The Experiences of Motherhood in Female Surgeons: A Scoping Review.

OBJECTIVE: The objective of this study is to systematically synthesize the existing literature on the experiences of motherhood in female surgeons both during surgical training and as staff physicians, to identify knowledge gaps, and to provide recommendations for institutional changes to better support pregnant female surgeons. BACKGROUND: There are disproportionately fewer medical students pursuing surgical specialties, as surgery is often seen as incompatible with childbearing and pregnancy. However, no review has summarized the published literature on the collective experiences of female surgeons in navigating motherhood. METHODS: Four databases were searched and 1106 abstracts were identified. Forty-two studies were included and a thematic analysis was performed. RESULTS: Four themes were identified: path toward motherhood (n=18), realities of motherhood (n=25), medical culture and its impact on career and family life (n=24), and institutional reproductive wellness policies (n=21). Female surgeons are more likely to delay motherhood until after training and have high rates of assisted reproductive technology use. Pregnancy during surgical training is associated with negative perception from peers, pregnancy complications, and scheduling challenges. Maternity leave policies and breastfeeding and childcare facilities are variable and often inadequate. Many female surgeons would agree that greater institutional support would help support women in both their roles as mothers and as surgeons. CONCLUSIONS: Both female residents and staff surgeons experience significant and unique barriers before, during, and after motherhood that impact their personal and professional lives. Understanding the unique challenges that mothers face when pursuing surgical specialties is critical to achieving gender equity.

Impact of nasal surgery on speech resonance.

OBJECTIVES: The nose and paranasal sinuses contribute to speech resonance and changes to these structures may alter speech nasality. This change may influence one's vocational and social functioning and quality of life. Our investigation explored objective and subjective changes in nasality following nasal surgery in a prospective and longitudinal fashion. METHODS: Recordings of sustained vowel and sentence stimuli and voice-related quality of life measurements were obtained preoperatively and at 2, 4, 8, and 24 weeks postoperatively from individuals undergoing nasal and/or sinus surgery. Objective measures of fundamental frequency, jitter, shimmer, and harmonic to noise ratio (HNR) were determined. Pre- and postoperative speech samples were assessed by 15 naïve listeners. RESULTS: In all, 15 subjects completed the study. Neither speakers nor listeners perceived a subjective change in nasality following surgery. No statistically significant change in microacoustic measures were identified. Although nasal sentences did not reveal differences for 3 microacoustic measures, a difference in HNR was identified. CONCLUSIONS: Patients undergoing nasal surgery did not exhibit subjective changes in resonance postoperatively. Aside from a difference in HNR for the nasal sentence, objective microacoustics remained unchanged. These results demonstrate the stability of oranasal resonance despite nasal surgery and provide valuable data for patient informed decision-making.

The Use of Ipratropium Bromide for the Treatment of Pediatric Sialorrhea: A Retrospective Clinical Case Series.

OBJECTIVE: This retrospective review documents the experience of ipratropium bromide use among pediatric patients with sialorrhea at our multidisciplinary sialorrhea clinic at Children's Hospital at London Health Sciences Centre (LHSC). METHODS: A retrospective chart review of patients diagnosed with sialorrhea at our multidisciplinary clinic between January 2015 and June 2021 was completed. Data on patient demographics, comorbidities, clinical presentation, previous interventions, quality of life, and medication adverse side effects was collected. Drooling Frequency and Severity Scale (DFSS) scores were reviewed to compare sialorrhea management pre- and post-treatment with topical 0.03% ipratropium bromide nasal solution. A descriptive analysis and Wilcoxon signed rank tests were conducted to compare pre- versus post-treatment DFSS scores. RESULTS: A total of 12 patients presented for follow-up and were included in the final analysis. At the pre-treatment visit, the median DFSS score was 4 for frequency and 5 for severity. Post-treatment, median DFSS score was 3 for frequency and 4.5 for severity, (P = .020 and .129, respectively). Minimal adverse effects were encountered. CONCLUSIONS: Ipratropium bromide provided a statistically significant benefit for drooling frequency in the patients studied and may present an additional topical medical option for pediatric sialorrhea with limited adverse effects.

Economic, Environmental, and Social Value of Virtual Care in Otolaryngology: Sustainability in Quality Improvement Framework.

OBJECTIVE: Apply the Sustainability in Quality Improvement framework to virtual care for Otolaryngology-Head and Neck Surgery (OHNS) patients to understand the economic, environmental, and social impacts. METHODS: This project consisted of retrospective analysis of anonymized data from all appointments that took place in three academic ambulatory OHNS clinics (pediatrics, head and neck, and otology/neurotology) from fiscal years of 2021 to 2023. Data were obtained from our institution's Virtual Care Dashboard. The following metrics were calculated: travel costs avoided with virtual appointments (economic value), fuel and carbon emissions avoided with virtual appointments (environmental value), and differences in Ontario Marginalization (ON-Marg) Index scores between patients seen virtually versus in-person (social value). RESULTS: A total of 41,343 visits occurred over the 2-year period (18.1% virtual). Nearly all virtual visits were by telephone (99.6%). The average cost savings per virtual care visit was $87.50, and total cost savings across all 3 clinics was $640,300. Total environmental savings were 82,500 L of fuel and 246.6 metric tons of carbon emissions. There were no statistical differences in monthly average marginalization (ON-Marg) indices in patients seen virtually compared to in-person. DISCUSSION: Virtual care demonstrated financial and environmental savings for OHNS patients that can accumulate over multiple appointments. No difference in ON-Marg indices between patients assessed virtually versus in-person suggests that virtual care was accessible for patients regardless of social background. IMPLICATIONS FOR PRACTICE: Our data suggests that virtual care may be a viable complement for delivering OHNS care that leads to fiscal and environmental savings for patients and ensures equitable access to care.

Carbon Footprint Reduction Associated With Multidisciplinary Pediatric Airway Clinics: A Program Evaluation Study.

Objective: Health care is a significant contributor to the climate crisis. Multidisciplinary clinics (MDC) may reduce carbon emissions by combining multiple appointments into one. This is the first program evaluation study to quantify the carbon footprint associated with multidisciplinary pediatric airway clinics. Study Design: Retrospective. Setting: Children's Hospital at London Health Sciences Center, London, Canada. Methods: Pediatric airway MDC allows patients to see otolaryngology and respirology in one appointment. The carbon and financial savings (Canadian Dollars) of all patients attending the MDC from January 1, 2018 to December 31, 2022 were calculated. Patient postal codes and institutional parking rates were inputted into the CASCADES carbon accounting tool. Total distance was divided into unsustainable (vehicles) and sustainable (transit, walking, cycling) transportation to calculate carbon emissions. Travel costs included cost/kilometer for vehicles (maintenance, license/registration, insurance, fuel) and costs/ride for transit. Results: A total of 560 MDC appointments for 300 patients saved 77,785 km. Total carbon emissions saved from travel averted was 16.21 tonnes. The total carbon emissions saved, minus public transit, was 15.60 tonnes. Using the Natural Resources Canada Greenhouse Gas Equivalencies Calculator, 16.21 tonnes are approximately equivalent to 5 passenger vehicles, 6906 L of gasoline, 3.8 homes' energy, and 10.8 homes' electricity use for one year, 36.6 barrels of oil consumed, and 675 propane cylinders. Travel costs of $28,891.83 (no parking), $30,519.40 ($4 minimum parking fee), or $33,774.55 ($12 maximum parking fee) were saved. Conclusion: MDC effectively reduced carbon emissions and offered patients financial savings. Similar models can be adapted across institutions to help mitigate climate change.

Gender Differences in Domestic Responsibilities of Otolaryngologists-A Mixed-Methods Analysis.

OBJECTIVES: Female otolaryngologist-head and neck surgeons (OHNS) confront unique barriers. This study examines the influence of home life, especially gendered division of household labor, on leadership, productivity, and burnout. METHODS: A survey was distributed through social media and national society list-serv. Demographics, responsibility for household roles, and Maslach Burnout Inventory for Medical Personnel were included. Participants were invited to participate in semi-structured interviews, employing purposive sampling, with qualitative thematic analysis. RESULTS: Response rate was 26.4% (145 of 550 of eligible participants; 38.7% women, 60.7% men). Significantly fewer women were married (64.3% vs. 92% of men, p < 0.001), and significantly more were childless (21.4% of women vs. 9.1% of men, p = 0.037). More men reported exclusive/major responsibility for five duties, including yard work and home maintenance (all p < 0.03). More women reported exclusive/major responsibility for 15 duties, including meal planning and coordinating childcare (all p < 0.03). Women had higher Emotional Exhaustion on univariate analysis (p = 0.015). Across 27 interviews, two main themes were identified, each with three associated subthemes: Theme one, "division of duties," with subthemes (1) the way household duties were divided, (2) traditional gender norms, and 3. changing duties over time/unexpected circumstances. Theme two, "impact of domestic duties," with subthemes (1) professional, (2) financial, and (3) burnout/life satisfaction. CONCLUSIONS: Women OHNS disproportionately manage domestic responsibilities, possibly altering career trajectory for some OHNS. Burnout, especially emotional exhaustion, may be elevated due to inequitable labor. Future research should focus on identifying ways to improve equity for this group. LEVEL OF EVIDENCE: N/A Laryngoscope, 2024.

Evaluating implicit gender bias at Canadian otolaryngology meetings through use of professional title.

Objectives: Increasing numbers of women enter medical school annually. The number of female physicians in leadership positions has been much slower to equalize. There are also well-documented differences in the treatment of women as compared to men in professional settings. Female presenters are less likely to be introduced by their professional title ("Doctor") for grand rounds and conferences, especially with a man performing the introduction. This study reviewed the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) meetings from 2017 to 2020 to determine the proportion of presenters introduced by their professional title and whether this varied by gender. Methods: Recordings from CSOHNS meetings were reviewed and coded for introducer and presenter demographics, including leadership positions and gender. Chi-squared tests of proportion and multivariate logistic regression was used to compare genders and identify factors associated with professional versus unprofessional forms of address. Results: No significant association was found between professional title use and introducer or presenter gender. Female presenters were introduced with professional title 69.6% of the time, while male presenters were introduced with professional title 67.6% of the time (P = 0.69). Residents were introduced with a professional title with the most frequency (75.8%), while attending staff were introduced with a professional title with the least frequency (63.0%) (P = 0.02). Conclusions: The lack of gender bias in speaker introductions at recent CSOHNS meetings demonstrates progress in achieving gender equity in medicine. Research efforts should continue to define additional forms of unconscious bias that may be contributing to gender inequity in leadership positions.

Feeding outcomes in tracheostomy-dependent infants - can we predict future gastrostomy tube use?

OBJECTIVES: To identify characteristics of infants with tracheostomy that require gastrostomy tube insertion versus those likely to orally feed to predict which patients may benefit from insertion of gastrostomy at the time of tracheostomy placement. METHODS: Retrospective review of infants undergoing tracheostomy from birth to 18 months of age. The primary outcome was to identify pre-operative factors predictive of future gastrostomy tube use. Univariate and multivariate analyses evaluated association between pre-operative patient characteristics and feeding outcomes. RESULTS: Of 103 patients identified, 73 met inclusion criteria. Upper airway anomaly was the indication for tracheostomy in 70.4 %. Gastrostomy tube was required in 52 patients (75.4 %), with 7 (13.5 %) placed concurrently with tracheostomy. Infants with birth complications, a neurologic diagnosis, multiple co-morbidities, or identified with aspiration risk were more likely to require a gastrostomy tube (p < 0.05). CONCLUSIONS: Most infants who require tracheostomy placement from birth until 18 months of age will require nutritional support. Tracheostomy and gastrostomy are uncommonly placed concurrently. Coordination of placement would theoretically minimize the risk of general anesthetic exposure while potentially reducing hospital length of stay and healthcare related costs.

Tumor volumes in T3 supraglottic cancers treated with radiotherapy in the modern era: A study of the Canadian Head & Neck Collaborative Research Initiative.

PURPOSE: To evaluate the association of primary tumor volume (TV) with overall survival (OS) and disease-free survival (DFS) in T3 N0-3M0 supraglottic cancers treated with intensity-modulated radiotherapy (IMRT). METHODS: This was a retrospective cohort study involving 239 patients diagnosed with T3 N0-3M0 supraglottic cancers between 2002 and 2018 from seven regional cancer centers in Canada. Clinical data were obtained from the patient records. Supraglottic TV was measured by neuroradiologists on diagnostic imaging. Kaplan-Meier method was used for survival probabilities, and a restricted cubic spline Cox proportional hazards regression analysis was used to analyze TV associations with OS and DFS. RESULTS: Mean (SD) of participants was 65.2 (9.4) years; 176 (73.6%) participants were male. 90 (38%) were N0, and 151 (64%) received concurrent systemic therapy. Mean TV (SD) was 11.37 (12.11) cm3 . With mean follow up (SD) of 3.28 (2.60) years, 2-year OS was 72.7% (95% CI 66.9%-78.9%) and DFS was 53.6% (47.4%-60.6%). Increasing TV was associated (per cm3 increase) with worse OS (HR, 1.01, 95% CI 1.00-1.02, p < 0.01) and DFS (HR, 1.01, 95% CI 1.00-1.02, p = 0.02). CONCLUSIONS: Increasing primary tumor volume is associated with worse OS and DFS in T3 supraglottic cancers treated with IMRT, with no clear threshold. The findings suggest that patients with larger tumors and poor baseline laryngeal function may benefit from upfront laryngectomy with adjuvant radiotherapy.

Trends in otolaryngology publications: a 9-year bibliometric analysis of articles published in Journal of Otolaryngology-Head and Neck Surgery.

BACKGROUND: The advancement of Otolaryngology-Head and Neck Surgery (OHNS) as a specialty relies on excellence in research. The Journal of Otolaryngology-Head and Neck Surgery is an open access, peer-reviewed journal publishing on all aspects and subspecialities of OHNS. It is the official journal of the Canadian Society of Otolaryngology-Head and Neck Surgery. This study aims to analyze bibliometric trends in authorships and institutional contributions within the Journal of Otolaryngology-Head and Neck Surgery over a 9-year period. METHODS: All research articles published online in the journal were analyzed from 2013 to the end of 2021. The professional designation of all authors was recorded along with the article type, article category, institutional affiliations and international collaborations. Cochran-Armitage trend tests were used to assess the change in proportion over time between years and groups. RESULTS: Of the 603 articles, 20 were excluded as they represented correspondence or corrections, or author identity could not be determined. 583 articles with 3409 total authors were included. Number of first authors with a Doctor of Medicine (MD) degree decreased from 90.2 to 85.3% (P = 0.165). Sub-group analysis of non-MD first authors demonstrated a significant increase in medical students as first authors from 1.6 to 11.8% (P = 0.008). Senior author degree demonstrated a significant increase in MD degree from 96.7 to 98.5% (P = 0.002). Analysis of article categories demonstrated a significant decrease in education and head and neck surgery related articles from 8.2 to 2.9% (P = 0.032) and 44.3 to 29.4% (P = 0.028) respectively. Pediatric otolaryngology articles increased significantly from 0 to 5.9% (P < 0.0001). Systematic and scoping reviews significantly increased, from 3.3 to 10.3% (P = 0.015) and original research significantly decreased from 83.6 to 82.4% (P < 0.0001). There was a significant decrease in Canadian/international collaborations from 14.3 to 4.7% (P = 0.037). There was a significant increase in international first and senior authors, from 23.0 to 36.8% (P = 0.008) and 19.7 to 38.2% (P = 0.002) respectively. CONCLUSION: The landscape of the journal is evolving with increased representation of non-MDs and international authors along with content that reflects higher level of scientific evidence. Future studies should characterize trends in other Otolaryngology journals to understand the research trajectory within the field.

Management of pediatric aural foreign bodies: Towards a universal Otolaryngology referral algorithm.

OBJECTIVES: Children with aural foreign bodies (AFB) frequently present to the Emergency Department (ED). Our objective was to analyze patterns of pediatric AFB management at our center to characterize children who are commonly referred to Otolaryngology. METHODS: A retrospective chart review of all children (ages 0-18 years) presenting with AFB to the tertiary care Pediatric ED over a three-year period was performed. Demographics, symptoms, type of AFB, retrieval strategy, complications, need for Otolaryngology referral, and, use of sedation, were evaluated with respect to outcomes. Univariable logistic regression models were conducted to determine which patient characteristics were predictive of AFB removal success. RESULTS: One hundred and fifty-nine patients seen at the Pediatric ED met the inclusion criteria. Average age at presentation was 6 years (2-18 years). Otalgia was the most common presenting symptom (18.0%). However, only 27.0% of children were symptomatic. ED physicians primarily flushed AFBs out of the external auditory canal with water, whereas Otolaryngologists exclusively used direct visualization. Otolaryngology-Head & Neck Surgery (OHNS) was consulted for 29.6% of children. Of these, 68.1% had complications associated with prior retrieval attempts. Sedation was administered in 40.4% of referred children, with 21.2% in an operative setting. Patients experiencing multiple retrieval methods by ED, and, age less than 3 years, were more likely to be referred to OHNS. CONCLUSION: Patient's age should be strongly considered as a factor for early OHNS referral. By synthesizing our conclusions with previously published results, we propose a referral algorithm.

Auto-Substitutions to Optimize Perioperative Antimicrobial Prophylaxis: Pre-Post Intervention Study.

BACKGROUND: Appropriate administration of perioperative antibiotics can prevent antimicrobial resistance, adverse drug events, surgical site infections, and increased costs to the health care system for many surgeries in Otolaryngology-Head and Neck Surgery (OHNS). OBJECTIVE: The objective of the study is to achieve 90% compliance with evidence-based perioperative antibiotic prophylaxis guidelines among elective surgical procedures in OHNS. METHODS: The pre-intervention group consisted of patients undergoing elective surgical procedures in the 13 months prior to the interventions (September 2019-2020) whereas the post-intervention group comprised patients undergoing elective procedures during the 8 months following the implementation (October 2020-May 2021). The 4 Es of knowledge translation and the Donabedian framework were used to frame the study. Components of the intervention included educational grand rounds and automatic substitutions in electronic health records. In June 2021, a survey of staff and residents assessed the self-reported perception of following evidence-based guidelines. RESULTS: Compliance with antimicrobial prophylaxis guidelines were evaluated based on agent and dose. The overall compliance improved from 38.8% pre-intervention to 59.0% post-intervention (p < 0.001). Agent compliance did not improve from pre- to post-intervention, that is, 60.7% to 62.8%, respectively, (p = 0.68), whereas dose compliance improved from 39.6% to 89.2% (p < 0.001). Approximately 78.5% of survey respondents felt that they strongly agreed or agreed with always following evidence-based antimicrobial prophylaxis guidelines. CONCLUSION: Compliance with antimicrobial prophylaxis guidelines improved, primarily due to increased dosing compliance. Future interventions will target agent compliance and selected procedures with lower compliance rates. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:3403-3408, 2023.

Effectiveness of pediatric Crawford tube implants when endoscopically assisted by ENT surgeons.

OBJECTIVE: Epiphora in pediatrics is commonly treated with silicone nasolacrimal stents. The most common treatment duration is 3 months, but tubes are often unintentionally removed earlier and are still effective. There is no consensus on how long tubes need to be in situ and what factors influence treatment success. METHODS: A retrospective chart review of patients who underwent Crawford tube placement over a 10-year period (2009-2019) was conducted. Patients were age <18 years and had Crawford tubes placed in conjunction with an otolaryngologist, who performed nasal endoscopy for direct visualization when retrieving Crawford tubes and infracture of the inferior turbinate. Bicanalicular intubation was attempted in all cases; if not possible, monocanalicular intubation was performed. RESULTS: Forty-two patients were included in this study, representing 50 eyes. Spontaneous extrusion of tubes occurred in 54% of eyes. Tubes remained in situ for an average of 17.1 weeks (0-113 weeks). Symptoms resolved in 86% of patients, similar to procedures without endoscopy. There were no intraoperative complications. There was no association between the rate of persistent symptoms and duration of treatment. CONCLUSION: Nasolacrimal duct intubation using Crawford tubes performed under direct endoscopic visualization is consistently successful for the treatment of epiphora. Although epiphora can be self-resolving, persistent symptoms typically lasting past the first year of birth, warrant treatment. Children who receive Crawford tubes for epiphora commonly have spontaneous tube extrusion before treatment duration is complete. However, treatment success was not related to the length of time the tubes were in situ. Endoscopic visualization can help prevent intraoperative complications.

Gender differences in publication rates at Canadian Society of Otolaryngology-Head and Neck Surgery annual meetings: an 11-year analysis.

BACKGROUND: Evaluating gender differences in publication rates after conference presentations is an avenue to assess women's contributions to academic medicine. The objective of this study was to assess gender differences in publication rates, time to publication, and subspeciality of publication of abstracts presented at Canadian otolaryngology conferences over an 11-year period. METHODS: Cross-sectional data was obtained from online conference schedules of annual Canadian Society of Otolaryngology-Head and Neck Surgery national meetings between 2009 and 2020. A total of 2111 abstract titles were searched in MedLine via PubMed. Gender of the first and senior author, publication status of presented work, and subspeciality of publication were extracted. RESULTS: Of 2111 scientific abstracts presented between 2009 and 2020, female first and senior authors accounted for 29.0% and 12.8% of published abstracts, respectively. There was a significant difference in the publication rate of senior authors by gender (p < 0.01). Male senior authors had a 9.70% higher rate of publication compared to female senior authors. Posters with a female first author were 33.0% (OR: 0.67; 95% CI 0.49-0.91) less likely to be published compared to posters with a male first author. Similarly, posters with a female senior author were 34.0% (OR: 0.66; 95% CI 0.45-0.96) less likely to be published. There was a significant difference in discipline of publication by gender of the senior author (p < 0.001). Male senior authors were more likely to supervise projects in otology while female senior authors were more likely to supervise projects in education and pediatrics. The time to publication and impact factor of the journal of publication did not differ by gender. CONCLUSION: Gender disparities exist in the publication rates of first and senior authors at Canadian otolaryngology meetings. Female senior authors have significantly lower publication rates compared to their male colleagues and differences exist in publication rates after poster presentations. Investigation of gender gaps in academic medicine, research productivity, and publications is essential for development of a diverse, equitable, and inclusive workforce in otolaryngology.

Understanding Gender Differences in Research Productivity of Canadian Otolaryngologists-A Comprehensive National Audit.

Objective: To understand the factors contributing to gender disparities in the research productivity of Canadian academic otolaryngologist-head and neck surgeons. Methods: Publicly available sources including departmental websites, SCOPUS, and the Royal College of Physicians and Surgeons of Canada were accessed between February and April 2022 to analyze gender differences in the academic productivity of otolaryngologist-head and neck surgeons across Canada. Gender differences in research productivity metrics, including h-index, i10-index, publication number, and number of first and senior authorships were assessed. Demographic data, including gender, institution, years in practice, and leadership roles were assessed for correlation with increased research productivity. Subgroup analyses were used to evaluate gender differences in productivity metrics, and univariable and multivariable regression analyses were used to evaluate predictors of research productivity. Results: Data were collected for 316 academic otolaryngologists (252 men, 64 women, P < .001). Men had significantly more years of publishing [mean (standard deviation, SD), 15.64 (9.45) vs 12.44 (8.28), P = .014], higher h-indices [12.22 (11.47) vs 7.33 (5.36), P < .001], i10-indices [22.61 (37.88) vs 8.17 (9.14), P > .001], publication numbers [46.63 (65.18) vs 19.59 (23.40), P < .001], and first [8.18 (9.95) vs 4.89 (6.18), P = .001] and senior authorships [12.98 (22.72) vs 3.83 (6.89), P < .001]. Gender differences were most pronounced in head and neck oncology, pediatrics, and the late career stage. Gender disparities in productivity were absent in the early career stage. Multivariate analysis identified only the number publications and number of senior author publications as being significantly influenced by gender. Conclusion: Canadian female otolaryngologist-head and neck surgeons appear to have equivalent research productivity to their male counterparts in the early career stage. This mirrors the recent findings in the United States, and demonstrates progress compared to earlier studies that found women to have lower research productivity in the early career stage.

Changes in operative otolaryngology infections related to the COVID19 pandemic: A retrospective cohort study.

BACKGROUND: Pediatric emergency admissions fell significantly during the COVID-19 pandemic. This study investigated the changes in severe infectious complications managed by otolaryngology between the pre-pandemic period and the first year of the pandemic to determine if COVID-19 or related public health measures influenced the rate or severity of presentations managed in otolaryngology. METHODS: A retrospective chart review was conducted on pediatric patients who presented with severe infectious otolaryngology presentations (acute mastoiditis, deep neck space abscesses, and orbital complications of sinusitis) over the pre-pandemic (March 2018-February 2020) and early pandemic (March 2020-February 2021) periods. Patient characteristics, details of presentation, treatment, and outcomes were extracted from patients' charts. Independent samples t-tests/Mann-Whitney U-tests for continuous variables and Pearson chi-squared tests/Fisher's exact test for categorical variables were conducted to compare the pre vs early pandemic groups. RESULTS: There were 93 pre-pandemic and 28 early pandemic presentations. The monthly case average was significantly lower during the early pandemic period than the 2 years prior [3.58 (2.80) vs 2.00 (2.00), P = .045]. The average monthly frequency of presentations for deep neck space abscess and mastoiditis were significantly higher in the pre-pandemic group when compared to the early pandemic group [1.96 (±0.33) vs 1.33 (±0.48), P = .049; .71 (±0.26) vs 0.17 (±0.41), P = .01, respectively]. The early pandemic group was significantly younger (3.81 vs 6.04 years, P = .005), however there were no differences in gender, length of admission, and days from symptom onset to presentation between the two groups (P > .05). The early pandemic group had significantly elevated inflammatory markers on presentation [CRP, WBC, neutrophils (P = .02, P = .02, P = .04, respectively)] compared to the pre-pandemic group. CONCLUSION: The COVID-19 pandemic has had an effect on severe infectious complications of ENT pathologies, including decreased average monthly cases during the early pandemic, younger age at presentation, and elevated inflammatory markers.

Attitudes and Perceptions of Canadian Otolaryngology-Head and Neck Surgeons and Residents on Environmental Sustainability.

Objective: Healthcare systems, specifically operating rooms, significantly contribute to greenhouse gas emissions. Addressing operating room environmental sustainability requires understanding current practices, opinions, and barriers. This is the first study assessing the attitudes and perceptions of otolaryngologists on environmental sustainability. Study Design: Cross-sectional virtual survey. Setting: Email survey to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Methods: A 23-question survey was developed in REDCap. The questions focused on four themes: (1) demographics, (2) attitudes and beliefs, (3) institutional practices, and (4) education. A combination of multiple choice, Likert-scale, and open-ended questions were employed. Results: Response rate was 11% (n = 80/699). Most respondents strongly believed in climate change (86%). Only 20% strongly agree that operating rooms contribute to the climate crisis. Most agree environmental sustainability is very important at home (62%) and in their community (64%), only 46% said it was very important in the operating room. Barriers to environmental sustainability were incentives (68%), hospital supports (60%), information/knowledge (59%), cost (58%), and time (50%). Of those involved in residency programs, 89% (n = 49/55) reported there was no education on environmental sustainability or they were unsure if there was. Conclusion: Canadian otolaryngologists strongly believe in climate change, but there is more ambivalence regarding operating rooms as a significant contributor. There is a need for further education and a systemic reduction of barriers to facilitate eco-action in otolaryngology operating rooms.

Canadian Women in Otolaryngology-Head and Neck Surgery part 1: the relationship of gender identity to career trajectory and experiences of harassment.

INTRODUCTION: Women in surgical specialties face different challenges than their male peers. However, there is a paucity of literature exploring these challenges and their effects on a Canadian surgeon's career. METHODS: A REDCap® survey was distributed to Canadian Otolaryngology-Head and Neck Surgery (OHNS) staff and residents in March 2021 using the national society listserv and social media. Questions examined practice patterns, leadership positions, advancement, and experiences of harassment. Gender differences in survey responses were explored. RESULTS: 183 completed surveys were obtained, representing 21.8% of the Canadian society membership [838 members with 205 (24.4%) women]. 83 respondents self-identified as female (40% response rate) and 100 as male (16% response rate). Female respondents reported significantly fewer residency peers and colleagues identifying as their gender (p < .001). Female respondents were significantly less likely to agree with the statement "My department had the same expectations of residents regardless of gender" (p < .001). Similar results were observed in questions about fair evaluation, equal treatment, and leadership opportunities (all p < .001). Male respondents held the majority of department chair (p = .028), site chief (p = .011), and division chief positions (p = .005). Women reported experiencing significantly more verbal sexual harassment during residency (p < .001), and more verbal non-sexual harassment as staff (p = .03) than their male colleagues. In both female residents and staff, this was more likely to originate from patients or family members (p < .03). DISCUSSION: There is a gender difference in the experience and treatment of OHNS residents and staff. By shedding light on this topic, as a specialty we can and must move towards greater diversity and equality.

Canadian women in otolaryngology: head and neck surgery part 2-challenges in family planning, fertility, and lactation.

BACKGROUND: Previous literature demonstrates that female surgeons face difficulties in family planning, meeting breastfeeding goals, leadership and advancement opportunities. These issues have received limited attention in Canadian surgeons despite different maternity leave patterns compared to the general Canadian population. We sought to describe the experience of otolaryngologist-head and neck surgeons in family planning, fertility, and lactation and to identify the role of gender and career stage in these experiences. METHODS: A RedCAP® survey was disseminated to Canadian otolaryngology-head and neck surgeons and residents from March to May of 2021 through social media and the national listserv. This survey examined fertility, pregnancy losses, and infant feeding. Major independent variables include gender and career stage (faculty and resident). Dependent variables include respondent experiences with fertility, number of children, and length of parental leave. Responses were tabulated and presented descriptively to communicate the experience of Canadian otolaryngologists. Further, statistical comparisons such as chi-square and t-tests were employed to identify relationships between these variables. Thematic analysis was conducted for narrative comments. RESULTS: We received 183 completed surveys (22% response rate). 54% of females versus 13% of males agreed that career influenced their ability to have children (p = 0.002). 74% of female respondents without children have concerns about future fertility compared to 4% of men (p < 0.001). Furthermore, 80% of women versus 20% of men have concerns about future family planning (p < 0.001). The average maternity leave was 11.5 weeks for residents, and 22.2 weeks for staff. Additionally, significantly more women than men stated that maternity leave impacted advancement opportunities (32% vs. 7%) and salary/remuneration (71% vs. 24%) (p < 0.001). Over 60% of those choosing to pump breastmilk at work reported having inadequate time, space, and breastmilk storage. In total, 62% of breastfed infants were receiving breastmilk at 1 year. CONCLUSION: Canadian female otolaryngologists-head and neck surgeons face challenges in family planning, ability to conceive, and breastfeeding. Focused effort is required to provide an inclusive environment that helps all otolaryngologists-head and neck surgeons achieve both their career and family goals, regardless of gender or career stage.

Exploring Diversity in Otolaryngology-Head and Neck Surgery Journal Editorial Boards.

OBJECTIVE: Despite increasing diversity in medical school entrants, disparities exist in academic leadership. This study sought to examine the proportion of women and visible minorities (VMs) among editorial board members (EBMs) of otolaryngology journals. METHODS: Two reviewers collected journal, editorial board, and editor-in-chief characteristics using journal mastheads or official websites. Gender and VM representation on editorial boards and factors associated with increased representation were investigated. RESULTS: Forty-one journals were explored, from January to April 2022. Of 2128 EBMs, 663 (31.3%) were VMs and 551 (25.9%) were women. Editor-in-chief roles were held by 12 (25%) VM individuals and 3 (6.2%) women. Gender differences in the distribution of editorial board positions were found (P < .001); women had higher representation as associate editors (24.5%, n = 551 vs 15.4, n = 1577%) and deputy/managing editors (2.2%, n = 551 vs 0.4%, n = 1577), while men were more represented as editor-in-chief (2.9%, n = 1577 vs 0.5%, n = 551). Similar VM representation existed between genders (31.0% male; 31.6% women) (P = .80). Journal impact factor quartile and gender were significantly correlated (P < .001); a higher proportion of women were represented in the first (27.0% vs 24.5%) and fourth (12.0% vs 4.9%) quartile. No significant factors were identified for higher women's editorial board representation. Larger editorial board size (P = .002) and Asian/South American journals (P = .003 to P < .001) had significantly higher representation of VMs. CONCLUSION: Women and VMs are underrepresented in high-ranking editorial positions. Diversity in editorial boards is needed to ensure fair and balanced journal reviews and equity within otolaryngology.