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Lawrence AS, Fei‐Zhang DJ, Hassett LC, Carlson ML, Wiedermann JP. The World's consumption of free web-based Otolaryngology-Head and Neck Surgery educational resources: A global assessment of video usage trends. Laryngoscope Investig Otolaryngol 2024; 9:e1246. [PMID: 38596229 PMCID: PMC11002986 DOI: 10.1002/lio2.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
Objectives Online educational platforms with open access have seen a growing adoption in the field of medical education. However, the extent of their global usage is still unclear. To fill this knowledge gap, our objective is to examine the usage patterns of two renowned open-access resources in Otolaryngology. This includes identifying the most sought-after topics and understanding the demographics of their users. Methods Retrospective study of web analytics data between 2016 and 2021 extracted from the Headmirror.com and Mayo Clinic Otolaryngology YouTube channel platforms analyzing demographic and education topic trends via descriptive, geospatial, time-series, t-tests, and ANOVA analyses. Results Viewership spanned 124 countries in 7 different geographic regions, with 72 countries comprising low- to middle-income countries, mostly represented ages of 25-34 years old, came from high-income countries rather than low-income (p < .001), and used mobile phones followed by computers for device access. Video-educational material comprised of subspecialty topics on Rhinology and Sinus Surgery (25%) at the highest end and Facial Trauma (1%) at the lowest. Controlling for the age of the video content, the most-accessed videos comprised of subspecialty topics on Head and Neck Surgery at the highest end and Laryngology at the lowest with significant differentiation across topics of interest (p < .044). Conclusions This assessment of web-analytics platforms from two widely used otolaryngology free, online-access materials showed increasing global usage trends with significant differentiating factors along viewership demographics, as well as sought-after subspecialty topics of interest. In turn, our results not only lay the groundwork for characterizing the global otolaryngology audience but also for future development of targeted educational materials and accessibility initiatives aimed at ameliorating global educational disparities in the field.
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Affiliation(s)
| | | | | | - Matthew L. Carlson
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Joshua P. Wiedermann
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
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Behmer Hansen RT, Palma SD, Blocher III WA, Behmer Hansen RA, Gold JL, Susman SJ, Batchu S, Silva NA, Richardson AM. A Decade of Global Skull Base Researchers: Authorship Trends from 3,295 Abstracts in the Journal of Neurological Surgery Part B: Skull Base. J Neurol Surg B Skull Base 2024; 85:44-56. [PMID: 38274488 PMCID: PMC10807966 DOI: 10.1055/a-2008-2884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023] Open
Abstract
Objective The North American Skull Base Society (NASBS) multidisciplinary annual conference hosts skull base researchers from across the globe. We hypothesized that the work presented at the NASBS annual conference would reveal diverse authorship teams in terms of specialty and geography. Methods In this retrospective review, abstracts presented at the NASBS annual meeting and subsequently published in the Journal of Neurological Surgery Part B: Skull Base between 01/01/2011 and 12/31/2020 were collected. Variables extracted included year, type of presentation, and author names and affiliations. Statistical analyses were performed with SPSS V23.0 with p -values less than 0.05 considered significant. Geographic heat maps were created to assess author distribution, and a network analysis was performed to display authorship collaboration between geographic regions. Results Of 3,312 published abstracts, 731 (22.1%) had an author with an affiliation outside of the United States. Fifty-seven distinct countries were represented. Three-hundred twenty-four abstracts (9.8%) had authorship teams representing at least 2 different countries. The top five US states by abstract representation were Pennsylvania, California, New York, Ohio, and Minnesota. A majority of authors reported neurosurgery affiliations (56.7% first authors, 53.2% last authors), closely followed by otolaryngology (39.1% first authors, 41.5% last authors). No solo authors and very few (3.3%) of the first authors reported a departmental affiliation outside of otolaryngology or neurosurgery. Conclusions Authors from many countries disseminate their work through poster and oral presentations at the NASBS annual meeting. Ten percent of abstracts were the product of international collaboration. Most authors were affiliated with a neurosurgery or otolaryngology department.
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Affiliation(s)
| | - Samantha D. Palma
- Department of Neurosurgery, Indiana University Indianapolis, Indiana, United States
| | | | | | - Justin L. Gold
- Department of Neurosurgery, Cooper Medical School of Rowan University, Camden, New Jersey, United States
| | - Stephen J. Susman
- Department of Neurosurgery, Indiana University Indianapolis, Indiana, United States
| | | | - Nicole A. Silva
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Angela M. Richardson
- Department of Neurosurgery, Indiana University Indianapolis, Indiana, United States
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Richard K, Sanchez R, Amado B, Lubner R, Niconchuk J, Chen H, Phillips J, Kynes M, Belcher RH. Pediatric Otolaryngology Short-Term Mission Outcomes at a Surgical Mission Hospital in Guatemala. Otolaryngol Head Neck Surg 2024; 170:252-259. [PMID: 37466003 DOI: 10.1002/ohn.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low- and middle-income country missions-based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes. STUDY DESIGN Retrospective cohort study. SETTING Guatemalan surgery center is called the Moore Center. METHODS Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses. RESULTS A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty-nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty-nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation. CONCLUSION This surgical center models effective surgical care in low-resource areas. Complications and follow-up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.
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Affiliation(s)
- Kelsey Richard
- Medical Doctorate Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Barbara Amado
- Centro Quirugico Pediatrico Moore, Guatemala City, Guatemala
| | - Rory Lubner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Niconchuk
- Department of Anesthesia, Pediatric Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Phillips
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Vanderbilt Children's Hospital, Nashville, Tennessee, USA
| | - Matthew Kynes
- Department of Anesthesia, Pediatric Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan H Belcher
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Vanderbilt Children's Hospital, Nashville, Tennessee, USA
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Kim EK, Shrime MG. Cost of open access publishing in otolaryngology-head and neck surgery. World J Otorhinolaryngol Head Neck Surg 2023; 9:352-356. [PMID: 38059140 PMCID: PMC10696265 DOI: 10.1002/wjo2.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/20/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Open access (OA) publishing makes research more accessible but is associated with steep article processing charges (APCs). The study objective was to characterize the APCs of OA publishing in otolaryngology-head and neck surgery (OHNS) journals. Methods We conducted a cross-sectional analysis of published policies of 110 OHNS journals collated from three databases. The primary outcomes were the publishing model, APC for original research, and APC waiver policy. Results We identified 110 OHNS journals (57 fully OA, 47 hybrid, 2 subscription-only, 4 unknown model). After excluding 12 journals (2 subscription-only, 4 unknown model, 5 OA with unspecified APCs, and 1 OA that accepts publications only from society members), we analyzed 98 journals, 23 of which did not charge APCs. Among 75 journals with nonzero APCs, the mean and median APCs were $2452 and $2900 (interquartile range: $1082-3520). Twenty-five journals (33.3%) offered APC subsidies for authors in low- and middle-income countries (LMICs) and/or on a case-by-case basis. Eighty-five and 25 journals were based in high-income countries (HICs) and LMICs, respectively. The mean APC was higher among HIC journals than LMIC journals ($2606 vs. $958, p < 0.001). Conclusion APCs range from tens to thousands of dollars with limited waivers for authors in LMICs.
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Affiliation(s)
- Eric K. Kim
- Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonMassachusettsUSA
- School of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Mark G. Shrime
- Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonMassachusettsUSA
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Purnami N, Palandeng RW, Nugroho PS, Falerina R, Wiyadi HMS, Arifianto D, Moon IS. Screening for hearing loss using the electronic whisper test: A prospective cross-sectional study. Int J Crit Illn Inj Sci 2023; 13:173-177. [PMID: 38292393 PMCID: PMC10824205 DOI: 10.4103/ijciis.ijciis_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/19/2023] [Accepted: 07/10/2023] [Indexed: 02/01/2024] Open
Abstract
Background Hearing screening is a method for early identification of hearing loss. Hearing screening is widely used in hospitals as part of physical examination. However, some of them are difficult to operate outside the hospitals regarding portability and user-friendliness. Therefore, we developed a simple yet easy-to-use portable electronic whisper test (EWT) for field deployment, particularly on many subjects. The EWT validity is a hearing screening method compared to pure-tone audiometry. Methods This study was a cross-sectional comparative with a prospective approach. The subjects were outpatients at the Audiology Clinic of Dr. Soetomo Academic Medical Center, Surabaya, Indonesia, who met the inclusion and exclusion criteria. Statistical analysis made sensitivity and specificity tables using a 2 × 2 table, positive and negative predictive values. Results Samples of 50 participants (100 ears) obtained a sensitivity value of 83%, specificity of 78%, positive predictive value of 45%, and negative predictive value of 95%. Conclusions The EWT is valid for use as a hearing screening method.
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Affiliation(s)
- Nyilo Purnami
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - Rian Waraney Palandeng
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - Puguh Setyo Nugroho
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - Rosa Falerina
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - H. M. S. Wiyadi
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - Dhany Arifianto
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitas Airlangga, Dr. Soetomo General Academic Hospital Center, Indonesia
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University, Seoul, South Korea
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Lemfuka AD, Huang AH. Plastic surgery within global surgery: the incidence of plastic surgery cases in a rural Gabonese hospital. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01837-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Quraishi N, Quraishi S. Otolaryngology education and training in the COVID-19 and post-COVID-19 digital era: a developing world perspective. Curr Opin Otolaryngol Head Neck Surg 2021; 29:225-229. [PMID: 33896912 DOI: 10.1097/moo.0000000000000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This article reviews the literature on the challenges to Otolaryngology training in the developing world, the solutions that have been implemented thus far and the role of technology in first the Digital, and now the Covid era. RECENT FINDINGS There is an increasing prevalence of Otolaryngological pathology in the developing world. Efforts to treat this are hampered by multiple factors including appropriate medical training. A number of solutions have been implemented for this both in terms of face-to-face as well as virtual training. SUMMARY The Covid era has created new challenges for Otolaryngology training in the developed world, sparking a huge shift in the delivery of education. Traditional forms of training have disadvantaged colleagues in the developing world and so this change in training modalities may benefit the developing world.
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Affiliation(s)
- Natasha Quraishi
- Department of Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
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Khoza-Shangase K, Masondo N. In Pursuit of Preventive Audiology in South Africa: Scoping the Context for Ototoxicity Assessment and Management. J Pharm Bioallied Sci 2020; 13:46-60. [PMID: 34084048 PMCID: PMC8142905 DOI: 10.4103/jpbs.jpbs_334_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 11/04/2022] Open
Abstract
Aim The study explored the South African healthcare context for ototoxicity assessment and management from the audiologists' perspectives. Materials and Methods This was done through a survey research methodology that adopted a cross-sectional research design. South African audiologists were recruited from professional associations databases using specific inclusion criteria; and 31 audiologists from across the country participated. The study used an 18-item web-based survey guided by the Health Professions Council of South Africa (HPCSA) (2018) guidelines. Data were analyzed through both descriptive and inferential statistics. Results Findings revealed serious contextual challenges influencing the implementation of assessment and management programs within the South African context. Over two-thirds of the participants engage with ototoxicity monitoring and management, but the practices adopted are not aligned to international standards nor the national HPCSA guidelines on assessment and management of patients on ototoxic medications. Findings speak to the frequency of practice; the referral pathways audiologists use; prevention and promotion methods used; availability of resources for the implementation of ototoxicity assessment and management; barriers to ototoxicity assessment and management; the influence of language and culture in ototoxicity assessment and management; as well as information management practices within this context. No relationship could be established between knowledge regarding ototoxicity, communication, caseload, and ototoxicity assessment and management on the chi-square. Conclusion Implications for strategic planning, budget allocation, collaborative multidisciplinary within the same institution approaches; training; policy formulation; and translation of policies and guidelines into practice are raised by these findings.
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Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Nothando Masondo
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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Li LYJ, Wang SY, Wu CJ, Tsai CY, Wu TF, Lin YS. Screening for Hearing Impairment in Older Adults by Smartphone-Based Audiometry, Self-Perception, HHIE Screening Questionnaire, and Free-Field Voice Test: Comparative Evaluation of the Screening Accuracy With Standard Pure-Tone Audiometry. JMIR Mhealth Uhealth 2020; 8:e17213. [PMID: 33107828 PMCID: PMC7655471 DOI: 10.2196/17213] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/30/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
Background Hearing impairment is the most frequent sensory deficit in humans, affecting more than 360 million people worldwide. In fact, hearing impairment is not merely a health problem, but it also has a great impact on the educational performance, economic income, and quality of life. Hearing impairment is therefore an important social concern. Objective We aimed to evaluate and compare the accuracy of self-perception, Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) questionnaire, free-field voice test, and smartphone-based audiometry as tests for screening moderate hearing impairment in older adults in China. Methods In this study, 41 patients were recruited through a single otology practice. All patients were older than 65 years. Patients with otorrhea and cognitive impairment were excluded. Moderate hearing impairment was defined as mean hearing thresholds at 500, 1000, 2000, and 4000 Hz >40 dB hearing loss (pure-tone average > 40 dB hearing loss). All patients completed 5 hearing tests, namely, the self-perception test, HHIE-S questionnaire test, free-field voice test, smartphone-based audiometry test, and standard pure-tone audiometry by the same audiologist. We compared the results of these tests to the standard audiogram in the better-hearing ear. Results The sensitivity and the specificity of the self-perception test were 0.58 (95% CI 0.29-0.84) and 0.34 (95% CI 0.19-0.54), respectively. The sensitivity and the specificity of the HHIE-S questionnaire test were 0.67 (95% CI 0.35-0.89) and 0.31 (95% CI 0.316-0.51), respectively. The sensitivity and the specificity of the free-field voice test were 0.83 (95% CI 0.51-0.97) and 0.41 (95% CI 0.24-0.61), respectively. The sensitivity and the specificity of the smartphone-based audiometry test were 0.92 (95% CI 0.60-0.99) and 0.76 (95% CI 0.56-0.89), respectively. Smartphone-based audiometry correctly diagnosed the presence of hearing loss with high sensitivity and high specificity. Conclusions Smartphone-based audiometry may be a dependable screening test to rule out moderate hearing impairment in the older population.
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Affiliation(s)
- Lok Yee Joyce Li
- Department of Medicine, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shin-Yi Wang
- National Taiwan University Hospital Hsin-chu Branch, Hsin-chu, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,PhD Degree Program of Biomedical Science and Engineering, National Chiao Tung University, Hsinchu, Taiwan.,Department of Otolaryngology-Head And Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
| | - Te-Fang Wu
- Department of Otolaryngology - Head And Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yaoh-Shiang Lin
- Department of Otolaryngology-Head And Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan.,Department of Otolaryngology - Head And Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Jayawardena ADL, Ghersin ZJ, Mirambeaux M, Bonilla JA, Quiñones E, Zablah E, Callans K, Hartnick M, Sahani N, Cayer M, Hersh C, Gallagher TQ, Yager PH, Hartnick CJ. A Sustainable and Scalable Multidisciplinary Airway Teaching Mission: The Operation Airway 10-Year Experience. Otolaryngol Head Neck Surg 2020; 163:971-978. [PMID: 32600113 DOI: 10.1177/0194599820935042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy. STUDY DESIGN Consecutive case series with chart review. SETTING This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic. METHODS Demographic data, diagnostic and operative details, and operative outcomes were collected. A country's program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes. RESULTS A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded. CONCLUSION This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.
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Affiliation(s)
- Asitha D L Jayawardena
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Zelda J Ghersin
- Pediatric Intensive Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcos Mirambeaux
- Department of Otolaryngology, Roberto Reid Cabral, Santa Domingo, Dominican Republic
| | - Jose A Bonilla
- Department of Otolaryngology, Benjamin Bloom Hospital, San Salvador, El Salvador
| | - Ernesto Quiñones
- Hospital de los Valles, Universidad San Francisco de Quito, Quito, Ecuador
| | - Evelyn Zablah
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kevin Callans
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Marina Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Nita Sahani
- Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Makara Cayer
- Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Cheryl Hersh
- Pediatric Airway, Voice and Swallowing Center, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Thomas Q Gallagher
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Phoebe H Yager
- Pediatric Intensive Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Availability of ENT Surgical Procedures and Medication in Low-Income Nation Hospitals: Cause for Concern in Zambia. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1980123. [PMID: 32280679 PMCID: PMC7128045 DOI: 10.1155/2020/1980123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/26/2020] [Indexed: 11/17/2022]
Abstract
Background Ear, nose, and throat (ENT) diseases are an oft overlooked global health concern. Despite their high prevalence and associated morbidity and mortality, ENT diseases have remained neglected in health care delivery. In Zambia and many other low-income countries, ENT services are characterized by poor funding, unavailable surgical procedures, and erratic supply of essential drugs. Objective To investigate ENT service provision in Zambia with regard to availability of surgical procedures and supply of essential drugs. Methods A descriptive cross-sectional survey was conducted using a piloted structured questionnaire between 17 January 2017 and 2 January 2018. Included in the study were the 109 hospitals registered with the Ministry of Health (MoH) across the 10 provinces of Zambia. Results Of the participating hospitals, only 5.9% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% (n = 1) and 40% ( Conclusion ENT service delivery in Zambia is limited with regard to performed surgical procedures and availability of essential drugs, necessitating urgent intervention. The findings from this study may be used to direct national policy on the improvement of provision of ENT services in Zambia.
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Shinn JR, Zuniga MG, Macharia I, Reppart J, Netterville JL, Jayawardena ADL. Community health workers obtain similar results using cell-phone based hearing screening tools compared to otolaryngologists in low resourced settings. Int J Pediatr Otorhinolaryngol 2019; 127:109670. [PMID: 31518844 DOI: 10.1016/j.ijporl.2019.109670] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To establish community health workers as reliable hearing screening operators in a technology-based pre-surgical hearing screening program in a low and middle-income country (LMIC). METHODS This is a cross sectional study that evaluated community health worker driven hearing screening that took place in semi-rural Malindi, Kenya during an annual two-week otolaryngology surgical training mission in October 2017. At five separate locations (four schools) near Malindi, Kenya, children between the ages of 2-16 underwent hearing screening using screening audiometry (Android-based HearX Group). Children were screened by a community health worker who underwent a short training course, a senior otolaryngology resident, or both. Hearing screening results were compared to determine the reliability and concordance between independent, blinded community health worker and otolaryngology resident testing. RESULTS One hundred and four participants (53% males) underwent hearing screening. Hearing screening pass rate was 93%. Community health workers obtained a similar result to otolaryngology residents 96% of the time (McNemar test: p = 0.16, OR 0.96, 95% CI 0.9-1.0). CONCLUSION Community health workers can obtain reliable results using a technology-based, pre-surgical hearing screening platform when compared to otolaryngology residents. This finding has profound implications in low-resourced settings where hearing healthcare specialists (audiologists and otolaryngologists) are limited and can ultimately improve the surgical yield of patients presenting to local otolaryngologists in these settings.
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Affiliation(s)
- Justin R Shinn
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - M Geraldine Zuniga
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ian Macharia
- Department of Otolaryngology, University of Nairobi, Nairobi, Kenya
| | | | - James L Netterville
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA; Caris Foundation, Malindi, Kenya
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Shinn JR, Jayawardena ADL, Patro A, Zuniga MG, Netterville JL. Teacher Prescreening for Hearing Loss in the Developing World. EAR, NOSE & THROAT JOURNAL 2019; 100:259S-262S. [PMID: 31608682 DOI: 10.1177/0145561319880388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The goal of this prospective cohort study was to characterize the ability of teachers to identify schoolchildren at risk of hearing loss in order to maximize hearing screening efficiency in low-resource settings. At 4 semirural schools in Malindi, Kenya, preselected schoolchildren perceived as hearing impaired were compared to children thought to have normal hearing using portable audiometry. Eight of 127 children (54% male) failed hearing screening, all of who were identified by schoolteachers as having a high risk of hearing loss. Thus, for every 5 children prescreened by schoolteachers, an average of 1 child would be identified as having hearing loss. Overall, teacher prescreening had a 100% hearing loss identification rate and a 20% referral rate. In conclusion, in resource-limited settings, where universal hearing screening is challenging, teachers can effectively identify children with hearing loss for early intervention.
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Affiliation(s)
- Justin R Shinn
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Asitha D L Jayawardena
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ankita Patro
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Geraldine Zuniga
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - James L Netterville
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Head and Neck Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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Lukama L, Kalinda C, Aldous C. Africa's challenged ENT services: highlighting challenges in Zambia. BMC Health Serv Res 2019; 19:443. [PMID: 31266482 PMCID: PMC6604437 DOI: 10.1186/s12913-019-4267-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diseases of the ear, nose and throat (ENT) are common and are a major cause of morbidity and mortality. In many low income countries like Zambia, the high ENT disease burden has not received the required resources for treatment. We investigated ENT service provision in hospitals in Zambia by documenting the profile of hospitals offering ENT services and examining the country's ENT services with regards to human resource, infrastructure and availability of equipment based on the levels of care of various hospitals. METHODS The study was a cross-sectional descriptive survey conducted using a structured and piloted questionnaire which was administered to the 109 Ministry of Health (MoH) registered hospitals across the country. Ethical clearance was granted by University of KwaZulu-Natal and the Zambia National Health Research Authority. Participation in the study was voluntary and all respondents signed informed consent. Descriptive statistics were used to analyse the data. RESULTS Of the 109 hospitals approached to participate in the study, 61 (55.9%) hospitals responded. This represented 83.3% (n = 5) of Third Level Hospitals (TLH), 89.5% (n = 17) of Second Level Hospitals (SLH) and 41.7% (n = 35) of First Level Hospitals (FLH) countrywide. Of the participating hospitals, 6.6% (n = 4) were unclassified. Within this sample, 8.6% (n = 3) FLH, 11.8% (n = 2) SLH and 60.0% (n = 3) TLH had an ENT examination room. Only 2.9% (n = 4) hospitals had an audiology booth and 1.6% (n = 1) had a speech therapy room. Of the second and third level hospitals, 9.1% (n = 2) had flexible rhinolaryngoscopes, 18.2% (n = 4) had operating microscopes and 68.2% (n = 15) adenotonsillectomy sets. The data revealed that there were 4 ENT surgeons, 1 Audiologist and no Speech Therapists across the country. CONCLUSION Zambia's ENT services were deficient at all levels of hospital care. There were deficiencies in infrastructure, human resource and equipment in hospitals. With the current burden of disease, critical intervention is required. These findings should be used to direct national policy on the improvement of ENT service provision in Zambia.
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Affiliation(s)
- Lufunda Lukama
- College of Health Sciences, Nelson R. Mandela School of Clinical Medicine, Discipline of Otorhinolaryngology, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Chester Kalinda
- University of Namibia, Katima Mulilo Campus, Private Bag, Katima Mulilo, 1096 Namibia
- College of Health Sciences, Howard College Campus, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Colleen Aldous
- College of Health Sciences, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001 South Africa
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Eichhorn T. [Global surgery from an otorhinolaryngological perspective]. HNO 2019; 67:519-527. [PMID: 31172203 DOI: 10.1007/s00106-019-0691-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since the middle of this century, the United Nations (UN) has paid increasing attention to the surgical care of the worldwide population, with the aim of global access to basic surgical procedures ("global surgery") in the future. The current article describes models for training and continuing education of "global surgeons," with a focus on activities in the field of otolaryngology. The diagnostic inventory in which the global surgeon should be educated is presented. Lists of indications and operative procedures the global surgeon should master are suggested, as are the limits of his/her actions. The surgical instruments required by the global surgeon are summarized in a table, whereby their description is oriented toward the different individual anatomic regions relevant to the otorhinolaryngologist. The paper concludes with an outlook devoted particularly to the idealized vision of availability of global surgery in the future.
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Affiliation(s)
- T Eichhorn
- , Gaglower Str. 44, 03051, Cottbus, Deutschland.
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Portable audiometric screening platforms used in low-resource settings: a review. The Journal of Laryngology & Otology 2018; 133:74-79. [PMID: 30392484 DOI: 10.1017/s0022215118001925] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Millions of people across the world suffer from disabling hearing loss. Appropriate interventions lead to improved speech and language skills, educational advancement, and improved social integration. A major limitation to improving care is identifying those with disabling hearing loss in low-resource countries. OBJECTIVES This review article summarises information on currently available hearing screening platforms and technology available from published reports and the authors' personal experiences of hearing loss identification in low-resource areas of the world. The paper reviews the scope and capabilities of portable hearing screening platforms, including the pros and cons of each technology and how they have been utilised in low-resource environments. CONCLUSION Portable hearing screening tools are readily available to assess hearing loss in low-resource areas. Each technology has advantages and limitations that should be considered when identifying the optimal methods to assess needs in each country.
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Mulwafu W, Ensink R, Kuper H, Fagan J. Survey of ENT services in sub-Saharan Africa: little progress between 2009 and 2015. Glob Health Action 2018; 10:1289736. [PMID: 28485648 PMCID: PMC5496047 DOI: 10.1080/16549716.2017.1289736] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND A 2009 survey of ENT, audiology, and speech therapy services and training opportunities in 18 Sub-Saharan African countries reported that the availability of services was extremely poor, the distribution of services was very inequitable, and training opportunities were limited. Objective: We conducted a new survey to determine the current status of ear, nose, and throat (ENT), audiology, and speech therapy services in sub-Saharan Africa. METHOD This study is a cross-sectional study. A questionnaire was distributed by email to an ad hoc group of ENT surgeons and audiologists in 30 sub-Saharan African countries. Data from the current survey were compared to those of a 2009 survey. The numbers of ENT surgeons, audiologists, and speech therapists/100,000 people were compared to the ratios in the United Kingdom. RESULTS A total of 22 countries responded to the questionnaire. When data of the 15 countries that responded in both 2009 and 2015 are compared, the number of ENT surgeons had increased by 43%, audiologists had increased by 2.5%, and speech therapists by 30%. When the 23% population growth is taken into account, the numbers of ENT surgeons, audiologists, and speech therapists per 100,000 people had declined in four countries, and there remains a severe shortfall of ENT surgeons, audiologists, and speech therapists when compared to the UK Respondents cited lack of availability of basic equipment as the most frequent limitation in providing ENT services. Other important factors causing limitations in daily practice were: lack of ENT training facilities and audiological rehabilitation, low awareness of the burden of ENT pathology, as well as poor human resources management. CONCLUSIONS There has been a lack of progress in ENT, audiology, and speech therapy services and training opportunities in sub-Saharan Africa between 2009 and 2015. There is a need to look at increased collaboration with developed countries and non-governmental organisations, establishing new and improving existing training centres in Africa, and task-shifting of some ENT services to primary health workers.
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Affiliation(s)
- Wakisa Mulwafu
- a Department of Surgery , College of Medicine , Blantyre , Malawi.,b Centre for International Health , University of Bergen , Bergen , Norway
| | - Robbert Ensink
- c Division of Oto-rhino-laryngology , Gelre Hospitals Zutphen , The Netherlands
| | - Hannah Kuper
- d International Centre for Evidence in Disability (ICED) , London School of Hygiene and Tropical Medicine , London , UK
| | - Johannes Fagan
- e Division of Otolaryngology , University of Cape Town , Cape Town , South Africa
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Rosa T, Bellardi K, Viana A, Ma Y, Capasso R. Digital Health and Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis. J Clin Sleep Med 2018; 14:1605-1620. [PMID: 30176971 DOI: 10.5664/jcsm.7346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/19/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep disorders in most individuals remain undiagnosed and without treatment. The use of novel tools and mobile technology has the potential to increase access to diagnosis. The objective of this study was to perform a quantitative and qualitative analysis of the available literature evaluating the accuracy of smartphones and portable devices to screen for sleep-disordered breathing (SDB). METHODS A literature review was performed between February 18, 2017 and March 15, 2017. We included studies evaluating adults with SDB symptoms through the use mobile phones and/or portable devices, using standard polysomnography as a comparison. A qualitative evaluation of studies was performed with the QUADAS-2 rating. A bivariate random-effects meta-analysis was used to obtain the estimated sensitivity and specificity of screening SDB for four groups of devices: bed/mattress-based, contactless, contact with three or more sensors, and contact with fewer than three sensors. For each group, we also reported positive predictive values and negative predictive values for mild, moderate, and severe obstructive sleep apnea (OSA) screening. RESULTS Of the 22 included studies, 18 were pooled in the meta-analysis. Devices that were bed/mattress-based were found to have the best sensitivity overall (0.921, 95% confidence interval [CI] 0.870, 0.953). The sensitivity of contactless devices to detect mild OSA cases was the highest of all groups (0.976, 95% CI 0.899, 0.995), but provided a high false positive rate (0.487, 95% CI 0.137, 0.851). The remaining groups of devices showed low sensitivity and heterogeneous results. CONCLUSIONS This study evidenced the limitations and potential use of portable devices in screening patients for SDB. Additional research should evaluate the accuracy of devices when used at home.
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Affiliation(s)
- Talita Rosa
- Global Brain Health Institute, University of California, San Francisco (UCSF), San Francisco, California
| | - Kersti Bellardi
- Department of Global Health, University of California, San Francisco (UCSF), San Francisco, California
| | - Alonço Viana
- Graduate Program of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University, Stanford, California
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Jayawardena ADL, Kahue CN, Cummins SM, Netterville JL. Expanding the Capacity of Otolaryngologists in Kenya through Mobile Technology. OTO Open 2018; 2:2473974X18766824. [PMID: 30480210 PMCID: PMC6239030 DOI: 10.1177/2473974x18766824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/05/2018] [Accepted: 03/05/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To determine if reliable, objective audiologic data can be obtained by
nonotolaryngology and nonaudiology practitioners using novel mobile
technology in an effort to expand the capacity for early identification and
treatment of disabling hearing loss in the developing world. Study Design Cross-sectional, proof-of-concept pilot study. Setting Screenings took place during an annual 2-week otolaryngology surgical mission
in October 2016 in semirural Malindi, Kenya. Subject and Methods Eighty-seven patients (174 total ears) were included from 2 deaf schools (n =
12 and 9), a nondeaf school (n = 9), a tuberculosis ward (n = 8), and a
walk-in otology clinic at a local hospital (n = 49). An automated,
tablet-based, language-independent, clinically validated, play audiometry
system and wireless otoscopic endoscopy via an iPhone or laptop platform was
administered by Kenyan community health workers (CHWs) and nursing
staff. Results Various degrees of hearing loss and otologic pathology were identified,
including 1 child presumed to be deaf who was found to have unilaterally
normal hearing. Other pathology included 2 active perforations, 2 healed
perforations, 2 middle ear effusions, and 1 cholesteatoma. CHWs and nursing
staff demonstrated proficiency performing audiograms and endoscopy. Patients
screened in a deaf school were more likely to complete an unreliable
audiogram than patients screened in other settings (P <
.01). Conclusion This study demonstrates the feasibility of a non–otolaryngology-based hearing
screening program. This may become an important tool in reducing the impact
of hearing loss and otologic pathology in areas bereft of otolaryngologists
and audiologists by allowing CHWs to gather important patient data prior to
otolaryngologic evaluation.
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Affiliation(s)
- Asitha D L Jayawardena
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
| | - Charissa N Kahue
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
| | | | - James L Netterville
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
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Belcher RH, Molter DW, Goudy SL. An Evidence-Based Practical Approach to Pediatric Otolaryngology in the Developing World. Otolaryngol Clin North Am 2018. [PMID: 29525391 DOI: 10.1016/j.otc.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Despite humanitarian otolaryngology groups traveling in record numbers to resource-limited areas treating pediatric otolaryngology disease processes and training local providers, there remains a large burden of unmet needs. There is a meager amount of published information that comes from the developing world from an otolaryngology standpoint. As would be expected, the little information that does comes involves some of the most common pediatric otolaryngology diseases and surgical burdens including childhood hearing loss, otitis media, adenotonsillectomies, airway obstructions requiring tracheostomies, foreign body aspirations, and craniomaxillofacial surgeries, including cleft lip and palate.
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Affiliation(s)
- Ryan H Belcher
- Department of Otolaryngology-Head and Neck Surgery, Emory University, 550 Peachtree Street, MOT/Suite 1135, Atlanta, GA 30308, USA
| | - David W Molter
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St Louis, MO 63110, USA
| | - Steven L Goudy
- Department of Otolaryngology-Head and Neck Surgery, Emory University, 2015 Uppergate Drive, Atlanta, GA 30322, USA.
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Kligerman MP, Alexandre A, Jean-Gilles P, Walmer D, Cheney ML, Messner AH. Otorhinolaryngology/Head and Neck Surgery in a low income country: The Haitian experience. Int J Pediatr Otorhinolaryngol 2017; 93:128-132. [PMID: 28109483 DOI: 10.1016/j.ijporl.2016.12.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/28/2016] [Accepted: 12/28/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Little is known regarding the diagnosis and management of pediatric surgical conditions of the head and neck in low-income countries. Haiti, the western hemisphere's poorest country, recently developed its first Otorhinolaryngology (ORL) department at the Hopital de L'Universite d'Etat d'Haiti (HUEH). This manuscript assesses the caseload at HUEH with a special emphasis on pediatric cases, with the aim of characterizing ORL related conditions and their treatments in low-income countries. METHODS We conducted a retrospective chart review of surgical case logs at HUEH for the calendar year of 2014 and recorded patient age, diagnosis, and surgical intervention for all ORL surgeries. RESULTS A total of 229 ORL surgeries were performed at HUEH during this time. The average age of the patient was 21.8 years and 54.2% of patients were 18 years or younger. The five most common diagnoses were tonsillar hypertrophy (23.6%), ingested foreign body (18%), mandibular fracture (9.2%), unspecified head or neck mass (6%), and thyroid goiter (4.8%). The five most common surgeries performed were tonsillectomy (23.6%), foreign body retrieval (17.9%), open reduction of mandibular fracture with direct skeletal fixation (6.9%), thyroidectomy (7.9%), and excision of unspecified mass. Trauma accounted for 33.6% of all ORL surgeries. CONCLUSIONS Diseases related to the head and neck constitute a common yet underserved surgical problem. Strengthening ORL surgical capacity in Haiti should focus on improving capacity for the most common conditions including tonsillar disease, ingested foreign bodies, and facial trauma, as well as improving capacity for rarely performed surgeries, such as ear surgery, nose and sinus surgery, and cancer resections.
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Affiliation(s)
- Maxwell P Kligerman
- Stanford University School of Medicine, Stanford, CA, USA; Family Health Ministries, 501-C3, Durham, NC, USA.
| | - Anahuma Alexandre
- Department of Otorhinolaryngology, Hopital de L'Universite d'Etat d'Haiti, Port-au-Prince, Haiti
| | - Patrick Jean-Gilles
- Department of Otorhinolaryngology, Hopital de L'Universite d'Etat d'Haiti, Port-au-Prince, Haiti
| | - David Walmer
- Duke Global Health Institute, Duke University, USA; Family Health Ministries, 501-C3, Durham, NC, USA
| | - Mack L Cheney
- Massachusetts Eye and Ear Infirmary, Harvard School of Medicine, USA
| | - Anna H Messner
- Department of Otolaryngology/Head & Neck Surgery, Stanford University, Stanford, CA, USA
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Educational workshops with graduates of the University of Cape Town Karl Storz Head and Neck Surgery Fellowship Program: a model for collaboration in outreach to developing countries. SPRINGERPLUS 2016; 5:1652. [PMID: 27722069 PMCID: PMC5035289 DOI: 10.1186/s40064-016-3290-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 09/11/2016] [Indexed: 12/01/2022]
Abstract
The University of Cape Town Karl Storz Head and Neck Surgery Fellowship is the only head and neck surgery fellowship in Sub-Saharan Africa. This article briefly describes this fellowship and outlines the experience and ongoing collaborative efforts of members of the American Academy of otolaryngology-head and neck surgery with graduates of this program who are now building head and neck surgery programs in East Africa. This educational collaboration avoids many common pitfalls associated with short-term humanitarian outreach and represents a successful model for international collaborative educational efforts with head and neck surgeons in developing countries in Africa.
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Chambers KJ, Aswani J, Patel A, Fundakowski C, Mannion K, Lin DT, Netterville J. The value of a collaborative course for advanced head and neck surgery in East Africa. Laryngoscope 2014; 125:883-7. [DOI: 10.1002/lary.25028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Kyle J. Chambers
- Department of Otolaryngology-Head & Neck Surgery; Massachusetts Eye & Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Joyce Aswani
- Department of Surgery; University of Nairobi School of Medicine; Nairobi Kenya
- Kenya Ear Nose & Throat Society; Nairobi Kenya
| | - Asmeeta Patel
- Department of Surgery; Kenyatta National Hospital; Nairobi Kenya
- Kenya Ear Nose & Throat Society; Nairobi Kenya
| | - Christopher Fundakowski
- Division of Head & Neck Surgery; Vanderbilt Bill Wilkerson Center
- Vanderbilt Department of Otolaryngology and Bill Wilkerson Center; Vanderbilt University Medical Center; Nashville Tennessee U.S.A
| | - Kyle Mannion
- Division of Head & Neck Surgery; Vanderbilt Bill Wilkerson Center
- Vanderbilt Department of Otolaryngology and Bill Wilkerson Center; Vanderbilt University Medical Center; Nashville Tennessee U.S.A
| | - Derrick T. Lin
- Department of Otolaryngology-Head & Neck Surgery; Massachusetts Eye & Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - James Netterville
- Division of Head & Neck Surgery; Vanderbilt Bill Wilkerson Center
- Vanderbilt Department of Otolaryngology and Bill Wilkerson Center; Vanderbilt University Medical Center; Nashville Tennessee U.S.A
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Van Buren NC, Groen RS, Kushner AL, Samai M, Kamara TB, Ying J, Meier JD. Untreated Head and Neck Surgical Disease in Sierra Leone. Otolaryngol Head Neck Surg 2014; 151:638-45. [DOI: 10.1177/0194599814542587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Demonstrate how the Surgeons OverSeas Assessment of Surgical Need (SOSAS) can be used to determine the burden of head and neck (H&N) surgical disease in developing countries and identify reasons for untreated disease. Study Design Cluster randomized, cross-sectional, countrywide survey. Setting Sierra Leone. Subjects and Methods The survey was administered to 75 of 9671 enumeration areas in Sierra Leone between January 9 and February 3, 2012, with 25 households in each cluster randomly selected for the survey. A household representative and 2 randomly selected household members were interviewed. Need for surgical care was based on participants’ responses to whether they had an H&N condition that they believed needed surgical care. Results Of 1875 households, data were analyzed for 1843 (98%), with 3645 total respondents. Seven hundred and one H&N surgical conditions were reported as occurring during the lifetime of the 3645 respondents (19.2%).The current prevalence of H&N conditions in need of a surgical consultation was 11.8%. No money (60.1%) was the most common reason respondents reported for not receiving medical care. A bivariate analysis demonstrated that age, village type, education, and type of condition may be predictors for seeking health care and/or receiving surgical care. Conclusions These results show limited access for patients to be evaluated for a potential H&N surgical condition in Sierra Leone. The true incidence of untreated surgical disease is unknown as most respondents were not evaluated by a surgeon. This survey could be used in other countries as health care professionals assess surgical needs throughout the world.
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Affiliation(s)
- Nicholas C. Van Buren
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reinou S. Groen
- Surgeon OverSeas, New York, New York, USA
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Adam L. Kushner
- Surgeon OverSeas, New York, New York, USA
- Department of Surgery, Columbia University, New York, New York, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mohamed Samai
- College of Medicine and Allied Health Science, Freetown, Sierra Leone
| | - Thaim B. Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Jian Ying
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jeremy D. Meier
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Optimising the pre-treatment process before mobile ear surgery for chronic suppurative otitis media in Wolisso and Attat, Ethiopia. The Journal of Laryngology & Otology 2014; 128:421-4. [DOI: 10.1017/s002221511400098x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Chronic suppurative otitis media is a major cause of long-standing hearing impairment in many Sub-Saharan African countries.Methods:Attempts were made to optimise the pre-treatment process before mobile ear surgery for chronic suppurative otitis media in Wolisso, a semi-urban community in the Oromia region, and in Attat, a rural community in the Gurage region, both in the south-west of Ethiopia, between 2008 and 2010. This included special training for ENT nurses, and the use of a strict scheduling regime and improved topical treatment.Results and conclusion:This strategy allowed effective middle-ear surgery to be carried out using simple means and with a mobile ear surgery team, the latter of which is only transiently but regularly on site.
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Mulwafu W, Nyirenda TE, Fagan JJ, Bem C, Mlumbe K, Chitule J. Initiating and developing clinical services, training and research in a low resource setting: the Malawi ENT experience. Trop Doct 2014; 44:135-9. [DOI: 10.1177/0049475514524393] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Sub-Saharan Africa countries like Malawi have a paucity of ear, nose and throat (ENT) data, services and training opportunities. Objective To reflect on new Malawian ENT experience and to propose guidelines to poorly resourced countries. Design Analysis of data predating and following establishment of ENT services in Malawi. Results In 2008 the first and only Malawian ENT specialist established ENT services with external funding. Fifteen clinical officers have been trained and a nurse placed at each outreach hospital. In 2012, 15,284 consultations were recorded: 543 (3.6%) from outreach clinics. Forty-nine percent needed medical treatment, while 45% needed medical advice. Surgery was performed on 2.7% of patients; 21% for foreign bodies in the nose and throat and 18% for foreign bodies and biopsies of ears. Conclusions To establish accessible and sustainable specialist ENT services in a poor country requires building on an established local health delivery system, careful planning and investment in personnel, infrastructure, training and data collection.
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Affiliation(s)
- Wakisa Mulwafu
- ENT Surgeon and Head of Unit, College of Medicine, University of Malawi, Malawi
| | - Thomas Elliot Nyirenda
- South-South Networking and Capacity Development Manager, European and Developing Countries Clinical Trials Partnership, Medical Research Council, Cape Town, South Africa
| | - Johannes J Fagan
- Professor and Chairman, Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Chris Bem
- Consultant ENT and Neck Surgeon, Bradford Hospital, United Kingdom
| | - Kumvana Mlumbe
- CBM/BMZ Project Coordinator, College of Medicine, University of Malawi, Malawi
| | - Jean Chitule
- Company Manager, Clinical Research Education and Management Services Limited, Malawi
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Abstract
AbstractDisabling hearing impairment is the world's most common disability. Traditionally, hearing levels measured by pure tone audiometry have been used to define and quantify hearing loss. The effects of disabling hearing loss on patients' quality of life can be profound, and audiometric data alone may not correlate with quality of life measures. Generic measures of quality of life can be used to compare different diseases, and as such are useful in resource allocation and burden of disease studies. Their disadvantage is that they are not disease-specific and can therefore under-estimate the effects of a disease on patients' quality of life. Disease-specific measures are more sensitive. In chronic otitis media, additional factors such as discharge augment the effect of hearing loss alone on quality of life. Many of the quality of life measures developed for chronic otitis media have been used to assess improvement following reconstructive surgery. Quality of life measures have also been used to assess the effect of paediatric otitis media. Quality of life measures also have utility in the developing world, where hearing impairment is a huge burden.
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WHO shows it cares about hearing loss. The Journal of Laryngology & Otology 2013; 127:331. [PMID: 23552483 DOI: 10.1017/s0022215113000674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Editorial. The Journal of Laryngology & Otology 2013. [DOI: 10.1017/s0022215112003143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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