surgeries to improve the data used to determine the cost-effectiveness of MIPS compared to SLTS.

Allergic rhinitis--history and presentation.

Allergic rhinitis is a common disorder that results from a complex interaction of environmental and genetic causes. This disorder has a tremendous impact on the quality of life and on health care expenditures, as evidenced by a large loss of worker productivity. Care must be taken to promptly diagnose patients with this condition, evaluate them for associated conditions, and begin appropriate management to reduce its impact on the individual and the health care system. Allergic rhinitis represents only a component of the spectrum of inflammatory diseases involving the unified airway.