Do Otologists and Other Otolaryngologists Manage Single-Sided Deafness Differently?

BACKGROUND:  The aim of this study was to survey the knowledge and treatment management practices for single-sided deafness (SSD) among different subspecialties of otolaryngology. METHODS:  A questionnaire was sent via Google Sheets to members of the Turkish and Egyptian Otorhinolaryngology Societies between December 2021 and February 2022. For the statistical analysis, the respondents were divided into 3 groups as otologists, non-otologists, and residents at the department of otolaryngology-head and neck department. RESULTS:  There were no statistically significant differences between otologists and non-otologists in radiological imaging (child P = .469, adult P = .140) and preferred treatment method (child P = .546, adult P = .106). However, otolaryngologists showed significant differences in radiological evaluation (P <.001), vestibular evaluation (P = .000), and frequency of treatment options recommended for pediatric and adult SSD patients (P = .000). CONCLUSION:  There were no significant differences in SSD diagnosis, treatment, and rehabilitation between otologists and non-otologists. However, when comparing pediatric and adult patients, there was a difference in the treatment management of SSD patients.

Second opinions: Do otolaryngologist demographics matter?

OBJECTIVE: Pediatric patients and their caregivers may receive information from their primary care physician (PCP) that does not match current American Academy of Otolaryngology (AAO) guidelines. The purpose of this study is to evaluate the frequency of parents deciding to seek a second opinion based on the demographics of pediatric otolaryngologists who deliver guideline supported advice, contrary to advice from their child's PCP. METHODS: A survey was distributed to parents in a pediatric otolaryngology clinic between June 2021 and July 2023. Demographics included parent age category, gender, race, and age of youngest child. The survey included a scenario depicting recurrent otitis media with clear ears and a suggestion to defer tympanostomy tube insertion per AAO guidelines after their child's PCP recommended tubes. Thirteen variations of otolaryngologist photos were used in the case, including a control case with no picture. RESULTS: Of the 658 participants, 460 (69.9 %) were female. 551 (83.7 %) were aged 30-49 years, 70 (10.7 %) were younger, and 37 (5.6 %) were older. 545 (82.8 %) were White, 30 (4.6 %) were Black, 20 (3.0 %) were Asian, and 31 (4.7 %) were Hispanic. 39.9 % of parents would seek a second opinion if an otolaryngologist recommended watchful waiting following evaluation of their child's otitis media. Participants given the control case were 2.23 times more likely to listen to the otolaryngologist's advice (p = .025). If a picture was provided, respondents were more likely to follow advice given if the pictured otolaryngologist was female (p = .025, OR = 1.47) or Asian (p = .042, OR = 1.53). CONCLUSION: In this group, there is evidence that physician race and gender may influence decision making when considering action versus monitoring in the context of recurrent otitis media.

Which Provider Specialties are Performing Diagnostic Procedures for Dysphagia in the United States?

OBJECTIVE: Care of patients with dysphagia occurs at the intersection of several different medical specialties. Otolaryngologists are uniquely equipped to diagnose dysphagia given their specialized training, yet the extent to which otolaryngologists perform diagnostic procedures for dysphagia is unknown. The objective of this study was to characterize the specialty-level variation among providers performing diagnostic assessments for dysphagia. METHODS: We performed a retrospective, cross-sectional analysis of dysphagia care utilization among Medicare beneficiaries from 2013 to 2021 using the CMS Physician & Other Practitioners by Provider and Service dataset. American Association of Medical Colleges (AAMC) data reports were used to determine the total number of providers per specialty. For each procedure and specialty, the percentage of providers performing >10 procedures annually and the average annual number of procedures per performing provider (non-radiology) were calculated. RESULTS: We analyzed nine common dysphagia diagnostic procedures, including manometry, 24-h pH testing, flexible endoscopic evaluation of swallowing (FEES), and modified barium swallow study (MBSS). Mean 3.7 (SD 1.4) otolaryngologists (0.04% of practicing) performed manometry testing annually, compared to 493 (69.3) gastroenterologists (3.3%). Less than 1% of practicing otolaryngologists (37.8 (8.0) (0.04%)) and gastroenterologists (51.6 (8.4), 0.35%) performed 24-h pH testing annually. FEES testing was most commonly performed by otolaryngologists; however, only 48 (6.3) providers (0.51% of practicing) performed these procedures annually. For MBSS, fewer otolaryngologists (5.2 (1.0), 0.05%) perform these assessments than other medical specialties. Each otolaryngologist performed 110.7 (52.5) studies annually, compared to 200.1 (68.0) per gastroenterologist. CONCLUSION: Otolaryngologists represent a small fraction of providers performing dysphagia-related diagnostic procedures despite a unique training within our specialty to comprehensively diagnose and manage this condition. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3698-3705, 2024.

The majority of negative online otolaryngology reviews are non-clinical.

OBJECTIVE: To characterize extremely negative online reviews of Otolaryngologists in the United States. METHODS: A search for reviews was performed on Yelp.com using the keyword "Otolaryngologist" in four major urban cities in the United States. On a five-star scale, one-star reviews were isolated, classified as clinical or non-clinical complaints, and further subcategorized. Chi-square analysis was used to determine differences in complaint types between patients reporting surgery and those who did not. RESULTS: From the 7653 reviews that were surveyed, 375 one-star reviews met the inclusion criteria and were used in the analysis. These negative reviews yielded 808 total complaints, 25 % were clinical, and 75 % were non-clinical. The most common clinical complaints were a lack of diagnosis, disagreement with the treatment plan and misdiagnosis, whereas the most common non-clinical complaints included poor physician bedside manner, cost, and unprofessional staff. Fifty-two (14 %) patients reported having surgery. The difference in the number of complaints by patients reporting surgery and patients not reporting surgery was statistically significant (P < .05) for almost all subcategories. CONCLUSION: The most common complaints in negative reviews of Otolaryngologists on Yelp are non-clinical, primarily centered around the professionalism of the physician and staff. This work offers insights into patient satisfaction within Otolaryngology. Considerations should be given to these results as a means for improvement in patient experiences.

Perceptions and Understanding of Transgender Patient Care: A Survey of Practicing Laryngologists.

OBJECTIVES: Transgender individuals face significant health disparities including deficiencies in physician education, knowledge, and comfort with transgender health care. As the prevalence of the transgender population increases more individuals may seek gender-affirming surgery. Herein, we present a survey study which presents data on (1) the current practice patterns, (2) the familiarity with, (3) the perception of, and (4) the future educational goals of transgender health care among laryngologists in the United States. METHODS: A cross-sectional survey study of practicing laryngologists in the United States. RESULTS: A total of 53 laryngologists participated in the study, with 50 (94.3%) coming from an academic practice. Survey response rate was 32.3% (54/167). The number of patients cared for and surgeries performed were significantly associated with self-perceived overall competence (p < 0.001 and p < 0.001), surgical competence (p = 0.013 and p < 0.001), and comfort counseling patients on gender-affirming surgeries (p < 0.001 and p < 0.001). Most obtained training through real-world experience (n = 46, 86.8%), whereas only 11 (20.7%) had formal training in residency or fellowship. Although 37 (70%) of participants felt competent caring for transgender patients, 38 (72%) want to learn more about transgender care, and 49 (93%) support incorporating transgender care into otolaryngology residency/fellowship curricula. CONCLUSION: There is a need for an increased awareness of transgender healthcare issues to address disparities experienced by this diverse population. Many laryngologists report wanting to learn more about this developing part of our field and support incorporating transgender care into training. We attempt to spotlight the degree by which practicing laryngologists are familiar, competent, and comfortable with transgender care. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:3215-3219, 2024.

Prescribing Practices and Barriers of Biologics for Chronic Rhinosinusitis Amongst Otolaryngologists.

OBJECTIVE(S): Biologics for chronic rhinosinusitis with nasal polyposis (CRSwNP) are an evolving therapeutic option, but there are limited data on physician experiences in prescribing them. The goal of this study was to gain a better understanding of these experiences including prescribing practices, patient factors which guide prescriber decision, and physician and patient-reported issues which might limit cost-effectiveness of these therapies. METHODS: A survey was distributed to attending otolaryngologists using the Canadian Society of Otolaryngology (CSOHNS) email distribution and eSurvey program. Responses were tabulated for the entire cohort and compared between rhinologists and non-rhinologists where appropriate. Frequencies and proportions were expressed as a percentage of total respondents. Fisher's exact test was used for statistical analysis between groups. RESULTS: Seventy-nine total survey responses were recorded representing a response rate of 43%. Significantly more rhinologists reported prescribing biologic medications on their own (100% vs. 50%; p < 0.001) and a higher proportion (1 to 10% vs. <1%) of their patients were on biologics compared with non-rhinologists (p = 0.023). Rhinologists were more likely to consider poor response to medical therapies, need for rescue steroids, and comorbid type 2 conditions in their decision to pursue biologics than non-rhinologists, but they also experienced poorer assistance from patient support programs and less availability to medications. CONCLUSION: Rhinologists are more comfortable with prescribing and managing biologics for CRSwNP compared with non-rhinologist colleagues. Clinicians prescribing biologic medications for CRSwNP should be familiar with guidelines, indications, and potential adverse events. LEVEL OF EVIDENCE: N/A Laryngoscope, 134:3493-3498, 2024.

Assessing National Trends and Perceived Safety of Off-Label Ciprofloxacin-Dexamethasone Use by Pediatric Otolaryngologists.

OBJECTIVES: Off-label use of Ciprodex® (ciprofloxacin-dexamethasone: CPD), an antibiotic-steroid combination solution, in the airway has been reported by pediatric otolaryngologists with anecdotal success. We examined national trends regarding off-label CPD use including prevalence, common indications, prescriber patterns, adverse events, and accessibility. METHODS: 15-item cross-sectional survey was distributed to American Society of Pediatric Otolaryngology members from January-April 2022. Univariate analyses were performed to compare responses for users of off-label CPD versus non-users. Ease of access was compared across geographies and practice types using multivariate logistic regressions. RESULTS: Of the 163 complete responses (26.6% response rate), 156 (95.7%) reported using off-label CPD. Most common indications for off-label CPD were tracheal granulation (87.8%, n = 137) and choanal atresia (82.1%, n = 128). Ease of access was significantly increased in the Midwest (OR:18.79, 95%CI:3.63-1.24, p = 0.001) and West (OR:29.92, 95%CI:3.55-682.00, p = 0.006). Ease of access was significantly lower at tertiary referral centers (OR:0.11, 95%CI:0.01-0.64, p = 0.041) and private practices (OR:0.04, 95%CI:0.002-0.33, p = 0.009) compared to academic free-standing children's hospitals. Two-thirds of respondents reported feeling "Very Comfortable" with the safety profile of off-label CPD; 99.4% (n = 156) felt that the benefits outweighed the risks of off-label use. Seven respondents (4.5%) reported adverse events (e.g., local allergic reaction, cushingoid symptoms) from off-label use. CONCLUSIONS: Our findings (26.6% response rate) suggest that off-label CPD is commonly used by pediatric otolaryngologists, many of whom reported feeling that the benefits of off-label CPD outweigh the risks. Our results establish a baseline for future efforts to assess the efficacy and safety of off-label CPD and to improve its accessibility. LEVEL OF EVIDENCE: V Laryngoscope, 134:2922-2930, 2024.

Prevalencia de infección por COVID-19 por serología positiva (IgG/IgM) en personal médico de la cátedra y servicio de otorrinolaringología del Hospital de Clínicas / Prevalence of COVID-19 infection by positive serology (IgG/IgM) in medical personnel of the chair and service of otorhinolaryngology of the Hospital de Clínicas

Resumen Introducción: El personal de otorrinolaringología presenta una elevada exposición al virus SARS-CoV-2, debido a los procedimientos que lleva a cabo. Es fundamental tomar las medidas de protección adecuadas. Determinar la seroprevalencia nos dará un mejor panorama sobre la exposición, contagios y efectividad de medidas de protección adoptadas. Objetivo: Determinar la prevalencia de resultados serológicos positivos en personal médico que presta servicio en la Cátedra de Otorrinolaringología de marzo del 2020 a marzo de 2021. Material y Método: Estudio observacional, descriptivo, corte transversal, retrospectivo con asociación cruzada. Muestreo no probabilístico de casos consecutivos. La población total fue de 38 médicos del Servicio de Otorrinolaringología del Hospital de Clínicas. Resultados: La media de edades fue 37,4 años, 63,5% refirió haber atendido a paciente conocido portador de COVID-19. Un 42% refirió no haber cumplido con todas las medidas de protección personal, mientras que un 23,7% de los sujetos de estudio dio positivo para IgG, interpretándose como infección previa por COVID-19. Conclusión: Más de las dos terceras partes de los médicos refirió dar consulta a paciente COVID-19 positivo. Casi la cuarta parte de los médicos resultó ser positivo para COVID-19 según la prueba de serología anti-N. No se halló asociación entre consulta ni cirugía a pacientes portadores de COVID-19 y el contagio al personal médico.

Abstract Introduction: Otolaryngology personnel have a high exposure to SARS-CoV-2 virus due to the procedures they perform. It is essential to take appropriate protective measures. Determining seroprevalence will give us a better picture of exposure, contagion and effectiveness of protective measures adopted. Aim: To determine the prevalence of positive serological results in medical staff serving in the otolaryngology department from March 2020 to March 2021. Material and Method: Observational, descriptive, cross-sectional, retrospective, retrospective study with cross-association. Non-probability sampling of consecutive cases. The total population was 38 physicians of the Otolaryngology Service of the Hospital de Clinicas. Results: The mean age was 37.4. 63.5% reported having seen a patient known to be a COVID-19 carrier, while 42% reported not having complied with all personal protection measures. A 23.68% of the study subjects tested positive for IgG, interpreting previous COVID-19 infection. Conclusion: More than two-thirds of the physicians referred to giving consultation to COVID-19 positive patients. Almost a quarter of the physicians were positive for COVID-19 according to the Anti-N serology test. No association was found between consultation or surgery of patients with COVID-19 and infection of medical personnel.

Comparing plastic surgery and otolaryngology surgical outcomes and cartilage graft preferences in pediatric rhinoplasty: A retrospective cohort study analyzing 1839 patients.

ABSTRACT: Rhinoplasty in children has raised concerns about its safety in the pediatric population. There is scarcity of evidence describing outcomes and surgical techniques performed in pediatric rhinoplasty. We analyzed post-operative complications and cartilage preferences between plastic surgeons and otolaryngologists.Data was collected through the Pediatric National Surgical Improvement Program from 2012 to 2017. Current Procedure Terminology codes were used for data extraction. Patients were grouped according to type of rhinoplasty procedures (primary, secondary, and cleft rhinoplasty). A comparison between plastic surgeons and otolaryngologists was made in each group in terms of postoperative complications. Additionally, a sub-group analysis based on cartilage graft preferences was performed.During the study period, a total of 1839 patients underwent rhinoplasty procedures; plastic surgeons performed 1438 (78.2%) cases and otolaryngologists performed 401 (21.8%) cases. After analyzing each group, no significant differences were noted in terms of wound dehiscence, surgical site infection, readmission, or reoperation. Subgroup analysis revealed that plastic surgeons prefer using rib and ear cartilage, while otolaryngologists prefer septal and ear cartilage.The analysis of 1839 pediatric patients undergoing three types of rhinoplasty procedures showed similar postoperative outcomes, but different cartilage graft utilization between plastic surgeons and otolaryngologists.

Publicly Reported Patient Satisfaction Scores in Academic Otolaryngology Departments.

OBJECTIVES/HYPOTHESIS: Despite controversy regarding their impact and validity, there is a rising national focus on patient satisfaction scores (PSS). We describe the landscape of online PSS as posted by academic otolaryngology practices. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Websites of academic otolaryngology programs were reviewed for PSS scores, provider type, and geographic location. Gender was determined by picture or profile pronouns. Years of experience were determined by year of initial American Board of Otolaryngology-Head and Neck Surgery certification. We defined PSS derived from Press-Ganey or Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys as "standardized PSS". We determined potential associations between provider characteristics and standardized PSS. RESULTS: Out of 115 Otolaryngology-Head and Neck Surgery academic programs, 40 (35%) posted a total of 64,638 online PSS surveys (nonstandardized plus standardized) of 507 unique otolaryngology care providers. Standardized PSS were posted for 473 providers (370 [78%] male; 446 physicians; 27 advanced practice providers). Median overall standardized PSS was 4.8 (interquartile range 4.7-4.9; range 3.8-5.0). PSS were similar between gender, provider type, and years of experience. Male providers had more surveys than female providers (149 vs. 93; P < .01). There was a linear relationship between number of surveys and years of experience (P < .01), but no relationship between number of surveys and overall standardized PSS. CONCLUSIONS: Patient satisfaction with otolaryngology providers at academic institutions is consistently high, as demonstrated by high online PSS with little variability. The limited variation in PSS may limit their usefulness in differentiating providers and quality of care. LEVEL OF EVIDENCE: NA Laryngoscope, 131:2204-2210, 2021.

Opioid prescribing practices in academic otolaryngology: A single institutional survey.

OBJECTIVES: Opioids are highly addictive medications and otolaryngologists have a responsibility to practice opioid stewardship. We investigated postoperative opioid prescribing patterns among resident and attending physicians as an educational platform to underscore the importance of conscientious opioid prescribing. METHODS: This quality improvement study was designed as a cross-sectional electronic survey. Residents and attending clinical faculty members at a single academic institution were queried from February through April 2020. An electronic survey was distributed to capture postoperative opioid prescribing patterns after common procedures. At the conclusion of the study, results were sent to all faculty and residents. RESULTS: A total of 29 attending otolaryngologists and 22 residents completed the survey. Resident physicians prescribed on average fewer postoperative opioid pills than attendings. Among attendings, the largest number of opioids were prescribed following tonsillectomy (dose varied by patient age), neck dissection (12.6 pills), brow lift (13.3 pills), facelift (13.3 pills), and open reduction of facial trauma (10.7 pills). For residents, surgeries with the most postoperatively prescribed opioids were for tonsillectomy (varied by patient age), neck dissection (13.4 pills), open reduction of facial trauma (10.5 pills), parotidectomy (10.0 pills), and thyroid/parathyroidectomy (9.0 pills). The largest volume of postoperative opioids for both groups was prescribed following tonsillectomy. Attendings prescribed significantly more opioids after facelift and brow lift than did residents (p = 0.01 and p = 0.003, respectively). CONCLUSION: There was good concordance between resident and attending prescribers. Improvement in opioid prescribing and pain management should be an essential component of otolaryngology residency education and attending continuing medical education. LEVEL OF EVIDENCE: 4.

Predictors of Quality-of-Life Improvements Following Global Head and Neck Surgery Trips to Underserved Regions.

OBJECTIVES/HYPOTHESIS: To conduct longitudinal postoperative follow-up and discern health-related quality-of-life (HR-QoL) changes using a validated questionnaire among patients undergoing head and neck surgeries during a short-term, global surgical trip in a resource-limited setting. To identify clinicodemographic predictors of post-operative HR-QoL improvements in this setting. STUDY DESIGN: Retrospective observational study with prospective follow-up. METHODS: Patients undergoing surgery at Moi Teaching and Referral Hospital in Eldoret, Kenya through the authors' short-term surgical trip (STST) between 2016 and 2019 were asked to complete preoperative Short Form-36 (SF-36) HR-QoL questionnaires, and postoperative SF-36 questionnaires during subsequent follow-up. Preoperative and postoperative SF-36 domain scores, and two composite scores (mental component summary [MCS] and physical component summary [PCS]) were compared. Linear regression models were fit to identify clinicodemographic factors predictors of general health (GH), MCS, and PCS scores. RESULTS: Among the 26 participating patients, significant improvements were seen in post-operative GH (mean change = 19.8) and MCS (mean change = 11.2) scores. Lower pre-operative GH, MCS, and PCS scores were predictive of greater improvement in the corresponding post-operative scores. Longer time to follow-up was associated with greater improvement in GH score. Mean follow-up interval was 23.1 months (SD = 1.8 months). CONCLUSIONS: Utilizing the SF-36 questionnaire, we found that patients' perception of their general and psychosocial health improved after undergoing head and neck surgeries through a global STST. This study provides important, preliminary evidence that that elective surgeries performed in low-resource settings convey substantial benefit to patient QoL. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2006-2010, 2021.

Advanced Practice Provider Clinics: Expediting Care For Children Undergoing Tympanostomy Tube Placement.

OBJECTIVE/HYPOTHESIS: Advanced practice provider (APP) employment is becoming common in pediatric otolaryngology practices, though few studies have evaluated the consequences that APP-led clinics have on access to care. The objectives of this study were: 1) to investigate whether access to bilateral myringotomy with tympanostomy tube placement (BMT) for recurrent acute otitis media (RAOM) differed between patients seen in otolaryngologist and APP-led clinics 2) to compare clinical characteristics of patients seen by provider type. METHODS: Retrospective cohort study at an academic, tertiary care pediatric otolaryngology practice. All children were <18 years old and underwent evaluation for RAOM followed by BMT. We compared time in days from scheduling pre-operative appointment to appointment date and time from appointment to BMT between patients seen by APPs and otolaryngologists using Mann-Whitney U tests and multivariate linear regression models. We compared clinical characteristics by provider type using Mann-Whitney U tests and Fisher exact tests. RESULTS: A total of 957 children were included. Children seen by APPs had significantly shorter wait times for appointments (median 19 vs. 39 days, P < .001) and shorter times from preoperative appointment to BMT (median 25 vs. 37 days, P < .001). Patients seen by otolaryngologists had increased prevalence of craniofacial abnormalities, Down Syndrome, hearing loss, history of otologic surgery, and higher ASA physical status classification. CONCLUSIONS: Children seen by APPs received care more quickly than those seen by otolaryngologists. Patients seen by otolaryngologists tended to be more medically complex. Implementation of independent APP clinics may expedite and improve access to BMT for children with RAOM. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2133-2140, 2021.

Online Ratings and Perceptions of Pediatric Otolaryngologists.

OBJECTIVE/HYPOTHESIS: To assess and characterize online ratings and comments on pediatric otolaryngologists and determine factors that correlate with higher ratings. STUDY DESIGN: Online database analysis. METHODS: All American Society of Pediatric Otolaryngology (ASPO) members were queried on Healthgrades, Vitals, RateMDs, and Yelp for their online ratings and comments as of June 2020. Ratings were normalized for comparison on a five-point Likert scale. All comments were categorized based on context and positive or negative quality. RESULTS: Of the 561 ASPO members, 489 (87%) were rated on at least one online platform. Of those rated, 410 (84%) were on Healthgrades, 429 (88%) on Vitals, 236 (48%) on RateMDs, and 72 (15%) on Yelp. Across all platforms, the average overall rating was 4.13 ± 0.03 (range, 1.00-5.00). We found significant positive correlations between overall ratings and specific ratings (P < .001) on all individual topics. In addition, the majority of all narrative comments were related to perceived physician bedside manner and clinical outcome, with negative comments correlating negatively with overall score (P < .05). Time spent with the physician was the only category in which both positive and negative comments showed significant correlation with the overall physician rating (P = .016 and P = .017, respectively). Attending a top-ranked medical school or residency program did not correlate with higher or lower ratings. CONCLUSIONS: Online ratings and comments for pediatric otolaryngologists are largely influenced by patient and parent perceptions of physician competence, comforting bedside manner, and office and time management. LEVEL OF EVIDENCE: NA Laryngoscope, 131:2356-2360, 2021.

Financial Transactions from Manufacturers to Otolaryngologists in 2018.

OBJECTIVE: To characterize in depth non-research and research payments from industry to otolaryngologists in 2018 with an emphasis on product types. METHODS: Centers for Medicare and Medicaid Services Open Payments program was used for data collection: payment amount, the nature of payments, products associated with the payments, date of the payments, and companies making the payments were studied. Products associated with the payments were classified by categorical type. Descriptive statistics were used to analyze the data. RESULTS: There were 70,172 payments for a total of $11,001,875 made to otolaryngologists in 2018 with a median payment of $19. Food and beverage had the highest number of payments made (89.96%). Consulting fees (33.46%) composed the highest total payment amount. The two companies that contributed the highest amount were Stryker Corporation and Intersect ENT Inc. Sinus conditions had the most products within the top 25 products associated with payments. The top five products with the highest payments received were for balloon sinus dilation, nasal spray, sinus implant, Botox, and cochlear implant. There was a bimodal payment distribution demonstrating a higher number of payments made in the spring and fall. CONCLUSION: Our study is the first to review payments to otolaryngologists in 2018 and classify these payments into product types. The products and companies that contributed the highest payments were associated with sinus conditions. The products that dominated in each subspecialty of otolaryngology coincide with clinical practice trends and emerging technologies. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E388-E394, 2021.

Factors Associated With Distribution of Female Otolaryngology Residents in United States.

OBJECTIVE: The gender balance within medicine, and specifically within otolaryngology, is equalizing. It is important to determine the factors that impact the distribution of female residents among otolaryngology programs in the United States to better understand factors that may affect these changing trends. STUDY DESIGN: Retrospective Study. METHODS: Cross-sectional analysis was performed using data from 2018 of otolaryngology residents at 90 programs across the United States. Each program's website was searched for a current resident roster. Data of geography, number of female faculty, number of female physicians in leadership positions, program setting, and program size were obtained. Statistical comparison of these factors with number of female residents was performed with P < .05 as significant. RESULTS: There was a significant association between programs having a higher-than-average female faculty representation and a greater representation of female residents (P < .001). Larger residency programs were more likely to have greater female representation (P = .010). There was a slight predominance of both female residents and female faculty at urban programs (odds ratio [OR] = 1.27, P = .04; OR = 1.28, P = .03). Geographic location, presence of a female chairperson, and presence of a female residency program director were not associated with higher female-to-male resident ratio. CONCLUSION: Availability of female role models in faculty, along with program setting and size, may be more likely to promote greater female representation. Focusing on gender equality in the workplace can help promote diversity in the workforce and improve patient outcomes. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E367-E372, 2021.

Why Otolaryngologists Get Excluded From Medicare and Medicaid.

The List of Excluded Individuals and Entities (LEIE) is a federally updated and available list of providers who have been excluded from participating from federal healthcare programs. With over 40 year's worth of exclusion history, we were able to isolate and identify otolaryngologists who were excluded and the most common cause, albeit exceptionally rare, was revocation of their medical license due to negligence.

National Trends in Daily Ambulatory Electronic Health Record Use by Otolaryngologists.

OBJECTIVE: Since their development in the 1970s electronic health records (EHRs) are now nearly ubiquitous. This study aims to characterize the daily interactions of otolaryngology providers with EHRs. METHODS: This study was a cross-sectional review of provider efficiency profile (PEP) data, as collected by a major EHR vendor. Participating institutions had 6 months of de-identified PEP data reviewed starting January 1, 2019. PEP data is generated for providers with scheduled patients, both attendings and advanced practice providers (APPs). Time metrics are recorded when a provider is interacting with the EHR including a 5-second time-out for inactivity. RESULTS: Data on 269 otolaryngologists and 29 APPs from 10 institutions were evaluated. On scheduled ambulatory clinic days attendings spent 70 ± 36 (mean ± standard deviation) min interacting in the EHR versus 108 ± 46 min for APPs. Of the daily EHR time, mean time in notes, clinical review, in basket, orders, and schedule were 30.1 ± 19.4, 9.6 ± 6.1, 7.3 ± 5.8, and 5.8 ± 7.6 min, respectively. Per patient visit, median (interquartile range) time in notes, clinical review, and orders were 3.19 (2.2-4.9), 1.14 (0.63-1.8), and 0.70 (0.47-1.05) min, respectively. Mean progress note length was 4638 ± 2143 characters. CONCLUSION: Otolaryngology providers spend a meaningful portion of their clinic day interacting with the EHR. PEP data may provide means to target interventions and a metric to measure the impact of those interventions on provider EHR efficiency. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:975-981, 2021.

Current Status and Future Trends: Pediatric Intracapsular Tonsillectomy in the United States.

OBJECTIVES: 1) To assess the current status of pediatric intracapsular tonsillectomy in the United States, and 2) To apply lessons from the scientific literature and adoption of surgical innovation to predict future trends in pediatric intracapsular tonsillectomy. METHODS: This was a cross-sectional survey study and literature review. An anonymous survey was sent to all members of the American Society of Pediatric Otolaryngology (ASPO) to determine current practices in pediatric tonsillectomy. Statistical analysis was performed to compare differences in individuals who perform intracapsular tonsillectomy as opposed to extracapsular tonsillectomy. A literature analysis of the adoption of new technological advancements and innovative surgical techniques was then performed. RESULTS: The survey was sent to 540 pediatric otolaryngologists with a response rate of 42%. Of all respondents, 20% currently perform intracapsular tonsillectomy. The primary reason cited for not performing the procedure was concern for tonsillar regrowth. Time in practice, practice setting, and fellowship status was not associated with an increased incidence of intracapsular tonsillectomy. CONCLUSIONS: Only 20% of pediatric otolaryngologist respondents in the United States perform intracapsular tonsillectomy. Based on the documented advantages of intracapsular tonsillectomy over extracapsular tonsillectomy and an analysis of adoption of novel surgical techniques, we predict a paradigm shift in the specialty toward intracapsular tonsillectomy. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:S1-S9, 2021.

Digital Otoscopy Videos Versus Composite Images: A Reader Study to Compare the Accuracy of ENT Physicians.

OBJECTIVES/HYPOTHESIS: With the increasing emphasis on developing effective telemedicine approaches in Otolaryngology, this study explored whether a single composite image stitched from a digital otoscopy video provides acceptable diagnostic information to make an accurate diagnosis, as compared with that provided by the full video. STUDY DESIGN: Diagnostic survey analysis. METHODS: Five Ear, Nose, and Throat (ENT) physicians reviewed the same set of 78 digital otoscope eardrum videos from four eardrum conditions: normal, effusion, retraction, and tympanosclerosis, along with the composite images generated by a SelectStitch method that selectively uses video frames with computer-assisted selection, as well as a Stitch method that incorporates all the video frames. Participants provided a diagnosis for each item along with a rating of diagnostic confidence. Diagnostic accuracy for each pathology of SelectStitch was compared with accuracy when reviewing the entire video clip and when reviewing the Stitch image. RESULTS: There were no significant differences in diagnostic accuracy for physicians reviewing SelectStitch images and full video clips, but both provided better diagnostic accuracy than Stitch images. The inter-reader agreement was moderate. CONCLUSIONS: Equal to using full video clips, composite images of eardrums generated by SelectStitch provided sufficient information for ENTs to make the correct diagnoses for most pathologies. These findings suggest that use of a composite eardrum image may be sufficient for telemedicine approaches to ear diagnosis, eliminating the need for storage and transmission of large video files, along with future applications for improved documentation in electronic medical record systems, patient/family counseling, and clinical training. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1668-E1676, 2021.