Professional diversity and personal commitments of pediatric otolaryngologists

OBJECTIVE: To characterize the time demands and practice patterns of pediatric otolaryngologists. DESIGN: Prospective survey of members from the American Society of Pediatric Otolaryngology. RESULTS: The survey response rate was 54% (n = 136) of practicing members of the American Society of Pediatric Otolaryngology. Respondents described being actively engaged in clinical otolaryngology (99%), hospital or practice administration (71%), private enterprise (17%), research (71%), and teaching (89%) on a weekly basis. Sixty percent considered their time demands to be "too busy"; however, few anticipated changing their activities in 5 years. Among the responding physicians, 90% believed that nonotolaryngology peers within their institutions viewed pediatric otolaryngology favorably whereas only 50% thought that other otolaryngologists held the same opinion. CONCLUSIONS: Pediatric otolaryngologists participate in many activities beyond clinical medicine. While most considered their time demands to be too busy, few anticipated a change in their activities. This may be reflective of a high level of job satisfaction, financial constraints, or the relative youth of the subspecialty.     

Trends in the management of pediatric chronic sinusitis: survey of the American Society of Pediatric Otolaryngology

BACKGROUND: The management of chronic sinusitis (CS) in children has yet to be fully elucidated. The objective of this study is to assess practice trends within the pediatric otolaryngology community for the management of children with CS. METHODS: A multiple choice survey of the members of the American Society of Pediatric Otolaryngology (ASPO) was performed to assess for various factors related to the management of CS in children. RESULTS: A total of 175 ASPO members responded to the survey. The majority of respondents initially treat patients medically with oral antibiotics (95%), topical steroids (90%), and nasal saline sprays (68%). Fifty-five percent performed adenoidectomy as part of the treatment of CS, with 81% performing the operation before endoscopic sinus surgery (ESS). Compared with 3 years before the survey, 47% of respondents performed approximately the same number of ESS cases, whereas 35% reported doing fewer cases annually. Seventy-two percent of practitioners do not routinely perform a second-look surgery. CONCLUSIONS: The majority of pediatric otolaryngologists use oral antibiotics, nasal steroids, and saline lavage, and will perform adenoidectomy when managing patients with CS. More than a third of pediatric otolaryngologists are using more stringent criteria for surgery and performing less extensive surgery than 3 years before the survey. Surgical outcomes for CS do not appear to have changed over the past 3 years.     

The Internet-current trends and future expectations among Brazilian pediatricians and otolaryngologists with a special interest in pediatric otolaryngology

OBJECTIVE: To assess Internet use among a group of Brazilian pediatricians and otolaryngologists and to inquire about possible Web based medical resources. METHODS: Questionnaires were distributed among attendees of a 2001 Pediatric Otolaryngology meeting in Brazil. Multiple choice or yes/no questions related to the use of the Internet among physicians were presented. RESULTS: All of the 99 respondents of an estimated 900 attendees, had Internet access (high-speed 18%, conventional 77%); 52% at home, 42% in the office and 6% at both sites. Eighty-one percent of those responding regularly used the Internet for medical updating. Sharing a pediatric otolayngology medical association Web site with patients was desired by 73%; an interest in personal Web based medical information and updates was demonstrated by 97%. Five percent of respondents already had established personal practice Web sites and 54% agreed with potential benefits for improving medical practice. CONCLUSION: The potential role of electronic communication and a desire to establish a pediatric otolaryngology Web site that would maximize inclusiveness is appreciated by this group of Brazilian otolaryngologists and pediatricians.     

Vestibular evoked myogenic potential testing for the diagnosis of conductive hearing loss: Survey of pediatric otolaryngologists’ knowledge and beliefs

ObjectivesTo assess physicians’ knowledge and beliefs regarding vestibular evoked myogenic potential (VEMP) testing in children.MethodsA survey was delivered via email in html format to 1069 members of the American Academy of Otolaryngology – Head and Neck Surgery who identified as pediatric otolaryngologists. Study data were collected and managed using the Research Electronic Data Capture (REDCap) tools.Results443 (41.4%) physicians opened the email. 190 (42.9% of opens) initiated the survey, of which 117 (61.9%) fully completed the survey of the physicians who responded to a question regarding knowledge of VEMP, 16% of respondents had never heard of the test. 16% of participants would use it in the setting of diagnosing pediatric conductive hearing loss. Responses regarding the youngest age at which VEMP is possible ranged from younger than 6 months through greater than 13 years of age. Beliefs regarding utility and reliability of VEMP varied, with ‘unsure’ as the most frequent response. Additionally, only 26% of pediatric otolaryngologists indicated some access to the test.ConclusionThe knowledge and availability of VEMP testing in the pediatric otolaryngology community varies widely.     

Tobacco intervention teachable moments for pediatric otolaryngologists: Atopy and second hand smoke exposure among children

Objectives

Pediatric otolaryngology clinics have tremendous access to children with allergic conditions, yet no research has evaluated in this setting environmental tobacco smoke and the occurrence of atopic diseases.

Methods

Caregivers or parents of 201 consecutive patients in a Hungarian pediatric otolaryngology clinic were queried on otolaryngologic conditions; self-reported diagnoses of atopic diseases; and tobacco smoke exposure.

Results

A history of asthma was reported in 10.3% of children; 38.7% had at least one parent who smoked. Fifteen out of the 20 children with asthma (75.0%) had at least one parent who smoked. Having a diagnosis of hay fever and having a parent who smoked greatly increased the odds of having a diagnosis of asthma.

Conclusions

Second hand smoke exposure among children in an otolaryngology clinic was common, and was associated with co-existing atopic conditions. Pediatric otolaryngologists have an important opportunity to address parental smoking as part their care of children.     

Should obtaining a preoperative audiogram before tympanostomy tube placement be used as a quality metric? A survey of pediatric otolaryngologists

IntroductionObtaining a preoperative audiogram prior to tympanostomy tube placement is recommended by the American Academy of Otolaryngology-Head and Neck Surgery clinical practice guideline (CPG): Tympanostomy tubes in Children, and this process measure is also used as a quality metric by payers. However, whether audiograms should be mandated in cases of tube placement for both chronic otitis media with effusion (COME) and recurrent acute otitis media (RAOM) is controversial. The objective of this study is to determine reports of practice patterns of pediatric otolaryngologists regarding obtaining audiograms before and after tympanostomy tube placement and opinions regarding utility of CPGs and use of this process measure as a quality metric.MethodsA 16-question cross-sectional survey of American Society of Pediatric Otolaryngology (ASPO) members was conducted. Per ASPO policy, no repeated requests or other enhanced response techniques were permitted. Independent t-tests for proportions were used to compare responses.Results127 pediatric otolaryngologists completed the survey (response rate 26.9%). Nearly 70% of respondents reported being in practice for >10 years. 74% of respondents reported obtaining preoperative audiograms “always” or “most of the time” for COME, vs. 56.7% for RAOM (p < 0.0001). 76% agreed that obtaining a preoperative audiogram was representative of high quality for COME, vs. 52% for RAOM (p < 0.0001). 12% of respondents “completely agreed” that compliance with all aspects of CPGs represented high quality, while 68.8% responded that they somewhat agreed.ConclusionThere is no consensus among pediatric otolaryngologists regarding the necessity of a preoperative audiogram in tympanostomy tube placement, especially for RAOM. Further evidence demonstrating the benefit of preoperative audiogram obtainment should be developed prior to inclusion as a guideline recommendation and as a quality metric.     

International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Routine peri-operative pediatric tracheotomy care

ObjectivesTo develop consensus recommendations for peri-operative tracheotomy care in pediatric patients.MethodsExpert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group.ResultsConsensus recommendations including pre-operative, intra-operative, and post-operative considerations, as well as sedation and nutrition management are described. These recommendations are based on the collective opinion of the IPOG members and are targeted to (i) otolaryngologists who perform tracheotomies on pediatric patients, (ii) intensivists who are involved in the shared-care of these patients, and (iii) allied health professionals.ConclusionPediatric peri-operative tracheotomy care consensus recommendations are aimed at improving patient-centered care in this patient population.     

Safety and outcomes of outpatient pediatric otolaryngology procedures at an ambulatory surgery center

Objectives: To determine the safety and outcomes of outpatient pediatric otolaryngology procedures performed at an ambulatory surgery center (ASC). Methods: Retrospective review of all pediatric otolaryngology cases performed at a freestanding, outpatient ASC of a tertiary care, academic children's medical center from 2000 to 2007. Results: Of all cases, 4979 (55%) were otolaryngology procedures. Twelve surgeons and 10 pediatric anesthesiologists staffed the cases; no residents/fellows were involved. The case breakdown is as follows: 2045 (41.1%) myringotomy and tympanostomy tube; 1438 (28.9%) adenoidectomy (with tympanostomy tube placement and/or turbinectomy); 880 (17.7%) tonsillectomy (with or without adenoidectomy). According to American Society of Anesthesiologist (ASA) classification: 84.2% were ASA I, 15.1% ASA II, 0.7% ASA III. There were nine unanticipated outcomes: four postadenotonsillectomy and one postadenoidectomy bleeds (three requiring reoperation the same day), two patients with low psuedocholinesterase levels, one postadenotonsillectomy patient requiring overnight monitoring, and one patient with an incidental finding of a subglottic mass. Preoperative ASA status on these nine patients was 7 (78%) ASA I, 2 (22%) ASA II. Conclusions: Pediatric otolaryngology procedures constitute significant volume at our ASC. Surgery at our ASC is extremely safe with a rate of unanticipated outcomes of 0.2%—a comparison not available in the literature. Pediatric otolaryngology procedures performed with a highly skilled team at an outpatient ASC result in high quality and safe surgery.     

Pediatric otolaryngology trends in patient care volume during covid-19: A survey study

PurposeTo assess changes in outpatient clinic, inpatient consult, and operative volumes among pediatric otolaryngologists in response to the COVID-19 pandemic.Materials and methodsAn online questionnaire was distributed to 535 active members of the American Society of Pediatric Otolaryngology from April 21, 2020, to May 4, 2020. The questionnaire assessed operative and clinical volumes during a two-week period between April 6, 2020, to April 20, 2020, while restrictions on elective surgery were in place, as compared to an average two-week period before the start of the COVID-19 pandemic.ResultsBoth outpatient clinic and inpatient consult visit volume decreased significantly during the Covid-19 period. Academic practitioners typically reported seeing fewer outpatient visits than their private practice counterparts. Operative case volume decreased significantly across all procedures and surgeries common to pediatric otolaryngology. One-third of surveyed surgeons reported no operative cases during the assessed period.ConclusionsPediatric otolaryngologists reported a severe reduction in operative volume, in-office visits, and inpatient consults during a time period at the peak of the 2020 Covid-19 outbreak. Many respondents saw no patients, nor operated in any capacity. This time period could have lasting effects on practitioner finances and trainee education.     

Pediatric otolaryngologists' use of genetic testing

OBJECTIVE: To assess the use of genetic testing by pediatric otolaryngologists in evaluating a child with prelingual sensorineural hearing impairment (SNHI). DESIGN: Questionnaire on the use of genetic testing in the evaluation of prelingual SNHI was made available to pediatric otolaryngologists through the American Society of Pediatric Otolaryngology (ASPO) Web site (http://www.aspo.us). Each ASPO member was invited by e-mail to complete the questionnaire. PARTICIPANTS: Sixty-three ASPO members. RESULTS: Forty-two (69%) of 61 respondents indicated that they use genetic testing of the connexin 26 (Cx26) gene (GJB2) as an initial test in their workup of prelingual SNHI, and 30 (71%) of 42 reported that they provide genetic counseling for their patients and their families. However, 17 (45%) of 38 respondents answered questions regarding recurrence risks incorrectly or stated that they did not know the correct response. In addition, 7 (12%) of 60 respondents reported that they do not use DNA-based testing at any point in their workup. CONCLUSIONS: Many pediatric otolaryngologists use DNA-based testing in their evaluation of prelingual SNHI. However, many pediatric otolaryngologists do not have an adequate knowledge of the implications of genetic testing. Because it will take on an increasingly large role in clinical practice, pediatric otolaryngologists must be familiar with current genetic testing, counseling, and treatment recommendations. As these results demonstrate, such knowledge is still lacking in this physician population.     

Trends in the indications for pediatric tonsillectomy or adenotonsillectomy

Objective

To report trends in the indications for pediatric tonsillectomy or adenotonsillectomy.

Methods

To identify current indications, (1) a retrospective chart review analyzed all indications for procedures performed by a pediatric otolaryngologist on patients aged 0-3, 4-10, or 11-18 years, and (2) a cross-sectional survey to members of the American Society of Pediatric Otolaryngology asked for approximate percentages of children in the same age groups receiving procedures for obstruction, infection, or another indication. To assess changing indications over time, (3) a literature review was performed.

Results

(1) Chart review: 302 patients aged 5 months to 18 years (average: 6.34; median: 6) were analyzed. For the 0-3-year age group, obstruction was an indication in 100.0% of cases, and infection in 2.6%. For the 4-10-year age group: 91.9% and 13.4%, respectively. For the 11-18-year age group: 84.6% and 33.3%. (2) Survey: 120 surveys were returned (40% response rate), and 63 surveys were appropriate for analysis (21% completion rate). For the 0-3-year age group, obstruction was the primary indication in 91.8% of procedures and infection in 7.5%. For the 4-10-year age group: 73.2% and 25.3%, respectively. For the 11-18-year age group: 43.0% and 54.2%. (3) Literature review: 11 articles consistently illustrated a rise in obstruction and a decline in infection as an indication since 1978.

Conclusions

Obstruction has become a more prominent indication than infection for pediatric tonsillectomy or adenotonsillectomy in children, especially younger children. Infection becomes a more prominent indication as age increases. Data may not be absolutely reflective of all pediatric otolaryngologists or other otolaryngologists that treat children. Comparing studies is difficult owing to the variety of surgical procedures focused upon and terms used to define indications.     

Classification and consequences of errors in otolaryngology

Objective: To develop a preliminary classification system for errors in otolaryngology. Methods: A retrospective, anonymous survey was distributed to 2,500 members of the American Academy of Otolaryngology–Head and Neck Surgery (AAO‐HNS). Respondents were asked whether an error had occurred in their practice in the last 6 months, and if so, to describe the error, its consequences, and any corrective action taken. Results: There were 466 (18.6%) responses. Two hundred ten (45% of respondents) otolaryngologists reported 216 errors. A classification system for errors in otolaryngology was developed. Errors were classified as related to history and physical (1.4%), differential or final diagnosis (1.4%), testing (10.4%), surgical planning (9.9%), wrong‐site surgery (6.1%), anesthesia‐related (3.3%), wrong drug/dilution on the surgical field (3.8%), technical (19.3%), retained foreign body (0.9%), equipment‐related (9.4%), postoperative care (8.5%), medical management (13.7%), nursing/ancillary (0.5%), administrative (6.6%), communication (3.8%), and miscellaneous (0.9%). There were 78 cases of major morbidity and 9 deaths. If these data are representative, there may be more than 2,600 episodes of major morbidity and more than 165 deaths related to medical error in otolaryngology patients annually. Conclusions: Human error in otolaryngology occurs in all practice components, including diagnostic, treatment, surgical, communication, and administrative. Types of errors reported by otolaryngologists differ from those reported by other specialists. Error classification systems may need to reflect each specialty's realm of practice. Errors in otolaryngology cause appreciable morbidity and mortality. Quantitative study of errors and the development of targeted prevention and amelioration strategies should be a high priority.     

The KTP laser: an emerging tool in pediatric otolaryngology

PURPOSE: To report the frequency and spectrum of use of the potassium titanyl phosphate (KTP) laser in a tertiary referral pediatric otolaryngology practice and to focus on a novel use for the KTP laser which has not previously been described in the literature. DESIGN: A retrospective chart review of the operative log database of a pediatric otolaryngologist in a tertiary referral setting over a seven year period. RESULTS: Out of 2886 cases, a total of 49 (1.7%) involved the use of the KTP laser. These included 7 otologic cases, 3 laryngeal cases, 31 subglottic/tracheal cases, 1 esophageal case and 7 nasal cases. One of these cases involved a previously unreported use of the KTP laser, closure of a tracheo-esophageal fistula (TEF). CONCLUSION: The KTP laser is an important operative tool in pediatric otolaryngology and new uses for this laser continue to emerge. One of these, KTP closure of a TEF offers pediatric otolaryngologists the potential for significant changes in management of this congenital problem with reduced surgical morbidity. Familiarity with the KTP laser and expertise in its use and applications is essential in providing state-of-the-art care to pediatric otolaryngology patients in a tertiary referral center.     

Infant tracheotomy: results of a survey regarding technique

OBJECTIVE: To identify practice patterns regarding tracheotomy technique among pediatric otolaryngologists. DESIGN: Survey of physicians. SETTING: Academic medical center. PARTICIPANTS: Members of the American Society of Pediatric Otolaryngology (ASPO) residing in the United States. MAIN OUTCOME MEASURES: Physician responses to survey questions, including both multiple choice and free-text responses. We used chi(2) tests to determine if demographic factors (pediatric otolaryngology fellowship training, the number of tracheotomies performed yearly) correlated with differences in the technique used to perform infant tracheotomies. RESULTS: A total of 168 of 225 surveys mailed to ASPO members (75%) were completed and returned. Most respondents (87%) report that they make a simple vertical incision in the trachea. An even greater number (94%) use stay sutures routinely. On other technical points, such as management of the thyroid gland, the subcutaneous fat, and the method of securing the tracheostomy tube, there was much greater variability: 22% of respondents reported having had a serious tracheotomy-related complication in the immediate postoperative period, and 58% of these physicians changed their technique as a result. In several areas, chi(2) analysis revealed statistically significant differences in technique that were dependent on both fellowship training and the number of tracheotomies performed (P < or = .05). CONCLUSIONS: Among ASPO members practicing in the United States, there is near-unanimity on certain technical points, with considerable divergence on others. A substantial percentage of our colleagues have experienced a tracheotomy-related complication in the early postoperative period. In many cases, these incidents led to changes in surgical technique.     

Turbinate surgery in pediatric patients: A worldwide survey

ObjectiveImpaired nasal breathing is a common condition among pediatric patients, being rhinitis the most common cause. In recent years, turbinate surgery, mainly turbinate radiofrequency ablation (TRA), has increased in popularity amongst pediatric otolaryngologists and rhinologists as a safe and useful technique to address turbinate hypertrophy in pediatric patients. The present paper is designed with the aim of assessing the current worldwide clinical practice regarding turbinate surgery in pediatric patients.MethodsThe questionnaire was developed based on previous researches, by a group of 12 experts from the rhinology and pediatric otolaryngology research group belonging to the Young Otolaryngologists of the International Federation of Otorhinolaryngological societies (YO-IFOS). The survey was then translated to 7 languages and sent to 25 scientific otolaryngologic societies around the globe.Results15 scientific societies agreed to distribute the survey to their members. There were 678 responses from 51 countries. From them, 65% reported to usually perform turbinate surgery in pediatric patients. There was a statistically significant increased likelihood of performing turbinate surgery for those practicing rhinology, sleep medicine, and/or pediatric otolaryngology compared to other subspecialties. The main indication to perform turbinate surgery was nasal obstruction (93.20%); followed by sleep disordered breathing (53.28%), chronic rhinosinusitis (28.70%) and facial growth alterations (22.30%).ConclusionsThere is no general consensus on the indications and ideal technique for turbinate reduction in children. This dissension arises mainly from the lack of scientific evidence. The points with highest agreement (>75%) between respondents is the use of nasal steroids prior to surgery; reintroducing nasal steroids in allergic patients; and performing turbinate surgery as day-case surgery.     

Sleep-disordered breathing in children: survey of current practice

OBJECTIVES: The American Academy of Pediatrics recommends objective testing with polysomnography (PSG) before adenotonsillectomy for sleep-disordered breathing (SDB) in children. Several studies have also shown that a clinical diagnosis correlates poorly with the presence or severity of SDB as confirmed by PSG. The purpose of this study was to examine surgical practice patterns among members of the American Society of Pediatric Otolaryngologists (ASPO). METHODS: A questionnaire was sent electronically to all members of ASPO asking about demographics, PSG facilities, and pre- and postoperative management of children with SDB. RESULTS: A total of 245 questionnaires were sent, and 105 (43%) were completed. The results of the survey show that up to 50% of pediatric visits in individual practices were for SDB. Only 10% of children who underwent adenotonsillectomy had PSG, and the most common reason to request it was doubt about diagnosis. The average wait for PSG was 3 to 6 weeks. Preoperative PSG was routinely requested in children under 1 year of age and children with morbid obesity, craniofacial abnormalities, or neuromuscular disease. The majority of pediatric otolaryngologists proceeded with an adenotonsillectomy in symptomatic children with normal PSG findings. Postoperative PSG was requested in less than 5% of children. Approximately 20% of children who underwent adenotonsillectomy for suspected SDB were observed overnight in hospital. CONCLUSIONS: A majority of respondents from this survey rely on a clinical diagnosis rather than PSG to recommend an adenotonsillectomy for SDB in children. PSG was generally used when the diagnosis was in doubt.     

Establishing normative voice-related quality of life scores within the pediatric otolaryngology population

OBJECTIVE: To establish normative values for voice-related quality of life across a broad pediatric otolaryngology population using the Pediatric Voice Outcome Survey (PVOS). DESIGN: Longitudinal study. SETTING: Multiphysician outpatient pediatric otolaryngology practice. METHODS: The PVOS was completed by 385 parents of children and adolescents aged 2 to 18 years. Of the 385 parents, 75 were readministered the instrument 2 weeks after no intervention had been provided. Data were collected regarding the patients' age, main diagnosis, and operative intervention. RESULTS: The PVOS demonstrated robust internal consistency with an overall Cronbach alpha value of.70. Test-retest reliability demonstrated a weighted kappa value of 0.89 (95% confidence interval, 0.84-0.95) The mean +/- SD converted score (based on a 0-100 scale) for the overall population was 80.5 +/- 19.9. Converted PVOS scores are provided for each subpopulation according to main diagnosis. The PVOS scores varied significantly according to age (P<.05) and preoperative and postoperative status following adenoidectomy (P<.05). CONCLUSION: The PVOS represents a valid and reliable instrument to measure voice-related quality of life in a broad pediatric otolaryngology population.     

Ear,nose and throat disorders in children with Down syndrome

OBJECTIVE: To document the reasons for which children with Down syndrome were referred to a pediatric otolaryngology practice, the underlying causes for these referrals, and the complications of routine surgical therapy. STUDY DESIGN: The study is a retrospective review of children referred to the Pediatric Otolaryngology Clinic at the University of New Mexico Health Sciences Center (Albuquerque, NM) during a period of 2.5 years. METHODS: Data were collected on 55 parameters related to ethnicity, demographics, diagnosis, surgical therapy, complications, and systemic comorbid conditions. RESULTS: The ethnicity of the study population was predominantly Hispanic or Latino (62%). The majority of children (76%) were referred for upper airway obstruction. Obstructive sleep apnea and laryngomalacia were the most common disorders in these children. An otological disorder was diagnosed in 70% of the children. Complications occurred after 27% of procedures for insertion of pressure equalization (PE) tubes to treat recurrent otitis media. Systemic comorbid conditions were present in 93% of the children, and the most common was gastroesophageal reflux disease. CONCLUSIONS: Obstructive sleep apnea and laryngomalacia were the most common reasons for referral of children with Down syndrome. Routine surgical procedures that required general anesthesia caused complications that are not common in other children. Treatment for systemic comorbid conditions should be considered as a component of therapy for otolaryngological disorders in children with Down syndrome.     

Use of complementary and alternative medicine in pediatric otolaryngology patients attending a tertiary hospital in the UK

OBJECTIVE: Little data is available on complementary and alternative medicine (CAM) use in children attending otolaryngology services. We investigated the prevalence and pattern of CAM use among children attending the pediatric otolaryngology department in a tertiary pediatric teaching hospital in Scotland. DESIGN: A cross-sectional survey conducted by administering an anonymous questionnaire to the parents accompanying patients attending the pediatric otolaryngology department. Elective admissions and clinic attendees were included over a 3-month period in 2005/2006. SETTING: Academic tertiary care referral centre in North-East Scotland. PATIENTS: Five hundred and fifty-four consecutive patients aged less than 16 years were eligible. The response rate was 59% (n=327). MAIN OUTCOME MEASURES: Prevalence of CAM use in children. Secondary measures include types of CAM used, indications for use and communication with family physicians. RESULTS: Based on 327 responses, 93 patients (29%) had ever used CAM, 20% within the last year. Commonly used CAM preparations were cod-liver oil, echinacea, aloe vera, cranberry, primrose oil and herbal vitamin supplements. The popular non-herbal CAM included homeopathy, massage, aromatherapy, chiropractic, yoga and reiki. Nineteen percent used CAM for their admission illness. Sixty-one percent of parents thought that CAM was effective and 65% would recommend it to others. Fifty-one percent of parents stated that the family physician was unaware of CAM use by the child. CONCLUSIONS: Despite concerns regarding the efficacy, safety and cost effectiveness of complementary and alternative medicine, its use among the pediatric otolaryngology population is more common than many providers may realize. This has implications for all healthcare workers involved in their care.     

The gender gap in a surgical subspecialty: analysis of career and lifestyle factors

BACKGROUND: Although the percentage of women in surgical subspecialties is increasing, little is known about the experiences of these women compared with their male counterparts. OBJECTIVE: To identify career and lifestyle factors that distinguish female otolaryngologists. DESIGN, SETTING, AND PARTICIPANTS: Otolaryngologists were asked to respond to a confidential 119-item questionnaire. The instrument was sent to all 502 female members of the American Academy of Otolaryngology-Head and Neck Surgery who had finished their residency training and were practicing medicine. For response comparison, the survey was mailed to 2 male otolaryngologists who were matched to each female survey recipient for years since completion of training, geographic region, and practice type. RESULTS: Of the 673 respondents (52.6% response rate), women were more likely to be divorced or separated (P =.001) and have fewer children (P <.001). In contrast to men, women reduced their work hours in conjunction with having more children (P <.001). Controlling for professional hours and hours spent in the operating room per week, type of practice, and years since completion of residency, women earned 15% to 20% less per year than men (P <.001). Men relied more on their spouse or partner for household responsibilities and child care (P <.001), and 34.3% of the women (compared with 7.1% of the men) spent 21 to 40 h/wk on household management (P <.001). CONCLUSION: Although male and female otolaryngologists receive equal training opportunities, women earn less money for performing similar jobs and have increased family responsibilities, which may effect their career advancement.