Voice Pathologies and the General Population's Perception.

OBJECTIVES: To examine how the general population perceives voice pathology based on subjective qualities. STUDY DESIGN: Descriptive, cross-sectional, survey-based study. METHODS: This is an IRB-approved Qualtrics survey on Amazon MTurk for respondents ages 18 and older. Ten subjects with voice pathologies supplied voice recordings of the Rainbow Passage to be assessed by the respondents. Respondents then assessed the voice conditions on perceived qualities of intelligence, leadership ability, and employability. One-way analysis of variance (ANOVA) and Dunnett's multiple comparison test with Sidak correction compared the mean scores of the samples (alpha = 0.05). RESULTS: A total of 1754 responses were included in the final dataset. The female control voice was scored as more likely to be a Fortune 500 leader as well as more intelligent, friendly, attractive, and employable when compared to the female vocal fry and muscle tension dysphonia (MTD) recordings (P < 0.0001). Conversely, the male MTD was the only male pathology that received a significantly lower score on friendliness, attractiveness, Fortune 500 leader status and employability than the male control (P = 0.0102, P = 0.0007, P = 0.0338, and P = 0.0039, respectively). CONCLUSIONS: This study demonstrates the more critical appraisal of voice pathologies of female patients compared to their male counterparts. People with voice disorders are perceived as being less successful, a disadvantage to potential leadership and career opportunities.

Defining the Ideal Male Buttocks.

BACKGROUND: There is no well-defined male buttock aesthetic. The authors performed a crowdsourced analysis to define the ideal male buttocks. METHODS: A survey was deployed using the Amazon MTurk platform. Respondents rated a panel of digitally altered male buttocks from most to least attractive using three views. Respondents were asked questions pertaining to their own interest in gluteal augmentation, self-reported body type, and other demographics. RESULTS: A total of 2095 responses were recorded; 61% were from male respondents, 52% of respondents were between the ages of 25 and 34 years, and 49% were White respondents. The preferred lateral ratio in the anteroposterior dimension was 1.18; the oblique angle between the sacrum, lateral gluteal depression, and point of maximal projection of the gluteal sulcus was 60 degrees; and the posterior ratio between the waist and maximal width of the hips was 0.66. This corresponds to moderate gluteal projection in the lateral and oblique views, with a narrower gluteal width and defined trochanteric depression in the posterior view. Loss of the trochanteric depression was associated with lower scores. Subgroup analysis revealed differences when stratified by region, race, sexual orientation, employment industry, and athletic interest. No appreciable difference was found based on respondent sex. CONCLUSIONS: The authors' results demonstrate that there is a preferred male gluteal aesthetic. This study suggests that men and women favor a more projected male buttock with a more pronounced contour, but preferred a narrow width with defined lateral depression. These findings have the potential to guide future aesthetic gluteal contouring techniques in men.

Assessment of the Wisconsin Criteria at a Level I Trauma Center.

ABSTRACT: The Wisconsin Criteria was developed for physicians evaluating facial trauma to determine the likelihood of facial fractures. Subsequent studies have not consistently validated these criteria. This study seeks to validate the Wisconsin Criteria and determine its utility in predicting operative facial fractures.Retrospective chart review of the trauma database registry at a Level I Trauma Center was conducted from September 2011 to May 2019. Adult patients who had a complete facial examination by otolaryngology or plastic surgery as well as a head computed tomography scan completed, were included. Fisher exact test was utilized for statistical analysis ( P < 0.05) and positive predictive value, and negative predictive value (NPV) were calculated with a 95% confidence interval.After screening, 546 patients met eligibility, 448 had at least 1 finding of the Wisconsin Criteria, and 472 patients had facial fractures. The sensitivity of the Wisconsin Criteria for determining the presence of a facial fracture was 86.23%, the specificity was 44.59%, and the NPV was 33.67% ( P < .0001). Malocclusion was the criterion most specific in determining if a facial fracture was present (98.65%), and Glasgow Coma Score < 14 was the least specific (67.57%).The Wisconsin Criteria did aid in the identification of facial fractures in trauma patients with a comparable sensitivity, higher specificity, and much lower NPV than originally described. Further investigation should be done to validate the criteria in other large trauma centers.

How Do You Like Me Now? The Influence of "Likes" and Followers on Social Media in Plastic Surgery.

BACKGROUND: The number of "likes" and followers on social media is a surrogate marker for peer acceptance and popularity, but the influence of likes and followers on prospective plastic surgery patients has not been studied. The aim of this study was to evaluate whether the number of followers or likes on social media has an impact on perceived surgeon competence or likelihood of recruiting new patients. METHODS: A fictitious Instagram page was created with different permutations displaying different numbers of followers on the page. Similarly, fictitious Instagram posts were created displaying before-and-after results of ideal and suboptimal breast augmentation and gynecomastia surgery results, with the number of likes being the only variable. Using a crowdsourcing platform, survey responders rated surgeon competence and likelihood of patient recruitment based on the Instagram post. RESULTS: A total of 4284 responses were collected. The number of followers or likes did not impact perceived surgeon competence or patient recruitment scores. Optimal surgical results consistently scored higher than suboptimal results, regardless of the number of likes. Almost half the responders were unable to identify the American Board of Plastic Surgery as the appropriate board certification for performing aesthetic breast or body surgery. CONCLUSIONS: A high number of followers or likes, by itself, is unlikely to translate into higher likelihood of recruiting new patients. Overall, aesthetic results seem to be the most important driving force in receiving high competence scores and recruiting new patients, rather than social media presence or board certification.

Otolaryngology Department and Society Leadership: Evaluation of Diversity in a Nationwide Study.

OBJECTIVES/HYPOTHESIS: Diversity in medicine positively influences healthcare delivery. As we aim to make otolaryngology more diverse, it is essential to analyze our current leadership. STUDY DESIGN: Observational study. METHODS: A total of 262 department chairs and chiefs, residency program directors, and assistant and associate directors from 117 otolaryngology residency programs as well as 92 society leaders from nine otolaryngology national societies from 2010 to 2020 in the United States are included in this study. The position, academic rank, name, gender, inferred race (based on name and image), and h-index are collected and recorded from publicly available data. Fisher's exact test, unpaired t tests, and analysis of variance tests are used. RESULTS: The ethno-racial breakdown of all otolaryngology residency leaders is as follows: 78.63% non-Hispanic (NH) White, 16.03% NH Asian, 2.29% Middle Eastern, 1.91% NH Black, and 1.15% Latinx. Male gender is found to be a predictor of full professorship title (P < .0001) with an odds ratio (OR) of 4.066. NH White male is also a predictor of full professorship (P < .0001) with an OR 3.05. When comparing h-index, males and females differ (P < .0001) across all residency leadership positions. There is a higher h-index among full professors compared to non-full professors (P < .0001). The ethno-racial breakdown of society leaders is 84% NH White, 11% NH Asian, 2% NH Black, 2% Latinx, and 1% Middle Eastern. CONCLUSIONS: In conclusion, otolaryngology leadership has an under-representation of women and certain ethno-racial groups. Continued efforts should be made to diversify our specialty's leadership. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1729-1737, 2022.

Diversity in Academic Laryngology: An Evaluation of Academic Advancement and Research Productivity.

BACKGROUND: Diversity within the medical profession with respect to sex and racial minorities has been shown to have a positive effect on health and healthcare. Characterization of a field is key to evaluating trends and the advancement of diversity in an otolaryngology subspecialty. STUDY DESIGN: Observational study. METHODS: A comprehensive list of all the academic laryngologists was compiled from the Accreditation Council for Graduate Medical Education accredited otolaryngology residency programs in 2020. The last 20 past presidents of the American Laryngological Association (ALA) and American Broncho-Esophogological Association (ABEA) were analyzed. Academic rank and years in practice were determined from departmental websites, with online search tools used as secondary resources. The h-index was utilized as a measure of research productivity. Regression analysis was performed to analyze these variables. RESULTS: There are 184 academic laryngologists in the 124 programs. The majority of the population is Caucasian 76.6% (141/184), followed by Asian 16.3% (30/184), African American 4.34% (8/184), and then Hispanic 1% (2/184). There are 47 full professors with 83% Caucasian, 14.1% Asian, and 2.1% African American and 91.5% male and only 8.5% female. Past ALA presidents were 90% male and for the ABEA 75% male. H-index revealed a statistically significant difference between Caucasian and African American colleagues [P value (<.0005)]. CONCLUSIONS: Minorities are disproportionately underrepresented in laryngology. Women are less likely to be in leadership roles in laryngology and become full professors. Laryngology lags behind other surgical specialties in the representation of minorities and women. Continued efforts should be made to increase diversity in the field of laryngology, especially in regard to underrepresented minorities. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1245-1250, 2022.

Does Surgeon Training Affect Patient Perception of Surgeon Skill in DIEP Flap Breast Reconstruction?

BACKGROUND: The aim of this study is to investigate whether a surgeon's training background and years of experience advertised on a social media platform influences perception of surgeon competence, patient recruitment likelihood, and referral likelihood. METHODS: A mockup of an Instagram post was created using a before and after picture of a deep inferior epigastric perforator (DIEP) flap patient. The caption under each post was changed to reflect one of six possible training categories: 1 year of experience, 10 years of experience, 20 years of experience, fellowship, Ivy League training, and a null case (with no training information against which all other cases were compared). Surveys asked female responders to evaluate surgeon competence, likelihood of becoming a patient, and likelihood of making a referral to their friends or family. Amazon MTurk crowdsourcing platform was used to distribute the survey. RESULTS: A total of 1,878 responses were recorded, with the majority identifying as Caucasian (59%). The surgeon with 20 years of experience had the highest patient recruitment scores when compared with the null, 1 year, 10 year, and Ivy League training backgrounds (p = 0.0314, p = 0.0065, p = 0.0207, and p = 0.0244, respectively). The majority of responders (67%) preferred a female surgeon. Responders with a history of breast reconstruction assigned lower surgeon competence scores compared with women without a history of breast cancer (p <0.0001). Women who underwent breast reconstruction were also less likely to make referrals to their family and friends (p <0.0001). CONCLUSION: Surgeon's experience influences whether a patient is likely to seek care from a plastic surgeon. Personal history of breast cancer has a negative impact on perceived surgeon competence as well as patient recruitment likelihood and referral likelihood. Emphasizing fewer years of training or Ivy League training did not make an appreciable difference in patient perception of competence or likelihood of recruiting a new patient.

What's in a Name? Implicit Bias Affects Patient Perception of Surgeon Skill.

BACKGROUND: Implicit bias is the unconscious associations and beliefs held toward specific demographic groups. Instagram is commonly used by plastic surgeons to market their practice. This study investigates whether a surgeon's name on a social media platform influences perception of their competence and their likelihood of gaining a new patient. METHODS: A mock Instagram post was created using before-and-after photographs of a breast augmentation patient. Eight different ethnicities were selected, and common female and male names were selected based on U.S. Census data for each ethnicity. Surveys using the Instagram post were distributed asking responders to evaluate the competency of the surgeon and how likely they are to become a patient of that plastic surgeon. The surgeon's name was the only variable in the survey. RESULTS: A total of 2965 survey responses were analyzed. The majority of responders were Caucasian (57 percent); 55 percent were men and 45 percent were women. Overall, competence and recruitment likelihood scores between surgeons of different ethnicities were not significantly different. Caucasian and Latinx responders both assigned higher competence and recruitment likelihood scores to their own respective ethnicities. CONCLUSIONS: Implicit bias plays a role in whether or not a patient is likely to seek care from a surgeon with an ethnically identifiable name. The two most common cosmetic surgery demographic groups, Caucasians and Latinxs, were also the only two ethnic groups to display in-group favoritism. Public education should be directed toward surgeon qualifications and experience in an effort to reduce implicit bias on patient decision-making.