OTO Journal

Women comprise nearly half of all US medical students but they remain underrepresented in academic practice within surgical specialties. To see if this occurs in otolaryngology departments, the authors analyzed faculty listings from academic departments and compared academic rank and h-index by gender. The h-index was chosen to reflect scholarly productivity, since it reflects the number of manuscripts published by the author that have been cited at least that many times (e.g., an h-index of 10 means they published 10 articles cited by others 10 or more times each). Men had higher h-indices than women at junior academic ranks, but the productivity rates of women increased and equaled, or surpassed, those of men later in their careers. Women academic otolaryngologists of senior rank had higher h-indices than their male counterparts. Despite this higher productivity women are underrepresented in positions of leadership and seniority, which is likely generational since the proportion of female otolaryngology residents has only recently exceeded 20%.

Women comprise nearly half of all US medical students but they remain underrepresented in academic practice within surgical specialties.  To see if this occurs in otolaryngology departments, the authors analyzed faculty listings from academic departments and compared academic rank and h-index by gender.  The h-index was chosen to reflect scholarly productivity, since it reflects the number of manuscripts published by the author that have been cited at least that many times (e.g., an h-index of 10 means they published 10 articles cited by others 10 or more times each).  Men had higher h-indices than women at junior academic ranks, but the productivity rates of women increased and equaled, or surpassed, those of men later in their careers.  Women academic otolaryngologists of senior rank had higher h-indices than their male counterparts.  Despite this higher productivity women are underrepresented in positions of leadership and seniority, which is likely generational since the proportion of female otolaryngology residents has only recently exceeded 20%.

As defined by the Institute of Medicine (IOM), clinical practice guidelines are "statements that include recommendations to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options." In crafting their recent standards for trustworthy guidelines, the IOM repeatedly referenced the AAO-HNS manual discussed in this podcast as an example of best practice. This third edition of the manual builds upon prior editions (from 2006 and 2009) with new material that includes standards for trustworthy guidelines, updated evidence levels, increased patient and public involvement, assessing confidence in the evidence, documenting differences of opinion, managing conflict of interest, and using computerized decision support for crafting actionable recommendations. The participants discuss unique features of the manual, the preeminent role of action statement profiles in promoting transparency, and how guideline users and developers can best take advantage of the principles and practices described.

As defined by the Institute of Medicine (IOM), clinical practice guidelines are "statements that include recommendations to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options."  In crafting their recent standards for trustworthy guidelines, the IOM repeatedly referenced the AAO-HNS manual discussed in this podcast as an example of best practice.  This third edition of the manual builds upon prior editions (from 2006 and 2009) with new material that includes standards for trustworthy guidelines, updated evidence levels, increased patient and public involvement, assessing confidence in the evidence, documenting differences of opinion, managing conflict of interest, and using computerized decision support for crafting actionable recommendations.  The participants discuss unique features of the manual, the preeminent role of action statement profiles in promoting transparency, and how guideline users and developers can best take advantage of the principles and practices described.

Although tracheostomy is one of the oldest and most common surgical procedures, management is often based on opinion and local practices because of a paucity of high level evidence to guide care. To address this issue, the AAO-HNS convened a national expert panel representing pediatric and adult otolaryngology, laryngology, head and neck oncologic surgery, advanced nursing practice, respiratory therapy, and emergency medicine. Using systematic review and a modified Delphi method the group achieved consensus on 77 statements that address emergencies, complications, decannulation, perioperative care, ancillary devices, and patient education. Part one of this podcast emphasizes supportive care and patient education from the perspective of two nurses on the expert panel. Part two offers the physician perspective from two panel participants with expertise in adult and pediatric tracheotomy care. A common theme is the importance of engaging patients and caregivers in all aspects of decision making and supportive care to improve outcomes and reduce complications.

Although tracheostomy is one of the oldest and most common surgical procedures, management is often based on opinion and local practices because of a paucity of high level evidence to guide care. To address this issue, the AAO-HNS convened a national expert panel representing pediatric and adult otolaryngology, laryngology, head and neck oncologic surgery, advanced nursing practice, respiratory therapy, and emergency medicine. Using systematic review and a modified Delphi method the group achieved consensus on 77 statements that address emergencies, complications, decannulation, perioperative care, ancillary devices, and patient education. Part one of this podcast emphasizes supportive care and patient education from the perspective of two nurses on the expert panel. Part two offers the physician perspective from two panel participants with expertise in adult and pediatric tracheotomy care. A common theme is the importance of engaging patients and caregivers in all aspects of decision making and supportive care to improve outcomes and reduce complications.

Although tracheostomy is one of the oldest and most common surgical procedures, management is often based on opinion and local practices because of a paucity of high level evidence to guide care.  To address this issue, the AAO-HNS convened a national expert panel representing pediatric and adult otolaryngology, laryngology, head and neck oncologic surgery, advanced nursing practice, respiratory therapy, and emergency medicine.  Using systematic review and a modified Delphi method the group achieved consensus on 77 statements that address emergencies, complications, decannulation, perioperative care, ancillary devices, and patient education.  Part one of this podcast emphasizes supportive care and patient education from the perspective of two nurses on the expert panel.  Part two offers the physician perspective from two panel participants with expertise in adult and pediatric tracheotomy care.  A common theme is the importance of engaging patients and caregivers in all aspects of decision making and supportive care to improve outcomes and reduce complications.

Using data from a national database the authors analyzed more than 8 million ambulatory health care encounters for adults with obstructive sleep apnea (OSA). Although OSA affects up to 7% of adults in the United States, only 10% of ambulatory health care visits studied were associated with otolaryngologic care. This presents an opportunity for increased awareness of OSA and the unique role of otolaryngologists in management. OSA was significantly associated with commonly encountered comorbid conditions, including obesity, asthma, depression, and hypertension. Otolaryngologists who diagnose and treat patients with OSA should be aware of increased risk for these background conditions since their presence could impact therapeutic outcomes. Clinicians in general are likely to see more OSA patients given the rising prevalence of obesity and the aging of the population, since elderly patients are more likely to have the multiple chronic conditions associated with an increased risk for OSA.

Using data from a national database the authors analyzed more than 8 million ambulatory health care encounters for adults with obstructive sleep apnea (OSA).  Although OSA affects up to 7% of adults in the United States, only 10% of ambulatory health care visits studied were associated with otolaryngologic care.  This presents an opportunity for increased awareness of OSA and the unique role of otolaryngologists in management.  OSA was significantly associated with commonly encountered comorbid conditions, including obesity, asthma, depression, and hypertension.  Otolaryngologists who diagnose and treat patients with OSA should be aware of increased risk for these background conditions since their presence could impact therapeutic outcomes.  Clinicians in general are likely to see more OSA patients given the rising prevalence of obesity and the aging of the population, since elderly patients are more likely to have the multiple chronic conditions associated with an increased risk for OSA.

Although computed tomography (CT imaging) is an essential diagnostic tool for patients with paranasal sinus disease the test is associated with significant costs, radiation exposure, and overuse concerns. To help define appropriate use of CT imaging an expert panel was convened and areas of clinical consensus were identified using a 3 round modified Delphi method. Statements reaching consensus included (a) CT imaging is not indicated for clinicall diagnosed uncomplicated acute sinusitis or when sinusitis has fully responded to antibiotic therapy, (b) CT imaging is indicated for adults with chronic sinusitis, recurrent acute sinusitis, and those not responding appropriately to medical management, and (c) CT imaging is indicated for tumor surveillance, complicated sinusitis, complicated dental infections, and for facial pain following dental surgery (odontogenic sinusitis). When CT imaging is obtained for routine chronic sinusitis intravenous contrast is not indicated. Further, plain radiographs and ultrasonography are not recommend for evaluating sinusitis.

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