Factors predictive of an academic otolaryngologist’s scholarly impact

ObjectivesDescribe the h index as a bibliometric that can be utilized to objectively evaluate scholarly impact. Identify which otolaryngology subspecialties are the most scholarly. Describe if NIH funding to one’s choice of medical school, residency, or fellowship has any impact on one’s scholarly output. Determine other factors predictive of an academic otolaryngologist’s productivity.Study designAnalysis of bibliometric data of academic otolaryngologists.MethodsActive grants from the National Institutes of Health (NIH) to otolaryngology departments were ascertained via the NIH Research Portfolio Online Reporting Tools Expenditures and Reports database. Faculty listings from these departments were gleaned from departmental websites. H index was calculated using the Scopus database.ResultsForty-seven otolaryngology programs were actively receiving NIH funding. There were 838 faculty members from those departments who had a mean h index of 9.61. Otology (h index 12.50) and head and neck (h index 11.96) were significantly (P < 0.0001) more scholarly than the rest of subspecialists. H index was significantly correlative (P < 0.0001) with degree of NIH funding at a given institution. H index was not significantly higher for those that attended medical school (P < 0.18), residency (P < 0.16), and fellowship (P < 0.16) at institutions with NIH funding to otolaryngology departments.ConclusionsH index is a bibliometric that can be used to assess scholarly impact. Otology and head and neck are the most scholarly subspecialists within otolaryngology. NIH funding to an individual’s medical school, residency, or fellowship of origin is not correlative with one’s scholarly impact, but current institutional affiliation and choice of subspecialty are.     

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.     

Burnout in academic faculty of otolaryngology-head and neck surgery

Objective/Hypothesis: To characterize burnout in academic faculty of otolaryngology—head and neck surgery. To identify associated modifiable factors to reduce burnout and improve the health of the field. Study Design: Mailed survey. Methods: A cross section of US academic otolaryngologists was sampled through a mailed survey. Content included the Maslach Burnout Inventory‐Human Services Study (MBI‐HSS) and questions assessing potential burnout predictors such as demographic information, professional stressors, satisfaction, self‐efficacy, and support systems. Results: Burnout was common among academic otolaryngologists. High burnout was observed in 4% of faculty, moderate burnout in 66%, and low burnout in 30%. Women experienced a statistically higher level of emotional exhaustion than men. In addition, associate professors were significantly more burned out than full professors and microvascular surgeons were notably more burned out than all other subspecialists. The strongest predictors of burnout were dissatisfaction with the balance between personal and professional life, low self‐efficacy, inadequate research time, and inadequate administration time. A significant association was seen between high burnout and likelihood to leave academic medicine within the next 1 to 2 years. Conclusions: Burnout was prevalent among US academic otolaryngologists, although levels were lower than those of otolaryngology chairs and residents. Modification of risk factors, such as allowing sufficient faculty time for research and administrative activities, should be undertaken to curb the development of burnout and its deleterious sequelae.     

Factors predictive of an academic otolaryngologist’s scholarly impact

ObjectivesDescribe the h index as a bibliometric that can be utilized to objectively evaluate scholarly impact. Identify which otolaryngology subspecialties are the most scholarly. Describe if NIH funding to one’s choice of medical school, residency, or fellowship has any impact on one’s scholarly output. Determine other factors predictive of an academic otolaryngologist’s productivity.Study designAnalysis of bibliometric data of academic otolaryngologists.MethodsActive grants from the National Institutes of Health (NIH) to otolaryngology departments were ascertained via the NIH Research Portfolio Online Reporting Tools Expenditures and Reports database. Faculty listings from these departments were gleaned from departmental websites. H index was calculated using the Scopus database.ResultsForty-seven otolaryngology programs were actively receiving NIH funding. There were 838 faculty members from those departments who had a mean h index of 9.61. Otology (h index 12.50) and head and neck (h index 11.96) were significantly (P < 0.0001) more scholarly than the rest of subspecialists. H index was significantly correlative (P < 0.0001) with degree of NIH funding at a given institution. H index was not significantly higher for those that attended medical school (P < 0.18), residency (P < 0.16), and fellowship (P < 0.16) at institutions with NIH funding to otolaryngology departments.ConclusionsH index is a bibliometric that can be used to assess scholarly impact. Otology and head and neck are the most scholarly subspecialists within otolaryngology. NIH funding to an individual’s medical school, residency, or fellowship of origin is not correlative with one’s scholarly impact, but current institutional affiliation and choice of subspecialty are.     

Geographic differences in academic promotion practices,fellowship training,and scholarly impact

Purpose

Previous literature described how clinical fellowship training impacts scholarly production among academic otolaryngologists, finding that fellowship-trained practitioners had higher research productivity than their non-fellowship-trained peers, and head and neck (H&N) surgeons and otologists had the highest scholarly impact. In this analysis we investigate whether geographic differences in academic promotion and scholarly impact exist, and whether such differences are associated with emphasis on regional fellowship training patterns.

Methods

The Scopus database was used to determine scholarly impact (as measured by the h-index) of 1109 academic otolaryngologists from 97 departments. Online faculty listings were organized by fellowship training, academic rank, and location.

Results

Fellowship-trained practitioners had greater research productivity than non-fellowship-trained otolaryngologists (H = 9.5 ± 0.26 SEM vs. 6.5 ± 0.43, p < 0.001), a finding that persisted throughout except in the Mountain and East South Central Regions. H&N surgeons and otologists had the highest h-indices. Practitioners in the West had the highest h-index, with differences persisting upon examination of junior faculty. The West (62.1%) and Midwest (60.5%) had the highest proportions of senior faculty. Regional differences in scholarly impact and academic promotion were further noted upon organizing faculty by subspecialty fellowship training.

Conclusions

Geographic differences in academic promotion and scholarly impact exist, most markedly among junior faculty. Practitioners in the West had high impact and were more represented at senior ranks. Upon examination by fellowship training status, fellowship-trained otolaryngologists had higher impact in most, but not all, geographic regions. Regional variations in promotion were noted upon organizing faculty by subspecialty, although association with scholarly impact differs by region.     

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.     

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.     

Deficiencies of cross-training between pediatrics and otolaryngology

OBJECTIVE: Conditions relating to the ear, nose and throat are very frequent problems encountered by general pediatricians. Similarly, a major percentage of patients seen and operated on by the general otolaryngologist are of the pediatric age group. It is my hypothesis that there is a deficiency of cross-training between these two specialties. METHODS: All pediatric and otolaryngology program directors in Canada were contacted by mail. They were asked to complete a questionnaire regarding the need for further cross-training, what training their residents are presently receiving, and clinical entities that needed more attention. RESULTS: Data were tabulated and analyzed. 62.5% of pediatric program directors and 83.3% of otolaryngology program directors responded. All pediatric program directors indicated a need for teaching by otolaryngologists for their residents and 90% identified an area of deficiency in training. Similarly, 90% of otolaryngology program directors indicated a need for teaching by pediatricians for their residents and 89% of those identified an area of deficiency in training. CONCLUSIONS: These results suggest that there is a deficiency in cross-training between pediatrics and otolaryngology.     

Interrater and intrarater reliability in the evaluation of velopharyngeal insufficiency within a single institution

OBJECTIVE: To explore the interrater and intrarater reliability in nasoendoscopic assessment of velopharyngeal (VP) function using the standardized reporting method described by Golding-Kushner within a single institution. DESIGN: Prospective blinded study. SETTING: Academic, tertiary care, pediatric hospital. PARTICIPANTS: Six health care providers (2 pediatric otolaryngology faculty members, 2 pediatric otolaryngology fellows, and 2 speech pathologists) independently rated 50 videotaped nasoendoscopy segments twice. The segments on the videotape were obtained in a clinical setting. MAIN OUTCOME MEASURES: The Golding-Kushner rating system was used to rate VP function. Raters described VP closure quantitatively by rating palatal and lateral pharyngeal wall movement for each segment. They also qualitatively described characteristics of the VP gap, rated gap size as none, small, medium, or large, and estimated the percentage gap size relative to the resting position. Reliability coefficients were calculated for the data sets. RESULTS: Fairly good interrater and intrarater reliability was seen in the quantitative measures. Faculty otolaryngologists rated segments more similarly to each other than did pediatric otolaryngology fellows, but intrarater reliability was similar for both the experienced and less experienced otolaryngologists. Less consistency was seen in the ratings of the speech pathologists. Raters tended to rate with less consistency when describing qualitative characteristics of the VP gap than when making quantitative measurements. CONCLUSIONS: The Golding-Kushner scale is a reasonably reliable tool for reporting nasoendoscopic findings at our institution. However, these data also indicate that there exists room for improvement and that rater training may increase reliability.     

Elective management of the clinically negative neck by otolaryngologists in patients with oral tongue cancer

BACKGROUND: The treatment of patients with squamous cell carcinoma of the head and neck who have a clinically negative (cN0) neck remains controversial. Furthermore, the treatment delivered to patients with a cN0 neck by practicing otolaryngologists is not known. OBJECTIVE: To determine the variability in the management of the cN0 neck in the otolaryngology community. DESIGN, SETTING, AND PARTICIPANTS: A random survey of 763 board-certified otolaryngologists in the United States. MAIN OUTCOME MEASURES: Physician respondents' preferences for observation vs treatment of the cN0 neck and the treatment modalities chosen. RESULTS: Forty-one percent of the surveyed physicians responded. Nearly 10% of the respondents observed all patients with a cN0 neck. Otolaryngologists who treat 35 or more new patients with cancer each year were more likely to perform elective treatment of the neck for a T2 lesion of the oral tongue than those who treat 10 or fewer patients each year (P =.03). They were also more likely to treat patients with a cN0 neck when the risk of occult cervical metastases was greater than 15% to 20% (P =.04). A comprehensive neck dissection was the preferred lymphadenectomy procedure for 21% of the otolaryngologists surveyed. CONCLUSIONS: Variations in the treatment of the cN0 neck are associated with differences in the frequency of treatment of patients with head and neck cancer by otolaryngologists. Uniformity of care must be established within the otolaryngology community by developing widely accepted evidence-based guidelines and referring patients to surgeons who routinely treat head and neck cancer.     

Transnasal esophagoscopy: a high-yield diagnostic tool

OBJECTIVES: Transnasal esophagoscopy (TNE) reveals a wide range of esophageal findings. TNE technique, indications, outcomes, advantages, limitations, and impact on patient care are described. STUDY DESIGN: Retrospective chart review. METHODS: Charts of the first 30 patients to undergo TNE in an academic otolaryngology practice were reviewed. Technique details, patient demographics, and procedure indications and findings as well as the disposition of patients in this series are described. TNE limitations are discussed with areas for future development. RESULTS: Thirty patients who underwent unsedated outpatient TNE by their otolaryngologist are described. TNE was directed toward select indications: dysphagia, screening esophagoscopy given long-standing gastroesophageal reflux (GER) or laryngopharyngeal reflux (LPR), and esophageal surveillance with a new diagnosis of head and neck squamous cell carcinoma. Positive findings included mucosal cobblestoning, Barrett's esophagus, esophagitis, gastritis, candidal esophagitis, esophageal diverticulum, postcricoid mass, patulous esophagus, and absence of secondary esophageal peristalsis. Outcomes included referral to a gastroenterologist for evaluation, with or without biopsy; direct laryngoscopy or esophagoscopy with biopsy by the otolaryngologist; planned cancer resection by the otolaryngologist; and medical management of GER/LPR by the otolaryngologist. CONCLUSIONS: With appropriate selection criteria, TNE yields a high percentage of positive findings and wide range of esophageal abnormalities, directly impacting patient management. Available to otolaryngologists in the outpatient setting, TNE expedites interventions by providing a safe, effective alternative to rigid esophagoscopy under general anesthesia and flexible upper endoscopy with sedation. Patients will benefit from the integration of TNE into otolaryngologists' outpatient diagnostic armamentarium.     

Ear,nose and throat manifestation of viral systemic infections in pediatric patients

Objective/MethodsAn exhaustive review of literature was performed to investigate available data and evidences regarding pediatric otolaryngologic manifestations of viral systemic infections.Results/ConclusionsModern otolaryngologists should be familiar with viral systemic infections since many have head and neck manifestations. Cooperation between otolaryngologist, paediatrician and virologist can be considered and excellent tool in diagnosis and treatment of these diseases in particular when complications occur.     

Comparison of scholarly impact among surgical specialties: An examination of 2429 academic surgeons

Objectives/Hypothesis

The h‐index, a bibliometric indicator that objectively characterizes the impact of an author's scholarship, is an effective tool that may be considered by academic departments for decisions related to hiring and faculty advancement. Our objective was to characterize the scholarly productivity of academic surgeons from different specialties relative to otolaryngologists.

Study Design

Analysis of a bibliometric database.

Methods

The h‐indices of 2,429 faculty members within surgical specialties at 20 randomly selected academic institutions were calculated using the Scopus database and were examined to determine relationship with academic rank and comparison among surgical subspecialties.

Results

The h‐index statistically increased with academic rank. Mean h‐indices were as follows: assistant professor, 4.37 (range, 2.73–6.69); associate professor, 8.70 (6.53–11.02); professor, 16.44 (13.39–20.45); and chairperson, 20.79 (14.81–27.89). Mean increase between academic rank was 5.47, with the largest increase between the levels of associate professor and professor. Further examination demonstrated statistically significant increases through all academic ranks for most, but not all, individual specialties. Urologists, general surgeons, and neurosurgeons had the highest mean h‐indices.

Conclusions

h‐indices among the different surgical specialties vary and are potentially impacted by the number of practitioners as well as research emphasis within a field. The mean h‐index of academic otolaryngologists falls in the lower values for academic surgeons. Because this metric varies among different fields, it is most relevant for comparison when examining values within a field. H‐indices reliably increase with increasing academic rank through professor and offer a quantifiable and objective alternative to other metrics when evaluating faculty members for academic advancement.     

Pediatric otolaryngologic manifestations of bleeding disorders

ObjectiveIn 1930, considering the diseases of the blood and lymphatic glands in relation to otolaryngology, Goldsmith and McGregor stated that “… the otolaryngologist has frequently to deal with bleeding from the nose and throat …”. After approximately 8 decades, in particular preoperatively, the use of universal coagulation screening in children is still controversial. Aim of the present review was to offer a concise but complete discussion of clotting disorders with pediatric otolaryngological interest recognizing: (i) vascular disorders, (ii) platelet disorders, (iii) disorders of coagulation, and (iv) thrombosis.MethodsAn exhaustive review of literature was performed to investigate available data and evidences regarding pediatric otolaryngologic manifestations of bleeding disorders.Results/ConclusionsModern otolaryngologists should be familiar with common bleeding disorders since many have head and neck manifestations. This knowledge allows the choice of appropriate pre-operative screening of surgical patients. The most important component of the preoperative assessment is the bleeding history that directs further laboratory evaluation. All otolaryngologic surgical procedures in children with bleeding disorders should be carried out with the close co-operation of the Haematology Department.     

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.     

变应性鼻炎诊疗现状调查

目的 变应性鼻炎(allergic rhinitis,AR)是鼻科常见病之一,但患者的就诊率不高,部分患者对疗效不满意,表明临床诊疗过程中存在亟待改进的问题.本研究针对中国部分大中城市的耳鼻咽喉头颈外科医师进行AR诊疗现状调查,通过剖析存在的问题,为提高临床诊疗水平提供参考.方法 采用问卷调查方式在全国13个省或自治区(63个市)和4个直辖市,针对508名耳鼻咽喉头颈外科医师,调查AR患者门诊状况、诊断状况和治疗状况.结果 AR患者占全部耳鼻咽喉头颈外科门诊患者的比例平均为19%±14%,占全部鼻腔鼻窦疾病门诊患者的35%±17%.既往使用过鼻用糖皮质激素或H1受体拮抗剂等抗过敏药物的患者为42%±26%.可进行皮肤点刺试验和血清特异性IgE检查的医师比例分别为74%和20%.仅依据患者症状和体征诊断,不进行皮肤点刺试验和血清特异性IgE检查等临床检测的比例为6l%±29%,而综合病史和皮肤点刺试验或血清学检测的诊断比例为35%±28%.从医师治疗成人AR患者的药物处方比例来看,鼻用糖皮质激素平均为70%4-27%,口服和鼻用H1受体拮抗剂分别为49%±32%和36%±28%.过敏原特异性皮下免疫治疗占23%4±26%,口服白三烯受体拮抗剂和鼻用色甘酸钠分别为18%±22%和16%±22%.重视复诊随访患者所占比例平均为24%±17%,对复诊和随访重视程度一般的患者所占比例为35%4±19%,而几乎不复诊随访的患者所占比例为39%±24%.结论 AR已成为我国耳鼻咽喉头颈外科门诊患者求诊的主要疾病,但无论是患者对疾病的整体认识,还是专科医师的整体诊治水平,均需要在现有基础上尽快提高.     

Increased Female Authorship in Otolaryngology Over the Past Three Decades

Objective To identify changing trends in female authorship and publication in the otolaryngology literature. Methods All articles published in the four major otolaryngology journals in each of the years 1978, 1988, and 1998 were reviewed. The authorship panel of each article was examined for number of authors, gender, educational degree category, and subspecialty area of publication. Data were analyzed for trends in female authorship and the association of gender with the other design variables. Results A total of 2,463 articles were analyzed. The average percentage of female authorship increased from 4.1% in 1978 to 8.7% in 1988 and 12.4% in 1998, and the percentage of articles with a female “first author” increased from 3.2% to 7.4% and 11.4% for the same years, respectively. Each of these increases was statistically significant (P < .001). The weighted rank of female authorship also increased from 0.063 to 0.164 and 0.243 for the same years, respectively (P < .001). With respect to subspecialty publication, women were first authors of 14.7% of articles concerning pediatric otolaryngology but accounted for 9.9% or less of the first authors in the other subspecialty areas (P < .001). Female authors were also much more likely to be nonphysicians (P < .001) than men. Conclusions There has been a significant trend toward increased female authorship in the otolaryngology literature. A significant portion of this is accounted for by nonphysician female authors, and female authorship tends to be concentrated in pediatric otolaryngology.     

Is NIH funding predictive of greater research productivity and impact among academic otolaryngologists?

Objectives/Hypothesis:

The h‐index is an accurate and reliable indicator of scholarly productivity that takes into account relevance, significance, and influence of research contributions. As such, it is an effective, objective bibliometric that can be used to evaluate academic otolaryngologists for decisions regarding appointment and advancement. In this study, we evaluate the impact of NIH funding on scholarly productivity in otolaryngology.

Study Design:

Analysis of bibliometric data of academic otolaryngologists.

Methods:

Funding data for the 20 otolaryngology departments with the largest aggregate total of NIH grants for the fiscal years (FY) 2011 and 2012 was obtained using the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Reports (RePORTER) Database. H‐indices were calculated using the Scopus online database, and then compared to funding data at both the departmental and individual level.

Results:

Faculty members in otolaryngology departments who received NIH funding had significantly greater research productivity and impact, as measured by the h‐index, than their nonfunded peers. H‐indices increased with greater NIH funding levels, and investigators with MD degrees tended to have higher mean NIH funding levels than those with PhDs. While there was no correlation between average h‐index and NIH funding totals at the level of departments, there was greater correlation upon examination of NIH funding levels of individual investigators.

Conclusions:

The h‐index has a strong relationship with, and may be predictive of, grant awards of NIH‐funded faculty members in otolaryngology departments. This bibliometric may be useful in decisions regarding appointment and advancement of faculty members within academic otolaryngology departments. Laryngoscope, 2013     

Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques

BACKGROUND/OBJECTIVES: Microvascular "free flap" transplants have become the preferred method of reconstruction for a great variety of complicated head and neck defects. As recently as 10 years ago, having a microvascular surgeon within a department of otolaryngology was the exception rather than the rule, whereas it is our impression that today most academic programs have one or more microvascularly trained head and neck surgeons. Among microvascular surgeons, postoperative care and management regimens vary greatly. Through informal conversations, we discerned that some surgeons take a very aggressive approach to monitoring, perhaps including prolonged stays in an intensive care setting with implanted Doppler devices to monitor flap blood flow and intravenous administration of dextran or other pharmaceutical projects. Others report that patients are quickly discharged from the hospital after just aspirin and subcutaneous heparin for a few days. Some physicians perform "flap checks" hourly, whereas others have residents check only once daily. DESIGN/METHODS: We surveyed academic otolaryngology-head and neck surgery departments that sponsor residency programs in the United States to 1) determine the prevalence of microvascular trained otolaryngologists within training programs and 2) assess variations in postoperative and monitoring regimens. RESULTS: We found that on average, 12.2% of otolaryngologists per department perform free flap transplants, and 71.6% of microvascular trained surgeons continue to do free flaps. The surgeons self reported a 96.4% average success rate and a 6.88% return rate to the operating room for complications. Monitoring methods used included flap color (used by 79.4% of surgeons), Doppler signal (79.4%), pin prick and bleeding rate (67.6%), capillary refill (61.8%), skin surface temperature (11.8%), and implanted Doppler (8.8%). Anticoagulants used included aspirin (used by 76.5% of microvascular surgeons), low-molecular-weight dextran (35.3%), and subcutaneous heparin (26.5%). CONCLUSIONS: Microvascular training has become commonplace in otolaryngology-head and neck surgery training programs, with more than one in eight of these academic physicians reporting microvascular training. There was no self-reported difference in flap failure rates on the basis of postoperative care and monitoring regimen. The results of this survey suggest that a simplified consensus postoperative regimen can be recommended.