OBJECTIVE: To explore the parents\' experience of postoperative care during the first two years after ventilation tube (VT) surgery in a setting where the check-ups were conducted either by otolaryngologists or their regular general practitioner (GP).
METHODS: 55 individual interviews of parents at up to three different time points (<1, 6, and 24 months) after their child received VT-surgery, analyzed with reflexive thematic analysis.
RESULTS: 1. Parents\' trust in the healthcare system and responsibility for booking check-ups. Nearly all parents seemed to maintain trust in the healthcare system and felt safeguarded regardless of where they had their check-ups. Still, they would prefer otolaryngologist-led care if they could choose from the top shelf. They took responsibility for seeking healthcare when needed and experienced that their GP referred their child if necessary. 2. As time goes by, parental worries are reduced. Most experienced that their child stayed healthy after surgery, and their demand for postoperative check-ups decreased. For the children who faced ongoing issues, most parents experienced that their child\'s challenges had been handled professionally, and they became less worried. Some parents attribute other diagnoses to their child\'s behavior or speech delays, refining their understanding of their child\'s condition. 3. The desire for closure. Parents sought reassurance about their child\'s recovery and desired professional evaluation for closure. While some advocated for audiometry, others trusted their own assessments about hearing. The transition to school marked a pivotal time, prompting concerns about social inclusion.
CONCLUSIONS: Overall, the parents experienced that their child was safeguarded irrespective of whether postoperative care was provided by otolaryngologists or GPs. Still, many preferred check-ups by an otolaryngologist. The parental worries and focus on the VTs were reduced as time went by after surgery, but even so many wanted a \'closure\' to be sure that the hearing was as good as it could be and the VTs rejected. We advocate for an individualized approach to postoperative care that addresses specific medical needs without imposing unnecessary check-ups.

OBJECTIVE: Surgery with ventilation tubes (VT) in children suffering from otitis media with effusion is quite common. However, the knowledge surrounding parents\' expectations to the treatment and postoperative care is sparse. The aim of this study was to describe the parents\' expectations to VT surgery and postoperative care shortly after surgery.
METHODS: A qualitative study was conducted based on semi-structured individual interviews with parents recruited from a study where postoperative care was randomized to either an otolaryngologist or the patient\'s general practitioner (GP). The interviews were conducted within the first weeks after surgery and analyzed by reflexive thematic analysis.
RESULTS: In total, 13 parents aged 29-42 years participated in the study. We identified three main themes elucidating parents\' expectations to VT surgery and postoperative care: 1) Preconceptions about VT surgery and hearing - most parents expected surgery to restore the child\'s normal hearing, and some were uncertain about their knowledge of normal hearing and VT treatment; 2) A safety net to ensure hearing and function - it was reassuring if the child received structured postoperative care that secured and notified appointments and had quick access to a specialist if needed; 3) High-quality care - most parents expected the otolaryngologist to provide the highest level of quality of care due to their specialist competence, special equipment and sufficient understanding of the problem to communicate well with parents. Postoperative care by the GP was perceived as incomplete among most parents due to a lack of both specialist competence and access to audiometry.
CONCLUSIONS: Parents expect postoperative care to safeguard their child as long as needed after VT surgery, and they expect access to high-quality care. Low health literacy among some parents challenges the current method of postoperative care and requires that more emphasis be set on both informing and educating parents regarding hearing and VT treatment.

OBJECTIVE: To determine the preferences of Ear, Nose, and Throat (ENT) and Head-Neck Surgery (HNS) specialists and residents undergoing training for online or face-to-face training and the factors affecting the preference.
METHODS: An 16-item questionnaire was created using Google Forms and was administered to residents undergoing training in ENT departments and to specialists working in the same field. The questionnaires were distributed online and requested to be completed between August and October 2020. The study participants were analyzed in two groups according to the preference for online training or face-to-face training.
RESULTS: Evaluation was made of a total of 173 participants, as 68 (39.3%) in online training, and 105 (60.7%) in face-to-face training. Online training comprised 47 (69.1%) females and 21 (30.9%) males with a mean age of 38.9 ± 8years and face-to-face training comprised 68 (64.8%) females and 37 (35.2%) males with a mean age of 37.9 ± 7.5years (gender: P = 0.55, age: P = 0.10). Of the total sample, 39 (22.5%) subjects were single and 134 (77.5%) were married. Face-to-face training was preferred by 61.2% of the married respondents and by 59% of those who were single. While 43.4% stated that visuals and documents were similar in both forms of training, those who stated that documentation was better in face-to-face training constituted 90.2% of the group that preferred face-to-face training (P = 0.0001). Of the total participants, 65.4% stated that concentration was easier in face-to-face training (P = 0.0001). When the groups were compared according to areas of interest, more of those involved in rhinology and head-neck surgery were in face-to-face training, and those with an interest in otology were seen to be in online training (P = 0.002). A wish to continue online training after the pandemic was expressed by 80.9% of the whole sample, and 68.6% wished to continue with face-to-face training (P = 0.0001). Hybrid meetings were determined to have been selected by 86.1% (P = 0.0001).
CONCLUSIONS: Online web seminars have an important role as a teaching and learning tool. There is a need for further research to evaluate how these clinically focused seminars can be presented at high quality and how they can provide benefit in training.

To deliver effective medical services and establish trust and psychological security in patients, care providers must prioritize ethical principles. Developing a comprehensive clinical education program for learners, along with specific ethical guidelines, and implementing managerial and executive interventions necessitates a thorough understanding of the ethical challenges within this field. This qualitative study aimed to elucidate the ethical issues faced by otolaryngologists. Sixteen otolaryngologists participated in the study, selected through purposive sampling. Data were gathered through semi-structured interviews, and the analysis, conducted through conventional content analysis, revealed eight main categories and 38 subcategories encapsulating the identified ethical issues. The primary categories encompassed ethical issues faced by otolaryngologists concerning patients and companions, education, communication with the treatment team, physicians\' rights, medical tourism, medical advertising, cultural considerations, and managerial challenges. resources and treatment approaches in alignment with Iranian cultural norms, address conflicts between treatment and education, and implement sound management plans to uphold rights of the treatment team. Additionally, the study suggests the necessity of ethical advertising programs and the strategic promotion of therapeutic tourism.

UNASSIGNED: To analyze the rural-urban access to otolaryngology (OHNS) care within the state of Nebraska.
UNASSIGNED: Cross-sectional study.
UNASSIGNED: Counties in Nebraska were categorized into rural versus urban status based upon the 2013 National Center for Health Statistics urban-rural classification scheme with I indicating most urban and VI indicating most rural. The information on otolaryngologists was gathered utilizing the Health Professions Tracking System. Otolaryngologists were categorized based on the county of their primary and outreach clinic location(s). Travel burden was estimated using census tract centroid distance to the nearest clinic location, aggregated to county using weighted population means to determine the average county distance to the nearest otolaryngologist.
UNASSIGNED: Nebraska is a state with a population of 1.8 million people unequally distributed across 76,824 square miles, with rural counties covering 2/3 of the land area. Nebraska has 78 primary OHNS clinics and 70 outreach OHNS clinics distributed across 93 counties. More than half (54.8%) of the counties in Nebraska lacked any OHNS clinic. Overall, a statistically significant difference was found when comparing mean primary OHNS per 100,000 population and mean miles to a primary OHNS clinic with Level III counties being 5.17 linear miles from primary OHNS compared to Level V counties being 29.94 linear miles.
UNASSIGNED: Overall, a clear discrepancy between rural and urban primary OHNS clinics in Nebraska can be seen visually and statistically with rural Nebraskans having to travel at least 5.5 times farther to primary OHNS clinics when compared to urban Nebraskans.

BACKGROUND: There are prevalent financial relationships between physicians and the pharmaceutical industry in medical specialties, including otorhinolaryngology. Although these relationships might cause conflicts of interest, no studies have assessed the size and contents of the financial relationships between otorhinolaryngologists and pharmaceutical companies in Japan. This study aims to evaluate the magnitude, prevalence, and trend of the financial relationship between Japanese otolaryngologists and pharmaceutical companies.
METHODS:  Using payment data publicly disclosed by 92 pharmaceutical companies, we examined the size, prevalence, and trend in personal payments made to the otorhinolaryngologist board certified by the Japanese Society of Otorhinolaryngology-Head and Neck Surgery (JSO-HNS) between 2016 and 2019 in Japan. Furthermore, differences in payments were evaluated by whether otolaryngologists were clinical practice guideline authors, society board members, and academic journal editors or not. Trends in payments were evaluated by generalized estimating equations.
RESULTS:  Of 8,190 otorhinolaryngologists, 3,667 (44.8%) were paid a total of $13,873,562, in payments for lecturing, consulting, and writing by 72 pharmaceutical companies between 2016 and 2019. The median four-year combined payment per physician was $1,022 (interquartile range: $473-$2,526). Top 1%, 5%, and 10% of otorhinolaryngologists received 42.3% (95% confidence interval (95% CI): 37.2%-47.4%), 69.3% (95% CI: 65.9%-72.8%), and 80.6% (95% CI: 78.3%-82.9%) of overall payments, respectively. The median payments per physician were significantly higher among otorhinolaryngologists authoring clinical practice guidelines ($11,522), society board members ($22,261), and journal editors ($35,143) than those without. The payments and number of otorhinolaryngologists receiving payments remained stable between 2016 and 2019.
CONCLUSIONS:  This study demonstrates that a minority but a large number of otorhinolaryngologists received personal payments from pharmaceutical companies for the reimbursement of lecturing, consulting, and writing in Japan. Large amounts of these personal payments were significantly concentrated on a small number of leading otorhinolaryngologists.

To forecast oropharyngeal carcinoma (OPC) incidence with otolaryngologist and radiation oncologist numbers per population by rural and urban counties through 2030.
Incident OPC cases were abstracted from the Surveillance, Epidemiology, and End Results 19 database, and otolaryngologists and radiation oncologists from the Area Health Resources File by county from 2000 to 2018. Variables were analyzed by metropolitan counties with over 1,000,000 people (large metros), rural counties adjacent to a metro (rural adjacent), and rural counties not adjacent to a metro (rural not adjacent). Data were forecasted via an unobserved components model with regression slope comparisons.
Per 100,000 population, forecasted OPC incidence increased from 2000 to 2030 (large metro: 3.6 to 10.6 cases; rural adjacent: 4.2 to 11.9; rural not adjacent: 4.3 to 10.1). Otolaryngologists remained stable for large metros (2.9 to 2.9) but declined in rural adjacent (0.7 to 0.2) and rural not adjacent (0.8 to 0.7). Radiation oncologists increased from 1.0 to 1.3 in large metros, while rural adjacent remained similar (0.2 to 0.2) and rural not adjacent increased (0.2 to 0.6). Compared to large metros, regression slope comparisons indicated similar forecasted OPC incidence for rural not adjacent (p = 0.58), but greater for rural adjacent (p < 0.001, r = 0.96). Otolaryngologists declined for rural regions (p < 0.001 and p < 0.001, r = -0.56, and r = -0.58 for rural adjacent and not adjacent, respectively). Radiation oncologists declined in rural adjacent (p < 0.001, r = -0.61), while increasing at a lesser rate for rural not adjacent (p = 0.002, r = 0.96).
Rural OPC incidence disparities will grow while the relevant, rural health care workforce declines.
NA Laryngoscope, 134:136-142, 2024.

The combined petrosectomy is one of the workhorse skull base approaches to the petroclival region. Traditionally, this approach starts with a temporosuboccipital craniotomy, followed by the mastoidectomy/anterior petrosectomy, and completed with the dural opening/tumor resection. This sequence of events (neurosurgery-neuro-otology-neurosurgery) involves at least 2 handoffs and change of surgical teams and instrumentation. This report describes a resequencing of events and a modification of the technique used to craft the temporosuboccipital craniotomy, with aims to reducing handoffs between surgical teams and improving operating room workflow.
Adhering to PROCESS guidelines, a case series is provided in addition to the surgical technique and surgical images.
The technique for performing a combined petrosectomy is described with illustrations. This description shows that the temporal bone drilling may be performed before the craniotomy to allow for direct visualization of the dura and sinuses before completing the craniotomy. In doing so, only 1 transition between the otolaryngologist and neurosurgeon is necessary, thereby improving operating room workflow and time management. A series of 10 patients is presented, showing the feasibility of this procedure and providing operative details that were previously absent in the peer-reviewed literature.
Combined petrosectomy, although often performed in a 3-step manner with the neurosurgeon starting the craniotomy, can be performed as described here in a 2-step manner, with similar outcomes and reasonable operating time.

Idiopathic intracranial hypertension (IIH), also called pseudotumor cerebri syndrome, is a disorder defined as elevated intracranial pressure (ICP) of unknown cause. It is a diagnosis of exclusion in most cases, and all other forms of elevated ICP must be ruled out. With its increasing prevalence, it is much more likely for physicians, otolaryngologists included, to encounter this condition. It is important to have a clear understanding of the typical and atypical presentation of this disease, along with its evaluative workup and management options. This article reviews IIH with a focus on those factors that are specifically relevant to otolaryngologic care.

The advent of Cone-beam computed tomography (CBCT), has revolutionized 3D imaging in dentistry. CBCT has enormous potential to be used as an alternative imaging modality by Otolaryngologists. But their knowledge regarding CBCT is limited. The study aims to evaluate the awareness of CBCT as an imaging modality among Ear, nose and Throat (ENT) practitioners. The validated questionnaire was sent by email and the participants were asked to fill the google form through the link provided to record the responses. The participants were asked to answer 25 multiple choice questions regarding the general information and practice related to CBCT imaging. Data was evaluated according to the descriptive statistics and the Chi-square test was used to determine the test of significance. The response rate for this study was 84.4%. The mean age of the participants was 44.9 ± 11.3. 69% of the respondents were academicians,14.2% had exclusive clinical practice, and 16.8% had both clinical and academic exposure. Among the study population, 76.8% had never advised CBCT in their practice. Only 10.3% of the study participants were aware of the potential of CBCT in ENT disorders. The mean knowledge, attitude and practice scores were very low regarding the applications of CBCT. Most of the study participants advised CBCT for maxillofacial fractures (78.1%) and was statistically significant p < 0.05. The knowledge about various advantages and clinical applications of CBCT among Otolaryngologists is limited. However, continuing medical education and inclusion in the medical curriculum will increase the scope and awareness about CBCT among ENT fraternity.