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OBJECTIVE: Although voice therapy is a highly effective treatment for voice disorders, benefits are diminished by poor adherence to appointments. Remote telehealth delivery of therapy may address this problem by improving access. This study investigates attendance at remote telehealth voice therapy and evaluates potential correlation with patient demographics and socioeconomic status. METHODS: Retrospective review of all adult patients referred for telehealth voice therapy between April 2020-November 2021. Evaluated patient demographics including referral diagnosis, health insurance status and interpreter use, were obtained from medical records. Area Deprivation Index scores served as proxy for socioeconomic status. Multivariate analysis examined relationships between patient factors and attendance. RESULTS: Of 423 patients referred for telehealth voice therapy, 220 (52%) attended more than one therapy session, 98 (23%) attended one, and 105 (25%) never attended therapy. Multivariate analysis did not identify significant correlations between telehealth attendance and sociodemographic factors including interpreter use, insurance status, and socioeconomic status, even after adjusting for ethnicity and primary language. CONCLUSION: Over half of patients referred to telehealth voice therapy participated in multiple sessions and 75% attended at least one session. Telehealth voice therapy attendance was not negatively impacted by public health insurance and patient race and socioeconomic status did not impact attendance. Telehealth voice therapy may minimize potential barriers to care in susceptible populations. LEVEL OF EVIDENCE: IV.

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OBJECTIVE: Hearing loss is a common sensory impairment in children that affects quality of life and development. Early intervention, such as hearing aids and communication therapies, can help children overcome these challenges and lessen the impact on their development. The objective of this study was to identify specific patient demographic factors correlated with the prevalence of pediatric conductive hearing loss. STUDY DESIGN: The study utilized the Kids' Inpatient Database (KID) by the Agency for Healthcare Research and Quality which collects inpatient information from hospitals for patients under 21 years old. We included all patients discharged in 2016 diagnosed with conductive hearing loss, and excluded neonatal patients discharged within 28 days of birth. METHODS: Statistical analyses were performed using R Studio and IBM SPSS Statistics. Weighted odds ratios were calculated for conductive hearing loss in relation to race and income, and a multivariate regression analysis examined associations between demographic variables and race categories in conductive hearing loss. RESULTS: The prevalence of conductive hearing loss (CHL) in pediatric patients in 2016 was 51.62 cases per 100,000 patients. Non-Hispanic White patients had the highest prevalence, while Black patients had the highest likelihood of CHL compared to the overall population. Lower income levels were associated with a decreased probability of CHL diagnosis. After adjusting for age, sex, hospital region, insurance, and income on multivariate analysis, White and Black patients were less likely to be diagnosed with CHL. Furthermore, patients in specific income quartiles also had lower CHL likelihood compared to the general population. CONCLUSION: While Black patients had a higher likelihood of being diagnosed with CHL than the general population, socioeconomic factors such as income greatly influenced the likelihood of CHL diagnosis. Other significant factors included income, region of the country, sex, and age. Further research is needed to better understand and address healthcare disparities related to pediatric hearing loss.

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OBJECTIVE: To determine if patient factors related to ethnicity, socioeconomic status (SES), medical comorbidities, or appointment characteristics increase the risk of missing an initial adult otolaryngology appointment. METHODS: This study is a retrospective case control study at Boston Medical Center (BMC) in Boston, Massachusetts, that took place in 2019. Patient demographic and medical comorbidity data as well as appointment characteristic data were collected and compared between those that attended their initial otolaryngology appointment versus those who missed their initial appointment. Chi-square and ANOVA tests were used to calculate differences between attendance outcomes. Multivariate analysis was used to compare the odds of missing an appointment based on various patient- and appointment-related factors. RESULTS: Patients who were more likely to miss their appointments were more often female, of lower education, disabled, not employed, Black or Hispanic, and Spanish-speaking. Spring and Fall appointments were more likely to be missed. When a multivariate regression was conducted to control for social determinants of health (SDOH) such as race, insurance status, employment, and education status, the odds of females, Spanish-speaking, students, and disabled patients missing their appointment were no longer statistically significant. CONCLUSION: A majority of patients at BMC come from lower SES backgrounds and have multiple medical comorbidities. Those who reside closer to BMC, often areas of lower average income, had higher rates of missed appointments. Interventions such as decreasing lag time, providing handicap-accessible free transportation, and increasing accessibility of telemedicine for patients could help improve attendance rates at BMC. LEVEL OF EVIDENCE: IV Laryngoscope, 134:4003-4010, 2024.

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OBJECTIVE: The purpose of this study is to examine the racial and ethnic representation of otolaryngology applicants and residents and determine if there have been any improvements in recruiting a diverse workforce over the past several years. METHODS: A retrospective study was conducted on self-reported race and ethnicity data of otolaryngology applicants to United States residency programs from 2016 to 2022 from the Association of American Medical Colleges (AAMC) and residents from 2011 to 2022 from the Accreditation Council for Graduate Medical Education (ACGME). The changes in proportions of applicants and residents by race and ethnicity separately was compared as well as the proportion of applicants to residents. Descriptive analyses and chi-square tests were used to compare proportions of groups by race and ethnicity. RESULTS: There was no statistically significant difference in the proportion of applicants by race or ethnicity from 2016-2017 to 2021-2022. There was a decrease in the proportion of White residents from 58.1% to 54.5% from 2011-2012 to 2018-2019. There were higher proportions of White residents than applicants and lower proportions of Black residents than applicants in the two cycles analyzed. In the most recent cycle analyzed, the proportion of Hispanic or Latino residents was higher than the proportion of Hispanic or Latino applicants. CONCLUSION: While there may be improvements to increase representation of otolaryngology applicants and residents, there continues to be inequalities and a lack of diversity. Further initiatives are needed to ensure diversity in the field improves moving forward.

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In-person swallow therapy is a primary and effective treatment for dysphagia. However, remote telehealth is now a widely utilized component of healthcare delivery for therapeutic interventions. This study evaluates potential factors influencing attendance at telehealth swallow therapy. Retrospective review of 308 patients referred for telehealth swallow therapy from April 2020-November 2021 included patient referral diagnosis, diagnostic swallowing evaluations, and sociodemographic information including age, race, health insurance, interpreter use, and socioeconomic status. Univariable and multivariable analyses compared patient and appointment factors for those who attended telehealth swallow therapy with those who did not attend. Overall, 71.8% of patients attended at least one telehealth swallow therapy appointment while 28.2% did not attend any. The most common referral diagnoses were "Cancer" (19.2%) and "Dysphagia Unspecified" (19.2%). Patients diagnosed with "Cancer" and "Muscle Tension" were significantly less likely to attend telehealth swallow therapy compared to those with "Dysphagia Unspecified," "Globus," and "Gastroesophageal Reflux Disease/Laryngopharyngeal Reflux" after adjusting for covariates. Lower socioeconomic status (p = 0.023), no interpreter use (p < 0.001), and more diagnostic evaluations (p = 0.001) correlated with higher telehealth swallow therapy attendance. Race and sex did not correlate with attendance. Most patients referred to telehealth swallow therapy attended at least one appointment. Patients with dysphagia associated with cancer and muscle tension, those with higher socioeconomic status, interpreter use, and fewer diagnostic swallowing evaluations were less likely to attend telehealth swallow therapy. Future research should investigate and compare attendance and efficacy of telehealth swallow therapy with in-person therapy.

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OBJECTIVES: To evaluate existing literature to understand the utility and safety of uvulopalatopharyngoplasty (UPPP) for treatment of pediatric obstructive sleep apnea (OSA). METHODS: A literature review was conducted by two authors to search for studies from the inception of two databases until March 1, 2023. Studies in which participants were under 18 years of age and underwent UPPP for OSA or upper airway obstruction were selected. Data on variables such as pre- and postoperative severity, efficacy, complications, and follow-up were collected from all studies. RESULTS: After applying inclusion criteria to the initial 91 abstracts that were screened, 26 studies remained that included 224 patients who underwent UPPP. Most children who underwent UPPP had neurologic impairment, developmental delay, craniofacial abnormalities, or were obese, and underwent several procedures for OSA treatment. Of the studies that reported outcomes, 85.6 % of patients had subjective improvement, and 25.6 % of patients had a reported complication. CONCLUSIONS: Most children who underwent UPPP had serious medical comorbidities with moderate or severe OSA and a multi-procedural treatment plan. Although most patients had subjective improvement and there were low complication rates, the heterogeneity of existing literature makes it difficult to draw conclusions. Future multi-center, prospective studies should be conducted to analyze the true safety and efficacy of UPPP in pediatric patients.

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BACKGROUND: Invasive fungal sinusitis (IFS) is a rare infection with high mortality, mainly impacting immunocompromised patients. Given its significant mortality, timely recognition and treatment is crucial. This study aims to highlight the differences in presentation of IFS between pediatric and adult patients to aid in prompt diagnosis and treatment of this condition. METHODS: A comprehensive literature search of PubMed, EMBASE, Web of Science, Global Index Medicus, Global Health (EBSCO) and Cochrane Database of Systematic Reviews was conducted to identify articles relating to IFS. Patient demographics, comorbidities, presentation, disease characteristics, treatments and outcomes were extracted from the studies, and statistical analyses were conducted to compare these variables between pediatric and adult patients. RESULTS: 111 studies identified 22 pediatric and 132 adult patients worldwide. Children were more likely to have hematologic malignancies compared to adults (59.1 % vs. 15.2 %, p < 0.001). Facial symptoms such as pain, edema, and numbness were the most common symptoms for both age groups. In the pediatric population, fever and nasal or oral mucosal lesions were more common presenting symptoms (both p < 0.001). Pediatric patients were more likely to present without disease extension beyond the sinuses (p < 0.001). There was no significant difference in either medication treatment or mortality between the two cohorts. CONCLUSION: IFS often presents with non-specific symptoms and a unique presentation in pediatric and adult populations. Clinical awareness of the varying presentations in both populations is important to treat in a timely manner given the rapid progression and high mortality rates of IFS.

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