OTO Open最新文献

Objective: To evaluate the perceptions of American Rhinologic Society (ARS) members on the compensation models of academic rhinologists and their impact on clinical practice, teaching, and academic responsibilities.

Study design: Survey study.

Setting: Academic rhinologists across the United States who are members of the ARS.

Methods: A twenty-six-question survey was distributed to 295 ARS members. The survey collected demographic information such as years of experience, geographic location, practice setting, and consultation volume. It also explored various compensation models and their impact on compensation, patient volume, case types, and the ability to support teaching and academic responsibilities.

Results: Out of 295 surveyed ARS members, 107 responded (36%), and 80 academic rhinologists were included in the final sample. Respondents varied in experience and geographic distribution. Most respondents were salaried (69%), while 63% were under relative value units (RVU)-based models, and 25% were under collections-based models. Additionally, 66% reported poor or no support for research and educational activities. Compensation models were found to influence patient volume (28%), procedure choices (14%), and academic duties, with 55% of respondents indicating reduced engagement with students.

Conclusion: Although a plurality of respondents (39%) believed that salaried models are most conducive to balancing academic and clinical responsibilities, survey findings highlight a dissonance. Respondents under collections-based models were more likely to feel adequately supported (64.71%) compared to those under salaried or RVU-based models. This suggests that although many perceive salaried models as ideal for balance, collections-based models may better address financial and structural needs, emphasizing the importance of developing flexible, tailored compensation structures that align with individual and institutional goals while fostering academic productivity.

Circulating tumor DNA (ctDNA) has been developed as a marker of tumor burden in human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Inflammatory indices are also increasingly being used as prognostic surrogate markers in solid tumors, including head and neck cancers. The relationship between ctDNA levels and inflammatory indices has not been studied in HPV-associated OPSCC. We hypothesize that higher levels of inflammation are associated with higher ctDNA levels. Herein, we demonstrate an association between high pretreatment ctDNA levels and specific inflammatory indices, which may be lower-cost surrogate markers of high HPV ctDNA levels and may act as a surrogate marker for the body's immune response to HPV-positive OPSCC.

Objective: This study aims to report the prevalence and characteristics of underrepresented in medicine (URiM) funding for visiting medical student clerkships in Otolaryngology-Head and Neck Surgery (OHNS) residency programs in the United States.

Study design: Manual online review of Accreditation Council for Graduate Medical Education (ACGME)-accredited OHNS residency programs as of January 2024, reflective of typical medical student search methodology.

Setting: An online review.

Methods: For each program, at least 2 authors captured presence of funding, the funding amount, funding origin, and eligibility criteria. Presence and amount funding were analyzed for possible associations with program type (by FREIDA™ program description), urbanization level, cost of living, and degree of racial and ethnic diversity in the program's geographic location.

Results: Of 131 programs, 49 (37.4%) offered URiM funding, primarily through diversity, equity, and inclusion (DEI) entities (67.3%) or OHNS departments (32.7%). Mean funding per 1-month rotation was $1908. Eligibility criteria varied, with 63.2% using a non-specific URiM definition and 18.4% following the Association of American Medical Colleges definition. Funding presence did not differ by geographic region (P = .06), program type, urbanization level, or cost of living. However, funding amounts varied significantly by region (P < .01) and were significantly different between programs in diversity index 35.0% to 44.9% versus 45.0% to 54.9% and 55.0% to 64.9% (P = .007 and P = .002, respectively).

Conclusion: URiM funding is available in a minority of OHNS programs, with substantial variability in funding amount and eligibility criteria. Standardized guidance on defining URiM eligibility may benefit students and institutions. Funding may correlate with local racial and ethnic diversity, warranting further research.

Objective: Postnasal drip (PND) is a common symptom that is difficult to verify with a traditional examination. Nasal endoscopy has the potential to improve the diagnostic process by confirming the presence and location of mucus. This study sought to describe the association of specific features of PND on nasal endoscopy with other clinical features.

Study design: Cross-sectional with prospective data collection.

Setting: Outpatient rhinology practice.

Methods: Data were prospectively collected on adult (≥18 years of age) patients with PND who underwent nasal endoscopy over a 6-month period. Variables of interest included reflux-related symptoms, nasal congestion, hyposmia, rhinorrhea, pruritic symptoms, inferior turbinate (IT) hypertrophy, 22-item sinonasal outcome test (SNOT-22) scores, and diagnoses of allergic rhinitis (AR), chronic rhinosinusitis (CRS), and reflux disease. Presence of mucus was designated at the nasal cavity (NC) floor, posterior IT, middle meatus (MM), and sphenoethmoidal recess (SER), and consistency of thick or thin was assigned during nasal endoscopy.

Results: Of 118 patients, 112 (94.9%) had identifiable mucus on nasal endoscopy. MM/SER mucus was associated with SNOT-22 score ≥ 50, diagnosis of CRS, and absence of IT hypertrophy or diagnosis of AR. NC and IT mucus was associated with nasal congestion, rhinorrhea, pruritic symptoms, IT hypertrophy, AR, and absence of CRS. Thick NC/IT mucus was associated with reflux symptoms.

Conclusion: Great majority of patients who report PND have posterior nasal drainage of abnormal mucus that can be directly observed with nasal endoscopy. Clinicians should be encouraged to utilize nasal endoscopy when available to evaluate patients with PND.

Objective: To investigate the incidence of dysphagia among head and neck cancer (HNC) patients and assess disparities in utilization of speech-language pathology (SLP) services across different demographic groups.

Study design: Retrospective cohort study.

Setting: Analysis of data from the TriNetX global health network, comprising over 125 million deidentified electronic health records worldwide.

Methods: HNC patients diagnosed with oral, oropharyngeal, laryngeal, or nasopharyngeal cancer with and without dysphagia between January 1, 2004 and October 30, 2024 were identified. Patients were divided into two cohorts for comparison: those who received SLP services after dysphagia diagnosis and those who did not. The association of demographic characteristics (sex, ethnicity, and race) with SLP services were analyzed.

Results: Of 269,629 HNC patients, 28.8% (n = 77,562) were diagnosed with dysphagia. Significant disparities were found: female and non-White patients were less likely to be diagnosed with dysphagia. Once diagnosed, female, Hispanic/Latino, and non-White patients were also significantly less likely to receive SLP services compared to female, Hispanic/Latino, and non-White patients. Overall, only 38.8% of patients with dysphagia received SLP services.

Conclusion: This study highlights significant sex, ethnic, and racial disparities in dysphagia diagnosis and SLP service utilization among HNC patients. Furthermore, SLP services are underutilized. There is a need for targeted interventions to increase dysphagia prevention and surveillance and ensure equitable access to dysphagia care, improving outcomes for all HNC survivors.

Objective: Investigate how private equity (PE) acquisitions shape the otolaryngology workforce.

Study design: Cross-sectional.

Setting: Private outpatient clinics.

Methods: A comprehensive market database, Pitchbook (Seattle, WA), was queried utilizing keywords for outpatient otolaryngology practices acquired by PE firms from 2010 to 2023. Acquisitions were manually verified using practice websites. An open-source website archive service, WayBack Machine, was utilized to track workforce history of practicing otolaryngologist physicians, audiologists (AuDs), and advanced practice providers (APPs) at these outpatient practices and then subjected to linear regression and Pearson correlation test analysis.

Results: In total, 25 otolaryngology practices were determined to have been acquired by PE, all between 2018 and 2023. Acquisitions predominantly occurred in 2020 (n = 8, 32%) and 2023 (n = 7, 28%) and were mostly in the South Atlantic (n = 10, 40%) or Midwest (n = 8, 32%) regions. From 2018 to 2023, total practice locations increased by 32.0% (n = 194 to n = 256), and the total clinician pool increased by 17.9% (n = 901 to n = 1007). Although physicians (n = 500 to n = 517, r = 0.59, P = .213) and AuDs (n = 229 to n = 242, r = 0.34, P = .507) increased nonlinearly, the increase in APPs was strongly linear (n = 172 to n = 248, r = 0.95, P = .003). As a proportion of the total clinician pool, there was a relative decrease in physicians (55.5%-51.3%) and AuDs (25.4%-24.0%), offset by a relative increase in APPs (19.1%-24.6%).

Conclusion: Our findings indicate a disproportionate increase in APPs relative to physicians and AuDs, although without a comparison group we are unable to draw conclusions in relation to changes in the non-PE workforce as a whole.

Objective: This study aims to (1) develop an augmented reality (AR) navigation platform for craniomaxillofacial (CMF) and head and neck surgery; (2) apply it to a range of surgical cases; and (3) evaluate the advantages, disadvantages, and clinical opportunities for AR navigation.

Study design: A multi-center retrospective case series.

Setting: Four tertiary care academic centers.

Methods: A novel AR navigation platform was collaboratively developed with Xironetic and deployed intraoperatively using only a head-mounted display (Microsoft HoloLens 2). Virtual surgical plans were generated from computed tomography/magnetic resonance imaging data and uploaded onto the AR platform. A reference array was mounted to the patient, and the virtual plan was registered to the patient intraoperatively. A retrospective review of all AR-navigated CMF cases since September 2023 was performed.

Results: Thirty-three cases were reviewed and classified as either trauma, orthognathic, tumor, or craniofacial. The AR platform had several advantages over traditional navigation including real-time 3D visualization of the surgical plan, identification of critical structures, and real-time tracking. Furthermore, this case series presents the first-known examples of (1) AR instrument tracking for midface osteotomies, (2) AR tracking of the zygomaticomaxillary complex during fracture reduction, (3) mandibular tracking in orthognathic surgery, (4) AR fibula cutting guides for mandibular reconstruction, and (5) integration of real-time infrared visualization in an AR headset for vasculature identification.

Conclusion: While still a developing technology, AR navigation provides several advantages over traditional navigation for CMF and head and neck surgery, including heads up, interactive 3D visualization of the surgical plan, identification of critical anatomy, and real-time tracking.

Objective: To assess associations of digital inequity with oropharyngeal cancer (OPC) prognostic and care outcomes in the United States while adjusting for traditional social determinants/drivers of health (SDoH).

Study design: Retrospective cohort study.

Setting: United States.

Methods: In total, 70,604 patients from 2008 to 2017 were assessed for regression trends in long-term follow-up period, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the Digital Inequity Index (DII). DII is based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (ie, digital-related variables) or sociodemographic (ie, education, income, and disability status) and weighted-averaged into a composite score.

Results: With increasing DII, decreases in length of follow-up (10.22%, 32.9-29.5 months; P < .001) and survival (8.93%, 19-17.3 months; P < .001) were observed. Affordability of internet access displayed the largest influence, followed by device access and internet-service availability. Compared to OPC patients with low digital inequity, high digital inequity was associated with increased odds of diagnosing more than one malignant tumor (odds ratio [OR] 1.01, 95% CI 1.01-1.03; P = .012) and advanced staging (OR 1.01, 95% CI 1.00-1.02; P = .034), while having decreased odds of receiving indicated chemotherapy (OR 0.98, 95% CI 0.97-0.99; P < .001), radiation therapy (OR 0.98, 95% CI 0.97-0.99; P < .001), or primary surgery (OR 0.98, 95% CI 0.97-0.99; P < .001).

Conclusion: Digital inequities contribute to detrimental trends in OPC patient care and prognosis in the United States. These findings can inform strategic discourse targeted against the most pertinent disparities in the modern-day environment.