Head And Neck Surgery Research Articles

Outcomes after dextranomer/hyaluronic acid bladder neck injection in patients with urethral incontinence following bladder neck repair

Many patients who undergo surgery for bladder neck (BN) incompetence may still experience incontinence postoperatively. Dextranomer/hyaluronic acid (Dx/HA) is widely used for endoscopic treatment of vesicoureteral reflux in children; however, few studies have reported its use in treating incontinence after BN surgery. The aim of this study was to evaluate outcomes after Dx/HA bladder neck injection in patients with persistent outlet incompetency following BN Repair. We retrospectively reviewed patients at a single pediatric tertiary care center with history of prior bladder neck surgery and reported persistent incontinence who then underwent endoscopic bladder neck Dx/HA injection from 2013 to 2018 and had subsequent follow-up post-injection. We described primary outcomes of reported incontinence as "wet" (leakage similar to before injection), "improved" (wet but leakage improved), and "dry" (no leakage). Our secondary outcome was need for a secondary procedure after Dx/HA injection, including Dx/HA injection or bladder neck closure (BNC). At first follow-up (median 2.3 months post-op), 7/19 were wet, 6/19 were improved, and 6/19 were dry. At last follow-up (median of 34.7 months), only three patients (16%) were dry. Only one patient who received a single surgery for Dx/HA injection was "dry", though nearly 2/3rds (12) were initially "improved" in their continence. Overall, seven patients had another intervention or surgery after first injection. Five patients had multiple Dx/HA injections after first procedure, which resulted in dryness by last assessment in two of these. Four patients (21%) in the overall cohort required subsequent BNC. Longer-term follow-up in our study demonstrated that only one patient who received a single procedure of Dx/HA injection remained dry. Several studies had follow up for greater than 1 year after initial bladder neck Dx/HA injection; rates of dryness after a single surgery for injection were variable and reported between 20 and 40% over follow-up times ranging from 1.5 to 7 years (Alova et al., 2012; DaJusta et al., 2013; Lottmann et al., 2006a; Lottmann et al., 2006b; Kitchens et al., 2007). Our st udy does have inherent limitations. This study was performed at a single institution in a retrospective manner, with a single surgeon reviewing the medical record to determine operative techniques and continence outcomes. The patient population is small, although relatively comparable to other previously reported studies. Outcomes were based on documentation of patient reports and are therefore lacking in objectivity. In patients with prior unsuccessful BN repair, long-lasting dryness after single Dx/HA BN injection is unlikely, although one-third may demonstrate relatively durable improvement in incontinence.

Correlation of the Degrees of Hearing Loss between Male and Female Patients with Otitis Media

Background: Otitis media (OM) is an infection of the middle ear and mastoid cavity. In many studies, hearing loss is described as a consequence of otitis media (OM); the degree of hearing loss can be analyzed by biologically calibrated AA 222 diagnostic audiometer. But in Bangladesh, we have not enough research-based information regarding this issue. Aim of the Study: The aim of the study was to evaluate the correlation of the degrees of hearing loss between male and female patients with otitis media. Methods: This was a prospective observational study and was conducted in the Department of Otolaryngology & Head Neck Surgery, Bashundara Ad-Din Medical College and Hospital, Dhaka, Bangladesh during the period from January 2022 to December 2022. A total of 64 patients with chronic otitis media (COM) suffered for the past three months or more attended the mentioned hospital were enrolled in this study as the study population. Among them 32(50%) were male and other 32(50%) were female patients. Ear drums of patients were inspected on both sides suction under microscope wherever necessary. The patient’s hearing levels in decibel were tested by a biologically calibrated AA 222 diagnostic audiometer. All data were collected, processed and analyzed by using MS Office and SPSS version 23.0 programs as per need. In comparison student’s T-tests were also performed. Results: In this study, in analyzing the hearing loss status of the patients regarding ear involvement we observed that, 6(18.8), 14(43.7) and 12(37.5) male participants on the other hand 10(31.2), 11(34.4) and 11(34.4) female patients right, left and both ears were found involved respectively. In comparing the ear involvement in hearing loss between the male-female groups, we did not find any significant correlation (P=0.427). In comparing the right dB grading, left dB grading, right ear comments and left ear comments of the patients in both groups we did not find any significant correlation; the P- value were 0.932, 0.983, 0.228 and 0.618 respectively. Conclusion: As per the findings of this study we can conclude that, there was no significant correlation of degrees of hearing loss between male and female patients with otitis media.

Consensus recommendations on the evaluation and treatment of congenital laryngeal clefts

Congenital laryngeal cleft is a rare airway malformation, mainly manifested as choking, feeding difficulties, which affects the growth and development of children. Patients with a severe laryngeal cleft may have recurrent aspiration, leading to cyanotic spells, or even death. Advances in development of endoscopic techniques have made early diagnosis possible. Depending on the degree of cleft, management may involve a variety of approaches ranging from medical management alone to open repair. Therefore, it is important for pediatric ENT doctors to diagnose and evaluate in clinical practice. This consensus statement, developed by the Pediatric otorhinolaryngology Professional Committee of the Pediatrician Branch of the Chinese Medical Doctor Association, provides comprehensive recommendations and standardized guidance on diagnosis and management of laryngeal cleft, based on symptomatology, physical examinations, and laboratory tests.

Evaluation of the Association Between Allergic Rhinitis and Middle Ear Dysfunction: A Clinicopathological Study.

The association between allergic rhinitis and otitis media with effusion (OME) has not yet been well studied in the Indian population. In our study, we have attempted to assess the role of nasal cytology on allergic rhinitis symptomatology and on middle ear dysfunction, and the diagnosis was established by symptomatology, AEC, and a nasal smear for eosinophils. The present study is a single-centre, hospital-based observational study and was conducted at the Department of Otorhinolaryngology and Head-Neck Surgery (All India Institute of Medical Sciences [AIIMS], Bhopal) among patients with symptoms of allergic rhinitis. The ENT examination included anterior rhinoscopy/diagnostic nasal endoscopy (zero-degree endoscope) along with otoscopy to examine the ear and nose. A nasal smear from the inferior turbinate of the nasal cavity was taken and then examined under a microscope to find out the percentage of eosinophils. The chi-squared test was used for group comparisons of categorical data. Statistical significance was kept at p < 0.05. In this study, out of 126 subjects with allergic rhinitis, 62 (49.2%) had middle ear dysfunction. The most prevalent middle ear pathologies were eustachian tube dysfunction (ETD; 28 cases, 22%), chronic otitis media (COM [16.6%]), OME (5.5%), and acute otitis media (AOM [4.5%]). ETD made up 45.1% of the ear diseases, with COM (33.87%), OME (11.29%), and AOM (9.6%) following. The mean value of absolute eosinophil count (AEC) among the allergic rhinitis participants (n = 32) was found to be 392.42. Absolute eosinophilia was present in 10 patients out of the 32 subjects being tested. Middle ear pathology was found in 7 of the 10 subjects found positive for absolute eosinophilia. Among the ear pathologies found in the participants (n = 7), the most common were ETD and OME (n = 5). There was no correlation between nasal smear cytology and the severity of nasal symptoms or middle ear disease. The majority of the participants were in nasal eosinophil grade I and showed sneezing as the most common nasal symptom and COM as the most common middle ear pathologic manifestation.

The use of a virtual surgical simulator for practicing otosurgery skills in the course of otorhinolaryngology

Ear surgery is a very specific area in which the practical skills differ significantly from other branches of surgery. At present, there is no standard for training in otosurgery worldwide. The study provides data on the use of a virtual simulator with haptic feedback in teaching ear surgery and compares the objective results of working on the simulator in groups of residents, outpatient doctors, ENT doctors and professional otosurgeons-experts. The study found that such training increases the basic knowledge of students of the anatomy, their spatial understanding of the structures of the temporal bone and its topography, the methods and technologies of ear surgery, which is the most important result for residents and inpatient operating doctors. For polyclinic otorhinolaryngologists, such knowledge is extremely important for understanding the surgical interventions performed in patients transferred to them for supervision from surgical hospitals.

Gender Differences in North American and International Otolaryngology Clinical Practice Guideline Authorship: A 17-Year Analysis.

To analyze gender differences in authorship of North American (Canadian and American) and international published otolaryngology-head and neck surgery (OHNS) clinical practice guidelines (CPG) over a 17-year period. Clinical practice guidelines published between 2005 and 2022 were identified through the Canadian Agency for Drugs and Technology in Health (CADTH) search strategy in MEDLINE and EMBASE. Studies were included if they were original studies, published in the English language, and encompassed Canadian, American, or international OHNS clinical practice guidelines. A total of 145 guidelines were identified, encompassing 661 female authors (27.4%) and 1756 male authors (72.7%). Among OHNS authors, women and men accounted for 21.2% and 78.8% of authors, respectively. Women who were involved in guideline authorship were 31.0% less likely to be an otolaryngologist compared to men. There were no gender differences across first or senior author and by subspeciality. Female otolaryngologist representation was the greatest in rhinology (28.3%) and pediatrics (26.7%). American guidelines had the greatest proportion of female authors per guideline (34.1%) and the greatest number of unique female authors (33.2%). Despite the increasing representation of women in OHNS, gender gaps exist with regards to authorship within clinical practice guidelines. Greater gender diversity and transparency is required within guideline authorship to help achieve equitable gender representation and the development of balanced guidelines with a variety of viewpoints.

0802 Quantifying Screening Efficacy and Referral Patterns in Well Child Visits

Abstract Introduction Sleep-disordered breathing (SDB) can have profound impacts on pediatric physical, psychological and behavioral health. However, proactive history taking is needed to identify the signs of SDB, such as snoring. The American Academy of Pediatrics (AAP) therefore recommends that primary care providers actively screen for snoring at routine health maintenance visits. This study aims to assess the use of a snoring screening tool in our institution’s Electronic Medical Record (EMR) well child visit templates and subsequent rate of screening for sleep disordered breathing during routine pediatric visits. Methods We queried our institution’s electronic medical record for all patients ages 0-17 years who were presenting for their Well Child Visit (WCV) from January 1, 2019 through September 30, 2022. The query yielded a convenience sample of 428,632 children. The question “does your child snore” was embedded into the WCV template for all primary care providers. Results Before the pandemic only 12.3% of WCVs (52,695 patients) had a completed screening question. The snoring prevalence was 6.4% (4,034 patients) with 15% (594 patients) of those who screened positive for snoring receiving a referral to ENT or sleep medicine (65% to ENT). During the COVID pandemic (2020-2021) the screening rate was 13.4%. The snoring prevalence was 5.2% with 19% being referred to ENT or sleep medicine. There was also an increase in screening during the COVID pandemic, but screening usage reverted to pre-COVID levels when pandemic restrictions eased in 2022. Conclusion The introduction of a snoring screening tool in generic WCV note templates did not significantly improve the rate of screening for sleep disordered breathing at routine pediatric visits. However, this embedded tool was used more often during the SARS-CoV2 pandemic, when many visits were performed using telemedicine. Our data collection also highlighted a high prevalence of snoring within our institution and a referral pattern that largely routes these children directly to Otolaryngology versus Pediatric Sleep Medicine. This makes it imperative to continue brainstorming ways to support primary providers' abilities to screen for SDB and empower them with management options. Support (if any) None

Combining Transoral Nasopharyngeal Brush and Plasma Epstein-Barr Virus DNA in Detecting Locally Recurrent Nasopharyngeal Carcinoma.

To evaluate the sensitivities and specificities of Epstein-Barr virus (EBV) DNA in the detection of locally recurrent or persistent nasopharyngeal carcinoma (NPC) through nasopharyngeal (NP) brush biopsy and plasma, respectively, and whether a combination of both would be superior to the individual tests. A case-control study was conducted from September 2016 to June 2022. A multicentre study at 3 tertiary referral centers in Hong Kong was conducted by the Department of Otorhinolaryngology, Head andNeck Surgery, The Chinese University of Hong Kong. Twenty-seven patients with biopsy-confirmed locally recurrent NPCwere recruited as study subjects. Magnetic resonance imaging was performed to rule out regional recurrence. The control group consisted of 58 patients with a prior history of NPC who were now disease-free based on endoscopic and imaging findings. Patients underwent both the transoral NP brush (NP Screen®) and blood for plasma Epstein-Barr DNA levels. The sensitivity and specificity of the combined modalities were 84.62% and 85.19%, respectively. The positive predictive value was 73.33% and the negative predictive value was 92.0%. The combination of NP brush biopsy and plasma EBVDNA is potentially an additional surveillance modality in detecting the local recurrence of NPC. Further study with a larger sample size would be required to validate the cutoff values.

Auto-Substitutions to Optimize Perioperative Antimicrobial Prophylaxis: Pre-Post Intervention Study.

Appropriate administration of perioperative antibiotics can prevent antimicrobial resistance, adverse drug events, surgical site infections, and increased costs to the health care system for many surgeries in Otolaryngology-Head and Neck Surgery (OHNS). The objective of the study is to achieve 90% compliance with evidence-based perioperative antibiotic prophylaxis guidelines among elective surgical procedures in OHNS. The pre-intervention group consisted of patients undergoing elective surgical procedures in the 13 months prior to the interventions (September 2019-2020) whereas the post-intervention group comprised patients undergoing elective procedures during the 8 months following the implementation (October 2020-May 2021). The 4 Es of knowledge translation and the Donabedian framework were used to frame the study. Components of the intervention included educational grand rounds and automatic substitutions in electronic health records. In June 2021, a survey of staff and residents assessed the self-reported perception of following evidence-based guidelines. Compliance with antimicrobial prophylaxis guidelines were evaluated based on agent and dose. The overall compliance improved from 38.8% pre-intervention to 59.0% post-intervention (p < 0.001). Agent compliance did not improve from pre- to post-intervention, that is, 60.7% to 62.8%, respectively, (p = 0.68), whereas dose compliance improved from 39.6% to 89.2% (p < 0.001). Approximately 78.5% of survey respondents felt that they strongly agreed or agreed with always following evidence-based antimicrobial prophylaxis guidelines. Compliance with antimicrobial prophylaxis guidelines improved, primarily due to increased dosing compliance. Future interventions will target agent compliance and selected procedures with lower compliance rates. 3 Laryngoscope, 133:3403-3408, 2023.

A Technical Approach to Anesthesia in the Case of Tonsillectomy

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tonsillectomy is the most common surgical procedure performed by an ENT doctor (Throat Nose Ear) in children. This surgery can cause pain, bleeding and swelling in the injured throat. Patient may complain of pain, difficulty swallowing, eating, drinking disorders, nausea and vomiting and fall into a dehydrated state. This can reduce patient satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion:&lt;/strong&gt; Postoperative pain management of tonsillectomy is a concern both by the ENT doctor and by the anesthesiologist. The high incidence of post-tonsillectomy pain or anxiety increases the risk of secondary post-tonsillectomy bleeding. It is necessary to know the mechanism of post operative pain and the negative impact of pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Doctors should give attention to reduce postoperative pain and choose a rational analgesic to overcome post operative tonsillectomy pain.&lt;/p&gt;&lt;/div&gt;

The Investigation of Whether the Choice of Medical Sponge in Sinus Surgery Has a Different Effect on the Recovery Period of Adhesions

Medical sponges play a vital role after surgery for hemostasis. However, for sinus surgery, using medical sponges will also bring one complication: adhesion. This research investigates the relationship between the choice of medical sponge in sinus surgery and the recovery period of adhesion. The method is to give out questionnaires to the professional ENT doctors in 21 hospitals in Jiangsu, one of the most productive regions in China, asking them to asses the performance of three types of medical sponges(expansion sponge, gelatin sponge, and absorbable nasopore) on the recovery period of adhesions. The result shows that the possibility of adhesions is greatest for the expansion sponge and least for the absorbable nasopore. The severity of their adhesions is almost the same. The recovery cycle takes the longest for gelatin sponges and the shortest for expansion sponges. As a result, for the future choice of medical sponges, it is recommended to choose expansion sponges and nasopore.

Investigation and management of stridor in neonates

Stridor is an uncommon yet potentially serious symptom in neonates. It is indicative of airway obstruction. This short article describes how to approach a baby with stridor. Assessment and investigation should proceed in a structured manner. Important clues about the likely cause can be determined using a combination of a careful history and clinical examination. The character and nature of any stridor, combined with information about the onset of symptoms are particularly important. These may help to determine the best initial investigations, including direct visualization of the airway and management. There are different types of airway endoscopy, ranging from awake flexible laryngoscopy that examines to the level of the vocal cords, to rigid laryngotracheobronchoscopy under general anaesthesia that allows additional examination of the subglottis, trachea and main bronchi, and to flexible bronchoscopy that assesses the respiratory tract further still and is particularly useful in assessment of tracheomalacia. A cross-speciality approach is often required to secure the best outcomes. This article is aimed at the whole team who will be involved in dealing with babies with stridor, including anaesthetists, paediatricians, advanced care practitioners and ENT doctors.

Quality of Life Impacts Following Surgery for Advanced Head and Neck Cancer

Understanding the impact of surgery on patients will enable clinicians to provide evidence-based perioperative management. This study aimed to investigate the quality of life (QoL) impacts following head and neck surgery for advanced stage head and neck cancer.Head and neck cancer survivors were invited to complete five validated questionnaires to investigate QoL. Associations between QoL and patient variables were analyzed. Variables included age, time since operation, length of surgery, length of stay, Comorbidity Index, estimated 10-year survival, sex, flap type, treatment and cancer type. Outcome measures were also compared to normative outcomes.The majority of participants (N = 27; 55% male; mean (standard deviation) age: 62.6 (13.8) years; mean time since operation: 801 days) had a squamous cell carcinoma (88.9%) and free flap repair (100%). Time since operation was significantly (P < 0.05) associated with higher rates of depression (r = -0.533), psychological needs (r = -0.0415) and physical/daily living needs (r = -0.527). Length of surgery and length of stay were significantly associated with depression (r = 0.442; r = 0.435) and length of stay was significantly associated with speaking difficulties (r = -0.456). There was a significant association between work and education scores with age (r = 0.471), length of surgery (r = 0.424), Comorbidity Index (r = 0.456) and estimated 10-year survival (r = -0.523).Age, time since operation, length of surgery, length of stay, Comorbidity Index and estimated 10-year survival were the outcomes associated with QoL. Patient-reported outcome measures and psychological support could be included in the standard care pathway for head and neck cancer patients to ensure holistic management of their condition.

Assessment of Bacteriological Pattern and Antimicrobial Susceptibility in Deep Neck Space Abscess

Background: Deep neck abscess is a common clinical entity in developing countries like ours. Despite the widespread use of antibiotics, deep neck infections do not disappear and remain one of the most difficult emergencies encountered in daily clinical practice. The extent and severity of the illness could become life-threatening. Therefore, coping with deep neck abscess remain a challenge to otolaryngologists. This study aimed to analyze the bacteriological pattern and antimicrobial susceptibility in deep neck space abscesses. Material Methods: It was a cross-sectional observational study. 50 patients with deep neck space abscesses fulfilling the inclusion and exclusion criteria admitted to the department of ENT Head Neck Surgery, Rangpur Medical College Hospital, Rangpur, from 1st July 2017 to 30th December 2017 were enrolled in this study. Pus from deep neck space abscess was collected by either aspiration or incision and drainage with proper aseptic measure and sent by sterile test tube to microbiology department immediately. Data were collected by detailed history taking and clinical examination investigations with informed written consent and analyzed by SPSS (version 20). Results: In this study most commonly involved deep neck spaces were Submandibular (38%), Peritonsillar (32%), Retropharyngeal (14%), and parapharyngeal (8%) spaces. Streptococcus viridans was the most prominent organism 14 (28%) followed by Klebsiella pneumonia 9(18%) and Staph. aureus 4 (8%). The most effective antibiotic was Ceftriaxone 34(79%) followed by Cefuroxime 30 (70%) and Erythromycin 23(54%). Aerobic organisms were highly sensitive to Cefuroxime (83%) and Ceftriaxone (83%) followed by Erythromycin (48%). Anaerobic organisms were sensitive to Clindamycin (100%), Metronidazole (100%), and Erythromycin (100%) followed by Ceftriaxone (75%). Conclusion: The most frequently isolated organism in deep neck space abscesses were Streptococcus viridans and Staphylococcus aureus and sensitivity results showed the majority of isolates are susceptible to Ceftriaxone and Cefuroxime.

Level of Knowledge, Attitude, and Behavior among Specialists of Otorhinolaryngology-Head and Neck Surgery in West Java Towards Cochlear Implants

Background: Hearing loss and deafness are still an issue in Indonesia, especially in West Java, with a prevalence of 2.5% and 0.06%, respectively. Cochlear implants are intended for patients with severe sensorineural hearing loss to stimulate the remaining auditory nerves. Based on their competency standards, Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) Specialists are expected to be able to inform patients and families about the cochlear implantation procedures. This study aimed to explore the level of knowledge, attitudes, and behavior of ORL-HNS Specialists in West Java towards cochlear implants.Methods: This study was a descriptive study with a cross-sectional approach. Primary data were collected through a questionnaire filled out by ORL-HNS Specialists who were actively working in West Java in 2021–2022.Results: Data from 157 specialists showed that 41.4% (n=65) had good knowledge about cochlear implants, and 43.9% (n=69) had adequate knowledge, however, 62.4% (n=98) showed a negative attitude. In addition, 99.3% (n=156) showed good behavior.Conclusions: ORL-HNS Specialists in West Java have a sufficient level of knowledge, negative attitude, and good behavior towards cochlear Implants. The negative attitude of the specialists need to be bettered, updating their knowledge about how cochlear implants work and their effectiveness for patients with hearing impairments might give them a new perspective and hopefully change their attitude towards cochlear implants.

Brush Cytology on Pre-Malignant and Malignant Oral Lesions with Histopathological correlation

Introduction: Oral cancer is the sixth most common malignancy worldwide and accounts for 30% of all cancers in India, with 5-year survival rate, except when diagnosed in the early stages. Hence, early diagnosis of oral cancer is very much essential for the sake of the patient. However its burden on the economy for providinghealthcare is substantial and with the increasing incidence of oral cancer in developing countries like India and the other South-East-Asian countries, the role of screening methodologies for early detection of pre – cancerous and cancerous lesions of oral cavity are becoming more vital&#x0D; Methodology: An observational cross-sectional study conducted in the departments of Otolaryngology &amp; head neck surgery in close association with department of Pathology in a tertiary based teaching institute in North Bengal, India, during April 2021 to March 2022. All the patients aged above 18 years, who visited the outpatient department of Otolaryngology &amp; Head Neck Surgery, and admitted in the ward of the same, having oral lesions which are clinically suspected as pre- malignant and malignant lesions were included in this study.&#x0D; Results: The study population comprised of total 69 cases. Among them 47 cases (~68%) were malignantlesions, 13 (~19%) cases were pre-malignant and 9 (~13%) cases were diagnosed as benign lesions consideringHistopathology result. 30 (63.8%) out of 47 malignant cases show class-5 cytological grading in brush cytology smear, stained with Pap stain. 25.5% of the malignant cases were in class-4 and 10.6% cases were in class-3 whereas, in premalignant cases (n=13), 3 cases were in class-2 and 7 cases were in class-3 and 3 were in class-1. Maximum value of AgNOR counts for benign, pre malignant and malignant lesions were 3.54, 4.16, 7.28 respectively.&#x0D; Conclusion: The brush cytology with PAP grading and AgNOR analysis in clinically suspected oral lesionscan be used as an early diagnostic tool for diagnosing oral squamous cell carcinoma especially for lower socio-economic status people who present with late stages.

Gender distribution and women leadership in German Otolaryngology, Head and Neck Surgery.

To determine the distribution of female physicians throughout the rank from resident to leadership positions in German Otolaryngology-Head and Neck Surgery (OHNS) departments. This cross-sectional study collected data about the physician workforce in the German OHNS.The primary outcome was the proportion of female physicians. Data were collected from 165 departments from January 2022 to February 2022. The physician workforce was stratified based on gender and leadership. We included 2089 physicians from 165 departments of OHNS in German hospitals. Female residents and specialists outnumbered male peers (484/872 [55.5%] vs. 388/872 [44.5%] and 224/363 [61.71%] vs. 139/363 [38.29%], respectively). However, the women proportion decreased gradually with elevated hierarchical rank starting at the attending physician level to reaching its lowest extreme (14/165 [7.23%]) at the head of the department level. Holding a leadership position was associated with being male (n = 282 [85.2%] vs. n = 49 [14.8%], p < .0001). This persisted even after controlling the academic rank in a multivariable regression model (OR: 5.027, 95% CI: 3.536-7.146). The gap between the two genders in favor of men regarding leadership persisted in all kinds of hospitals. However, this disparity was lowest in university hospitals, (male: n = 83 [78.3%] vs. female: n = 23, [21.7%], p < .0001). Even though women outnumbered men in resident and specialist positions, they are still underrepresented in leadership positions in OHNS. Continuous surveillance is needed to watch the dynamic changes in the gap between the two genders and address it with more sex equality-supporting policies. IV.

Cost analysis of face-to-face visits, virtual visits, and a digital care pathway in the treatment of tonsillitis patients

PurposeThe aim of this study was to compare the costs of two different telemedicine-assisted tonsillitis care pathways with traditional face-to-face visits at the Department of Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) at Helsinki University Hospital. MethodsWe characterized and analyzed the patient flows and their individual episodes of all tonsillitis patients at the Department of ORL-HNS between September 2020 and August 2022. Records were collected by doctors at the clinic. We investigated costs and allocated resources in four categories: invoice from the Department of ORL-HNS to the public payer, expenses to the Department, patient fees, and doctor's resource. ResultsAt least a third of the tonsillitis patients were eligible for telemedicine. The digital care pathway was 12.6 % less expensive for the public payer compared to the previous virtual visit model. For the Department, the expense of the digital care pathway was 58.8 % less per patient than the virtual visit model. Patient fees decreased 79.5 %. The digital care pathway reduced the doctor's resource from 30.28 min to 19.78 min, which accounts for a 34.7 % reduction. Patients finished the digital care pathway in a median of 62 min (SD = 60) compared to the 2–4 h which they would spend on an outpatient clinic visit. ConclusionOur study demonstrates that tonsillitis patients are eligible for preoperative telemedicine. With at least a third of the tonsillitis patients being eligible for telemedicine, major cost savings can be achieved with efficient e-health-assisted solutions.

The Association between Papillary Thyroid Carcinoma and Thyroid Stimulating Hormone (TSH)

Background: The results of thyroid-stimulating hormone (TSH) and thyroid hormones on the improvement of human Papillary thyroid cancer (PTC) stay poorly understood. TSH is an increase component that stimulates thyroid tissue to produce thyroid hormone; additionally, it influences the increase of thyroid cells and thyroid cancers cells. Objectives: The aim of this study is to assess the Association between Papillary Thyroid Carcinoma and Thyroid Stimulating Hormone (TSH). Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of Otolaryngology &amp; Head-Neck Surgery, TMSS Medical College, Bogura, Bangladesh and Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh. The duration of the period from March 2019 to February 2020. Data was entered in MS Excel and Statistical analysis was done using SPSS trial version. Results: This study indicates that in accordance to age distribution of 70 Patients. Here in accordance to Age distribution, 3(4.28%) have been &lt;30, 11(15.72%) have been 30-39, 14(20%) have been 40-49, 15(21.43%) had been 50-59, 21(30%) had been 60-69 and 6(8.57%) had been ≥70. And in accordance to gender (14.28%) had been Male, (85.72%) have been Female. Conclusion: We found a significantly extended threat of PTC related with TSH levels under the ordinary range amongst women and with TSH tiers above the normal range amongst men.

Digital image enhancement may improve sensitivity of cholesteatoma detection during endoscopic ear surgery.

This study investigates the possible benefits and limitations of the digital image enhancement systems provided by Storz Professional Image Enhancement System (SPIES) during endoscopic ear surgery (EES) for cholesteatoma. An increased detection of cholesteatoma residuals during the final steps of endoscopic surgery using DIE technology was hypothesized. Cross-sectional study. Tertiary referral hospital. A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image-enhancing modalities (Clara, Spectra A, Spectra B), were generated. Fifty-one experienced ear surgeons participated to the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. The answers were compared with the histopathological reports. Clara showed the highest accuracy in cholesteatoma detection, followed by Spectra A and lastly Spectra B. In contrast, Spectra B showed the highest sensitivity and Clara the highest specificity, while Spectra A was placed in the middle for both values. Using the Spectra B modality, most responses agreed across the two time points. Ear surgeons assessed the usefulness, as well as preference among image modalities for cholesteatoma surgery, in the following order: Clara, Spectra B, Spectra A. Digital enhancement technologies are applicable to EES. After complete cholesteatoma removal, Spectra B showed the highest sensitivity in the detection of cholesteatoma residuals as compared with Clara and Spectra A. Thus, Spectra B may be recommended to avoid missing any cholesteatoma residuals during EES.