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Objective To identify factors associated with cervical‐thoracic spine posture in otolaryngology surgeries and evaluate the efficacy of a commercially available posture‐training device in enhancing surgeon ergonomics. Methods Over 3 months, neck and spine posture from individuals performing otolaryngology surgeries was recorded using UpRight Go 2™. Average baseline posture was first recorded and biofeedback was later introduced to attempt to correct posture. The proportion of time spent in upright/neutral cervical‐thoracic spine posture was correlated with surgeon and procedure characteristics and compared to proportion of upright posture time after biofeedback intervention. Results The proportion of upright operating time was significantly different between procedure subtypes and surgical approaches with best performance in rhinology procedures and worst performance in head and neck surgeries (90% vs. 62%; both p < .001). Female gender, shorter stature, and use of sitting stools were associated with greater proportion of surgery spent upright (all p < .05). Loupes use was associated with less time in upright posture (p < .001). With biofeedback intervention, 8 of 10 subjects demonstrated an average of 5% improvement in operating upright, with most improvement found when performing laryngology procedures (7%) and least improvement in head and neck procedures (2%). Conclusions While surgeon posture varies across otolaryngology surgeries, sitting and minimizing the use of loupes may help promote a more ergonomic operating environment and improve surgeon posture. Although the efficacy of biofeedback intervention from a commercially available posture‐training device differs among otolaryngologists, exploration of alternative interventions and incorporation of an ergonomics curriculum is warranted to address postural issues experienced by many surgeons. Level of Evidence 3. Otolaryngologists are at high risk for sustained poor posture and subsequent development of musculoskeletal disorders, but there remains a lack of available and convenient interventions that can improve surgeon posture while operating. Using a commercially available‐posture training device, we found that males and taller individuals have greater risk for poor posture in the operating room as well as those performing head and neck surgeries over other procedure types, while a posture‐training device minimally improved surgeon posture when operating. Further exploration of alternative interventions is needed to address postural issues experienced by many surgeons.

Objective In recent years, the video sharing app TikTok has become a new venue for health care providers and medical educators. Research on health care information within the app has primarily focused on cosmetic and plastic surgery content. TikTok could potentially be a tool used to educate the public on otolaryngology‐related topics. This study is the first to analyze the quality and quantity of otolaryngology‐related TikTok content. Methods A cross‐sectional study of TikTok accounts using otolaryngology‐related hashtags within the preceding 6 months was conducted on February 4, 2023. Deductive qualitative analysis was performed between two coders to identify themes of the accounts and their content. Results A total of 47 accounts were selected for analysis. Facial plastic surgery was the most represented specialty (n = 20; 43%) and pediatric otolaryngology the least represented (n = 1; 2%). Content posted was primarily educational in nature (n = 30; 64%) and 66% (n = 31) of content creators advertised contact information in their account biography. The majority of accounts were in English (n = 30; 64%) and originated in the United States (n = 30; 64%). More accounts were run by male (n = 29; 62%) than female content creators. Conclusion Otolaryngology is a broad specialty with unequal representation of the related subspecialties on TikTok, a popular social media platform. The majority of current content focuses on patient education in facial plastic surgery. Future studies are warranted to examine the potential growth and impact of otolaryngology content on this video‐based platform. Level of Evidence 2. Based on otolaryngology‐related search terms, there appears to be room for growth and diversification of TikTok accounts dedicated to otolaryngology. Improved otolaryngology representation on the video‐sharing social media app TikTok opens possibilities for more comprehensive patient education and medical education.

Introduction Despite 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. Objectives To explore the trends in authorship of three high‐impact otolaryngology journals over a ten‐year period (2011–2020). Methods Journals 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. Results 2998 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). Conclusions Although 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 Evidence III. This study included 2998 articles from three high‐impact journals between 2011 and 2020 There has been no significant increase in the proportion of authors from low‐and ‐middle income countries (6.1%) during this time.Whilst the proportion of female first authors has significantly increased between 2011 and 2020 (OR 2.0, 95% CI 1.4–2.8) no change was observed in female senior authorship over time (18.4%).

Objectives To examine applicant characteristics and behaviors associated with a successful match into otolaryngology residency. Methods Self‐reported survey data from applicants to otolaryngology residency between 2018 and 2020 were obtained from the Texas STAR database. Characteristics and predictors associated with a successful match were examined using Chi‐square tests, two‐sided t‐tests, and logistic regression models. Results A total of 315 otolaryngology residency applicants responded to the survey of whom 274 matched (87%) and 41 did not match (13%). Matched applicants had a significantly higher mean USMLE Step 1 score (P = .016) and Step 2 CK score (P = .007). There were no significant differences in AOA status (45% vs 36%; P = .207), mean number of applications submitted (70 vs 69; P = .544), and mean number of away rotations (2.1 vs 2.0; P = .687) between matched and unmatched applicants. Significant predictors of a successful match included receiving honors in 5 or more clerkships (OR 2.0, 95% CI 1.0‐4.0; P = .040), receiving honors in an ENT clerkship (OR 3.7, 95% CI 1.0‐12.9; P = .044), and having 3 or more peer‐reviewed publications (OR 2.3, 95% CI 1.1‐4.5; P = .020). The majority of applicants (79.9%) matched at a program where they either did an away rotation, had a personal geographic connection, or attended medical school in the same geographic region. Conclusions Board scores, excelling on clinical rotations, and having productive research experience appear to be strong predictors of a successful match in otolaryngology. The majority of applicants report a personal or geographic connection to the program at which they match. Level of evidence 4.

Objectives To assess the impact of applicant and program characteristics on preference signaling outcomes during the 2021 and 2022 application cycles in otolaryngology. Methods The Texas Seeking Transparency in Applications to Residency survey was used for otolaryngology applicants during the 2021 and 2022 match years. The primary outcome of interest was signal yield, defined as the number of interviews at signaled programs divided by the total number of signals sent. Associations with applicant‐reported characteristics, geographic connections to programs, and program reputation were assessed. Results On average 59.5% of signals resulted in an interview (signal yield). There was a positive correlation between the number of signals sent to a program with a reported geographic connection and signal yield, with each additional signal resulting in a 3.4% increase in signal yield (p = .03). Signal yield was positively associated with number of publications (p < .001); number of s, posters, and presentations (p = .04); and whether the applicant took a research year (p = .003). Applicants with higher USMLE Step 1 (p = .01) and Step 2 (p = .003) scores, publications (p = .03), volunteer (p = .008) and leadership (p = .001) experiences received a lower percentage of their total interviews from signaled programs whereas applicants from the 3rd (p < .001) and 4th (p = .03) cumulative class ranked quartiles received a higher percentage of their total interviews from signaled programs. Conclusions Signal yield appears to have a significant association with geographic connections to programs and applicant competitiveness. This study may help applicants, advisors, and programs maximize the benefit of the preference signaling system. Levels of evidence: Level 4.

Objective To determine the distribution of female physicians throughout the rank from resident to leadership positions in German Otolaryngology‐Head and Neck Surgery (OHNS) departments. Methods This cross‐sectional study collected data about the physician workforce in the German OHNS. The primary outcome was the proportion of female physicians. Data were collected from 165 departments from January 2022 to February 2022. The physician workforce was stratified based on gender and leadership. Results We included 2089 physicians from 165 departments of OHNS in German hospitals. Female residents and specialists outnumbered male peers (484/872 [55.5%] vs. 388/872 [44.5%] and 224/363 [61.71%] vs. 139/363 [38.29%], respectively). However, the women proportion decreased gradually with elevated hierarchical rank starting at the attending physician level to reaching its lowest extreme (14/165 [7.23%]) at the head of the department level. Holding a leadership position was associated with being male (n = 282 [85.2%] vs. n = 49 [14.8%], p < .0001). This persisted even after controlling the academic rank in a multivariable regression model (OR: 5.027, 95% CI: 3.536–7.146). The gap between the two genders in favor of men regarding leadership persisted in all kinds of hospitals. However, this disparity was lowest in university hospitals, (male: n = 83 [78.3%] vs. female: n = 23, [21.7%], p < .0001). Conclusions Even though women outnumbered men in resident and specialist positions, they are still underrepresented in leadership positions in OHNS. Continuous surveillance is needed to watch the dynamic changes in the gap between the two genders and address it with more sex equality‐supporting policies. Level of Evidence IV. Women have outnumbered men at the resident level however, the vast majority of the leadership positions are held by men. The family‐accommodating policies seem to be alone not enough to achieve equity in leadership between the two genders.

Objectives To quantify the current proportion of women in otolaryngology at different levels of professorship and determine whether these proportions differ by US region. Methods Academic rank and gender at all ACGME‐accredited otolaryngology programs in the United States were determined from departmental websites, Doximity, and LinkedIn from November 2021 to March 2022. Individuals were then further organized using US Census Bureau‐designated regions. Results Among the 2682 faculty positions at 124 ACGME‐accredited programs, women held 706 (26.3%) of these positions. Female representation was highest at the assistant professorship level, with women holding 286 (37.2%) positions out of a total 769. At the associate professorship level, women held 141 (27.6%) of the 511 total positions. The largest gender disparity is seen at the full professorship level; only 69 (13.6%) positions out of 508 were held by women. Out of every region and rank, only assistant professorship in the West had no significant difference in percentages of men and women (p = .710). Female representation of professors in the Northeast was significantly lower than that of our reference group (the South; β = −10.9, p = .020). Conclusions Otolaryngology has exhibited great progress in increasing female representation, with assistant professorship in the West reaching gender parity. However, the gender gap at other faculty levels still leaves much to be desired, particularly in senior ranks. The lack of otolaryngologists at senior ranks is detrimental to mentorship of junior faculty, residents, and medical students. Renewed efforts should be made to decrease the gender disparity in the South, Northeast, and particularly at the professorship level. Gender gaps still exist at every rank and region in otolaryngology in the United States, with one exception‐assistant professorship in the West. Female representation was lowest at the professorship rank in the Northeast. Renewed and added efforts must be made to increase the recruitment of medical students and mentorship of junior faculty, residents, and medical students in the field.

Objective To provide an analysis of complications following eustachian tube balloon dilation as well as their treatments and outcomes. Data Sources PubMed, Ovid Embase, and MAUDE Database. Review Methods A systematic approach following PRISMA guidelines was used to identify publications pertaining to balloon dilation of the eustachian tube from PubMed and Ovid Embase databases was used. Once these publications were critically reviewed, the primary outcome extracted were reported complications. Additional complications were collected in the Manufacturer and User Facility Device Experience (MAUDE) database using the product class “eustachian tube dilation device” and searching through relevant manufacturers. Complications and outcomes were compared between these sources. Results Fifty five full‐length manuscripts involving 7155 patients were included and 98 complications reported for a 1.4% complication rate. The most frequently reported adverse events were subcutaneous emphysema of the head and neck (19%), epistaxis (12%), and acute otitis media (11%). The MAUDE search returned 18 distinct patient entries, of which 12 (67%) reported complications. The most reported complications in the MAUDE database included subcutaneous emphysema (8, 67%) and pneumomediastinum (3, 25%). The most serious complication was a carotid artery dissection reported in one patient in the MAUDE database. Conclusion Eustachian tube dilation is rarely associated with complications, which nevertheless may lead to morbidity and medical emergencies. Patients and providers should recognize potential risks associated with this intervention as well as methods to manage complications. A rapid review was performed reporting the significant adverse events reported in the modern literature and compared this with the domestic manufacturing database MAUDE.

Objective As of January 2022, USMLE Step 1 scores are reported as pass/fail. Historically, Step 1 scores have been a critical component of residency applications, representing one of the few metrics standardized across all applicants independent of the school they attended. In competitive specialties, such as otolaryngology, programs routinely get 100+ applicants for each residency spot and use Step 1 as a screening tool. This study seeks to assess quantifiable metrics in the application that highly competitive residency programs could use for screening in place of Step 1 scores. Methods Otolaryngology applications to an academic medical center for the 2019–20 and 2020–21 ERAS cycles were reviewed. Board scores and quantitative research data were extracted. The relationships between Step 1 score and the other metrics were examined by computing Pearson's correlation coefficients and building regression models. Similar analyses were done separately for three different score tiers defined by Step 1 cutoffs at 220 points and 250 points. Results Step 2 score was the only variable that had meaningful correlation with Step 1 score (R = .67, p < 2.2e−16). No other objective metric such as journal articles, posters, or oral presentations correlated with Step 1 scores. Conclusion Step 1 scores were moderately correlated with Step 2 scores; however, using a Step 2 cutoff instead of a Step 1 cutoff would identify a different cohort of applicants for interview. No other quantifiable application metric had a positive correlation. In future match cycles, highly competitive residency programs will need to adopt new methods to screen candidates. Level of Evidence: Level 3. Step 1 and Step 2 scores were moderately correlated, but using a Step 2 cutoff would identify a different cohort of applicants for interview because the distributions of Step 1 and Step 2 scores are different. No other quantifiable application metric was correlated with Step 1 score.

ObjectivesThe aim of our study was to investigate the representation of women in the editorial boards of otorhinolaryngology journals indexed in the Science Citation Index-Expanded (SCIE) database.MethodsWe examined the gender distribution of editors-in-chief, editorial board members, and associate/section editors in otorhinolaryngology journals indexed in the Web of Science SCI-E core collection. We also analyzed the number of years the journals have been publishing, their categories (general otorhinolaryngology, otology-audiology, phoniatrics, rhinology-allergy), the country and continent of publication, the Journal Citation Indicator (JCI) 2021 values, 2-year and 5-year impact factors (IF), H-index, and quartile rank of the journals.ResultsOut of the 54 editors-in-chief included in our study from a total of 44 journals, only 6 (11.1%) were women. Women constituted 21.6% of the editorial board members and 35.1% of the associate/section editors. The proportion of women in the editorial boards of journals with a 5-year impact factor >3.0 was significantly higher compared to others. As the 5-year impact factor of the journals increased, the number of women in the boards showed a linear increase. When evaluated based on journal categories, phoniatrics journals had higher representation of women in both editorial board membership and associate/section editor roles compared to other categories.ConclusionThe representation of women in the editorial boards of otorhinolaryngology journals is still inadequate. To rectify this situation, it is important for the entire academic community to exhibit a collective attitude rather than individual efforts.Level of Evidence2.