Female and low- and middle-income authorship trends in high-impact ENT journals (2011-2020).

Introduction: Despite a recent drive to increase diversity, the global academic workforce is skewed in favor of authors from high-income countries, and women are under-represented in the published medical literature. Objectives: To explore the trends in authorship of three high-impact otolaryngology journals over a ten-year period (2011-2020). Methods: Journals selected: JAMA Otolaryngology-Head and Neck Surgery, The Laryngoscope and Rhinology. Articles were reviewed from four issues per journal per year, and data was collected on: time of publication; subspeciality; number of authors; sex of first and last authors; country of practice of first author and country where each study was conducted. Trends were examined though univariate and multivariate logistic regression models. Results: 2998 articles were included. 93.9% of first authors and 94.2% of studies were from high-income countries.Women were first authors in 31.5% (n = 912) and senior authors in 18.4% (n = 524) of articles. Female first authorship significantly increased between 2011 and 2020 however female senior authorship remained the same. There have been no significant changes in the proportion of published articles from low-and middle-income countries (LMIC) over time (p = .65). Amongst the LMIC articles, 72% came from Brazil, Turkey or China and there were no published papers from countries with a low-income economy (gross national income per capita of $1085 or less). Conclusions: Although female first authorship has increased in the last decade, there has been minimal other demographic change in authorship over this time. High-impact otolaryngology journals poorly represent academia in low-and-middle income countries. There is a need for increased advocacy promoting gender and geographical research equity in academic medicine. Level of Evidence: III.

Barriers to head and neck cancer care in high-income and low- and middle-income countries: a scoping review.

PURPOSE OF REVIEW: Identify patient-perceived barriers to head and neck cancer care and compare differences in barriers by country income status. RECENT FINDINGS: Of the 37 articles, 51% ( n  = 19) were from low- and middle-income countries (LMICs), while 49% ( n =  18) were from high-income countries. Of the papers from high-income countries, unspecified head and neck cancer (HNC) subtype (67%, n =  12) were the most common cancer type, while upper aerodigestive tract mucosal malignancies (58%, n =  11) were more common in LMICs ( P  = 0.02). Based on World Health Organization barriers, level of education ( P  =  < 0.01) and alternative medicine use ( P  = 0.04) were greater barriers in LMICs compared to high-income countries. At least 50% of articles listed barriers at all three 'Three Delays' timepoints. There were no significant differences by country income status for the 'Three Delays' timepoints of deciding to seek care ( P  = 0.23), reaching the healthcare facility ( P  = 0.75), or receiving care ( P  = 1.00). SUMMARY: Patients face barriers to care for head and neck cancer regardless of country income status. There is overlap in several barriers and a need for systemic improvement in access. The differences in education and alternative medicine may guide region-specific interventions to improve the provision of head and neck services.

Race and Ethnicity in Otolaryngology Academic Publications.

OBJECTIVE: Within otolaryngology, race is commonly included as a study covariate; however, its value in clinical practice is unclear. This study sought to explore how race and ethnicity have been used and applied over time in otolaryngology publications. DATA SOURCES: PubMed database. REVIEW METHODS: A systematic review was done to identify original otolaryngology studies between January 1, 1946, and June 25, 2020, with the following search terms: "otolaryngology" AND "race" OR "ethnicity." RESULTS: Of the 1984 yielded studies, 932 were included in the final analysis. Only 2 studies (0.2%) defined race, and 172 (18.5%) gave participants the opportunity to self-identify race. Less than half (n = 322, 43.8%) of studies controlled for confounders. One hundred studies (10.7%) linked race to genetic factors. An overall 564 (60.5%) made conclusions about race, and 232 (24.9%) mentioned that race is relevant for clinical decision making. The majority of studies had first and senior authors from high-income countries (93.9% and 93.8%, respectively). Over time, there was a significant increase in publications that controlled for confounders, the number of race categories used, and studies that highlighted disparities. CONCLUSION: Race and ethnicity are often poorly defined in otolaryngology publications. Furthermore, publications do not always control for confounding variables or allow participants to self-identify race. On the basis of our findings, we suggest 7 foundational principles that can be used to promote equitable research in otolaryngology publications. Future efforts should focus on incorporating research guidelines for race and ethnicity into journal publication standards.

Current Application and Future Prospects of 3D Printing in Otorhinolaryngology-A Narrative Review.

Application of three-dimensional printing (3D) technology is relatively new in healthcare, but significant progress has been made over the last few decades. The technology has been evolved and became more accessible and affordable for the medical use. The aim of the review article is to discuss the potential use  of 3D printing in otorhinolaryngology and head and neck surgery. In the article, use of this novel technology is discussed across various subspecialties in terms of skill training, surgical planning and development of customised prosthesis. Internet searching was also performed for the commercial utility of 3D printed devices in ENT patient care. 3D printing is a promising technology. Numerous articles have been published in the international literature on its potential use in healthcare and progress is being made regularly by researchers to expand its implications in ENT. However, shortage of suitable 3D material which simulate human tissues for developing better training models discloses area of further research. Integration of tissue engineering 3D bioprinting provides significant opportunity to develop functional 3D printed implant for postsurgical reconstruction and organ transplantation.