Wiedermann, Joshua

AbstractIntroductionDespite a recent drive to increase diversity, the global academic workforce is skewed in favor of authors from high‐income countries, and women are under‐represented in the published medical literature.ObjectivesTo explore the trends in authorship of three high‐impact otolaryngology journals over a ten‐year period (2011–2020).MethodsJournals selected: JAMA Otolaryngology–Head and Neck Surgery, The Laryngoscope and Rhinology. Articles were reviewed from four issues per journal per year, and data was collected on: time of publication; subspeciality; number of authors; sex of first and last authors; country of practice of first author and country where each study was conducted. Trends were examined though univariate and multivariate logistic regression models.Results2998 articles were included. 93.9% of first authors and 94.2% of studies were from high‐income countries.Women were first authors in 31.5% (n = 912) and senior authors in 18.4% (n = 524) of articles. Female first authorship significantly increased between 2011 and 2020 however female senior authorship remained the same. There have been no significant changes in the proportion of published articles from low‐and middle‐income countries (LMIC) over time (p = .65). Amongst the LMIC articles, 72% came from Brazil, Turkey or China and there were no published papers from countries with a low‐income economy (gross national income per capita of $1085 or less).ConclusionsAlthough female first authorship has increased in the last decade, there has been minimal other demographic change in authorship over this time. High‐impact otolaryngology journals poorly represent academia in low‐and‐middle income countries. There is a need for increased advocacy promoting gender and geographical research equity in academic medicine.Level of EvidenceIII.

AbstractObjectiveThe aim of this study was to develop an international expert consensus on priority pediatric otolaryngology‐head and neck surgery (OHNS) conditions and procedures for which all national health systems globally should be capable of managing.Study DesignThe Delphi method is a multiround online questionnaire and was administered internationally to otolaryngologists with a focus on pediatric populations. This study was administered in parallel to a Delphi survey focusing on adult OHNS conditions amongst adult otolaryngology experts.SettingInternational online survey.MethodsIn round 1, participants listed the top 15 pediatric otolaryngological conditions and top 15 pediatric otolaryngology procedures for their World Bank region. In round 2, participants ranked round 1 responses in order of global importance on a 5‐point Likert scale. In round 3, participants reranked conditions and procedures that did not achieve consensus, defined as at least 70% of the round 2 Likert responses being ranked as either “important” or “very important.” Descriptive statistics were calculated for each round.ResultsThe survey was distributed to 35 experts globally, with a 40% (n = 14) response rate. Fifty percent (n = 7) of participants were from low‐ and middle‐income countries, with at least 1 participant from each World Bank region. A list of 28 consensus surgical procedures and 11 consensus conditions were identified.ConclusionThis Delphi survey method of world experts in pediatric otolaryngology identified a core list of medical conditions and surgical procedures that should be a part of every national health system's clinical goals of treatment, research, and capacity building.

ObjectivesTo explore the impact of female sex on the experiences of trainees and surgeons in otolaryngology from LMIC and HIC.MethodsThis study includes perspectives of five consultants and two resident physicians from the United States, United Kingdom, Uganda, Kenya and South Africa.ResultsSix themes emerged from these interviews. Overall, LMIC and HIC women shared similar experiences of microaggressions during patients, working along ancillary staff, related to pregnancy, imposter syndrome, difficulties during job search, and unique barriers as consultant.ConclusionsThe findings of this study highlight that gender disparities are present at all levels in Otolaryngology but can present differently depending on context. Laryngoscope, 133:547–551, 2023

ObjectiveTo compare the incidence of glottic stenosis in idiopathic subglottic stenosis (iSGS) patients with no prior surgical intervention to those with a history of endoscopic dilation and characterize the incidence of glottic involvement, changes in scar length, and progression of scar toward glottis following laser wedge excision (LWE).MethodsA retrospective review of iSGS patients who underwent LWE between 2002 and 2021 was performed. Patients without prior airway surgery were labeled LWE primary (LWEP) and operative findings for LWEP patients were reviewed for glottic involvement, scar length (DL), and distance from the glottis to superior‐most aspect of scar (DGS). Rates (in mm/procedure) of DΔL, reflecting an increase in length, and D−ΔGS, reflecting proximal migration, were calculated by dividing DΔL and D−ΔGS by the number of LWE procedures.Results213 iSGS patients underwent LWE, with 132 being LWEP patients. LWEP had a lower incidence of baseline glottic involvement (n = 6, 4.5%) than LWE secondary (LWES; n = 6, 7.5%). Four new cases of glottic involvement were noted in LWEP patients following LWE, with only one being clinically significant resulting in permanently decreased vocal fold mobility. With each procedure, scar length increased by 1.0 mm and DGS decreased by 0.7 mm, reflecting a migration or decrease in DGS of 9.5% with each procedure with respect to initial DGS. Overall rates of glottic stenosis following operations were similar between LWEP and LWES cohorts, 7.6% and 7.5% respectively.ConclusionThere appears to be a low risk of glottic involvement resulting from the LWE procedure in iSGS patients.Level of Evidence4 Laryngoscope, 133:875–882, 2023

Given the high prevalence of otolaryngology infections such as tonsillitis, otitis, and pharyngitis in low and middle income countries, the field of global otolaryngology continues to grow to accommodate patients around the world. This commentary focuses on best practices in transcultural communications between US doctors and foreign patients with an emphasis on cultural competency. We use alternative medicine as an exemplar for how to collaborate with patients to develop treatment plans that respect their cultural beliefs and lifestyles. Rather than assigning value to the patient’s alternative medicine practices, we believe that instructing and counseling a patient on how to incorporate follow‐up visits and rehabilitation after allopathic medical procedures such as surgical tonsillectomy should be done in a way that respects the patient’s preexisting health regimen. By doing so, these new aspects of their health care will take a discrete place in their wellness practices and engender more trust and better health outcomes.