Practice of pediatric otolaryngology: results of the future of pediatric education II project

OBJECTIVES: To define the practice of pediatric otolaryngology compared with general otolaryngology and to estimate pediatric otolaryngology workforce utilization and needs. METHODS: Survey of members of the American Academy of Pediatrics Section on Otolaryngology and Bronchoesophagology and the American Society of Pediatric Otolaryngology and of a random sample of the membership of the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS: Pediatric otolaryngologists were more likely to practice in urban and/or academic settings than were general otolaryngologists. Children (age <18 years) comprised over 88% of the patients of pediatric otolaryngologists and 30% to 35% of the patients of general otolaryngologists. Pediatric otolaryngologists were more likely to see children with complicated diseases such as airway disorders or congenital anomalies than were general otolaryngologists. Pediatric otolaryngologists, unlike general otolaryngologists, reported an increasing volume of pediatric referrals, as well as increased complexity in the patients referred. The surveyed physicians estimated the present number of pediatric otolaryngologists in their communities as approximately 0.2 to 0.3 per 100 000 people. CONCLUSIONS: Most children receiving otolaryngologic care in the United States receive such care from general otolaryngologists. The patient profile and practice setting of the subspecialty of pediatric otolaryngology differ from those of general otolaryngology. The demand for pediatric otolaryngologists appears to be increasing, but many general otolaryngologists do not believe there is an increased need.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

American Society of Pediatric Otolaryngology members' experience with recurrent respiratory papillomatosis and the use of adjuvant therapy

OBJECTIVE: To evaluate how evolving treatment technologies have affected our management of recurrent respiratory papilloma (RRP) since the last comprehensive survey of pediatric otolaryngologists in 1998. DESIGN: Web-based survey of all American Society of Pediatric Otolaryngology members residing in the United States, Canada, Europe, and Australia. RESULTS: Evaluable survey results were tabulated from 74 practitioners in 62 separate practices managing 700 current children with RRP. A total of 150 (21%) of these patients presently receive adjuvant medical therapies with cidofovir and interferon, accounting for more than two thirds of the total. Sixty-one percent of patients treated with cidofovir have experienced a beneficial response. Distal spread of RRP has occurred in 94 (13%) of the 700 patients. Half of the practices surveyed have experienced a death from RRP, with 89% of deaths directly related to RRP. The laryngeal microdebrider (53%) has supplanted the carbon dioxide laser (42%) as the preferred means of surgically removing papilloma from the larynx in children. Spontaneous, apneic, and jet ventilation (88%) anesthesia techniques have replaced the use of laser-safe endotracheal tubes (10%) as the preferred anesthetic management. Routine human papillomavirus subtyping is practiced by 45% of respondents while 15% treat all their patients with antireflux medications. Half of respondents send lesions for histologic examination only if there is a change in growth pattern while one third send lesions with every surgery. CONCLUSIONS: Recurrent respiratory papilloma continues to be a frustrating disease to treat and is associated with significant morbidity and mortality. There has been an evolution in the past decade toward the increased use of antiviral adjuvant therapy and the use of microdebrider techniques for surgical management.     

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.     

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.     

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.     

Perioperative adenotonsillectomy management in children: current practices

OBJECTIVE: To determine the current practices of preoperative evaluation, surgical techniques, and postoperative treatment of pediatric adenotonsillectomy. STUDY DESIGN: Forty-one-item survey measuring the frequency of different evaluations, procedures, and treatments performed, including selected case scenarios, with all items scored on a five-point ordinal scale ranking frequency. METHODS: The entire membership of the American Society of Pediatric Otolaryngology (ASPO) and active fellows and members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) residing in New York state were anonymously surveyed through mail-in questionnaires. RESULTS: History alone was the most frequent modality for diagnosing both adenoid enlargement and obstructive sleep apnea. The most common preoperative laboratory test ordered before an adenotonsillectomy is a complete blood cell count; ASPO members ordered fewer preoperative laboratory tests than AAO-HNS members. Unipolar cautery is the most frequently used tonsillectomy technique, and curettage followed by cautery is the most popular adenoidectomy technique. Steroids are the most common intraoperative medication administered during an adenotonsillectomy, and office visits remain the most frequently used methods of assessing adenotonsillectomy patients postoperatively. CONCLUSIONS: Although there are statistically significant trends uncovered by the survey, the results reflect a lack of consensus regarding adenotonsillectomy management. Further randomized controlled trials or large-scale outcomes projects are much needed to evaluate critically the current practices of pediatric adenotonsillectomies. Additional efforts may also be required to use the information from these studies in effecting changes in actual practice patterns, moving us toward a more evidence-based paradigm of treating pediatric adenotonsillar disease.     

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.     

Pediatric otolaryngologists' knowledge and understanding of genetic testing for deafness

OBJECTIVE: To assess the level of a cohort of pediatric otolaryngologists' knowledge and understanding of genetics and genetic testing for deafness and hard of hearing (D/HOH). METHODS: A questionnaire was designed to assess the level of knowledge and understanding of the genetic basis and genetic testing for deafness among a cohort of pediatric otolaryngologists. Three hundred questionnaires were made available to attendees of the 14th (1999) Annual Meeting of the American Society of Pediatric Otolaryngology, Palm Desert, Calif. A series of questions asked to gauge the respondent's level of knowledge of genetics and hearing impairment addressed estimating recurrence risks for deaf and normal-hearing parents and the likelihood of detecting a mutation in connexin 26 in specific clinical scenarios. RESULTS: A total of 28 questionnaires were completed and returned. All respondents reported that they regularly saw patients for D/HOH. Almost half commonly refer these patients for genetic testing and counseling. Seventeen (71%) of 24 otolaryngologists stated they offered genetic testing in all situations, while 6 offered counseling only at parental request or to address recurrence risk issues. One otolaryngologist offered genetic testing if there was a deaf sibling. Twelve (67%) of 18 offered pretest counseling, which was most frequently provided by a genetic counselor. Although 3 (19%) of 16 otolaryngologists provided the counseling themselves, 2 (13%) reported that they and a genetic counselor provided the counseling. While 24 (89%) of the 27 correctly stated that nonsyndromic D/HOH is usually autosomal recessive, recurrence risks were incorrectly estimated in several examples. CONCLUSIONS: While the surveyed pediatric otolaryngologists have a good knowledge of genetics and genetic testing for D/HOH, recurrence risks were often inaccurate. Since D/HOH testing is clinically available, it is imperative that physicians are educated about genetics and genetic testing and are able to communicate this to their patients and their patients' families.     

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.     

Survey of pediatric otolaryngologists: clinical practice trends used to prevent and treat blocked ventilation ear tubes in children

OBJECTIVE: To estimate clinical impact of blocked tubes in children and to identify prevention/treatment trends. METHODS: A survey was sent to American Society of Pediatric Otolaryngology (ASPO) members via Internet. RESULTS: One hundred twenty two members of ASPO members responded (58%). Most clinicians saw their patients 4-8 weeks after surgery. The estimated blockage rate was between 0 and 9% (despite the use of prophylactic drops applied perioperatively including those with antibiotics only (55%), antibiotic with steroids (36%) or decongestant drops (14%), respectively). Most clinicians opted to treat blocked tube with a course of drops applied at home (73% used drops over half the time). Those drops most commonly used included the following either alone or in combination for up to 14 days: antibiotics with steroids, antibiotics alone, or either 1.5 or 3% hydrogen peroxide. Fewer clinicians used suction and/or debridement under microscopic guidance to unblock the tube at the office visit. However, most clinicians agreed that microscopic debridement was more effective than a course of drops in opening blocked tubes (80% versus 70% estimated median success rate, respectively, p=0.0003). CONCLUSIONS: Approximately one half million sets of tubes (1,000,000 total tubes) are placed per year in North America. Based on results of this survey and those from the literature, 50,000 patients require treatment postoperatively because their tubes blocked (despite the use of prophylactic eardrops). This study identifies that a variety of treatments exist and confirms that further study is warranted to prevent postoperative tube blockage.     

Adolescent otolaryngology

OBJECTIVE: To determine the pattern of disease amongst ambulatory adolescents referred to a pediatric otolaryngology outpatient department. METHODS: Retrospective chart review of adolescents newly referred to a tertiary pediatric otolaryngology outpatient department over a 12-month period. RESULTS: One hundred and fifteen patients were included (male 56, female 59) mean age 14.9 years. There were 36 (31%) patients who had previously required otolaryngology management for another condition, and 29 patients with complex medical conditions. Investigations, including audiology and medical imaging, were performed in 35 patients. The patients were managed surgically 34 (30%), medically 28 (24%), referred to other departments 10 (9%) had no intervention 21 (18%), while 22 (19%) failed to attend for follow up. CONCLUSION: Ambulatory adolescent patients present with a comparable spectrum of otolaryngological problems to other pediatric age groups. These patients appear to be well managed by pediatric otolaryngologists, and there does not seem to be a need to develop a free standing adolescent otolaryngology subspecialty within tertiary pediatric otolaryngology at this time.     

Projected Societal Needs in Pediatric Otolaryngology

With the recent increase in pediatric otolaryngology fellowship training programs, fellows are being trained in record numbers and there is concern about the possibility that the supply of these physicians will soon exceed societal needs. This study was conducted to determine the number of fellowship-trained pediatric otolaryngologists that would meet the needs of society and when this need will be met. Information was collected from national organizations and from a survey of fellowship training programs. A hospital-based practitioner model was used to predict societal needs based on the anticipated changes in patient care, mainly managed-care capitated systems. The projected societal need is 382 pediatric otolaryngologists. If current fellowship training levels continue, this need will be met in just over 7 years.     

Fiftieth anniversary of the american board of otolaryngology

It is befitting that this issue commemorate a half century anniversary of the American Board of Otolaryngology. Dr. Tom Carmody, Denver, President of the American Academy of Ophthalmology and Otolaryngology in 1923 stated, “examination in otolaryngology with certification must be established as in ophthalmology, and as this Society is the pioneer in requiring examination, we must lead the way.” He referred to the great success of the meeting of our sister organization, the American Laryngological, Rhinological and Otological Society, Inc., (The Triological Society), with scientific papers.