Nyamurowa, Tafadzwa

ABSTRACTObjective(s)We aim to identify the diversity of barriers to care for otolaryngology‐head and neck surgery patients in Harare, Zimbabwe.MethodsInterviews were conducted at four general otolaryngology clinics in Harare in October 2022.The patient population included children and adults presenting to either government or private clinics. Via interpreter, six standardized questions were discussed with each patient. Survey responses were used to categorize patients into one or more of three types of delays: (1) deciding to seek care, (2) reaching the appropriate healthcare facility, and (3) receiving adequate care after reaching that facility.ResultsForty‐six patients participated in this survey. The average time from problem presentation to treatment in this population was 16.3 months. Twenty‐six percent of patients experienced more than one type of delay. The most common type of delay was Type 3 (67%). Many of these patients reached appropriate facilities but could not receive timely treatment due to lengthy wait times. Type 1 delays affected 35% of patients. Notable causes were fear of doctors, preference for traditional healing, or ignorance to a treatable problem. Type 2 delays were also reported in 37%, commonly due to long distance and time to travel and insufficient finances for these journeys.ConclusionsENT patients in Zimbabwe experience a myriad of delays to receiving appropriate care. Systemic issues, including backlogged surgical lists, convoluted referral patterns, and poor transportation infrastructure, are significant contributors to patient delays. The 3‐delay model is useful for identifying barriers to care for future efforts to improve patient access to safe and affordable surgical care.Level of EvidenceLevel VI.

Introduction: Differential diagnoses of a pediatric neck mass are extensive, ranging across benign, malignant, congenital and infectious causes. Limited access to imaging in low-resource settings increases the complexity of narrowing this list to appropriately diagnose and treat neck masses. This occasionally allows neck masses to grow unchecked, increasing the morbidity of their presence and eventual excision. The goal of this report is to describe nuances in the diagnosis and treatment of pediatric neck masses in resource-limited settings through a case report of a neck mass in a pediatric patient. Patient presentation: A 10-year-old girl in Harare, Zimbabwe, presented for surgical management of a midline neck mass that appeared 4 years prior to presentation for definitive treatment. A myriad of barriers delayed her care, allowing the mass to grow into her floor of mouth, displacing her tongue and leading to speech and feeding difficulties. Management and outcome: At presentation to the tertiary care facility, she received a pre-operative ultrasound showing a well-circumscribed, echogenic mass. Her neck mass was surgically excised through a transoral approach. Permanent pathology was consistent with a dermoid cyst. Conclusion: At 1-month postoperative follow-up, the patient had experienced no complications and had a complete resolution of her functional symptoms and appearance. Contribution: We present a case that can illuminate the utility of ultrasound in the diagnosis of pediatric neck masses. Additionally, we facilitate an important discussion on transoral versus transcervical approach for midline neck masses with the decision hinging on size, location, surgeon preference and comfort and consideration of cosmesis.