Disorders of the External Ear-A Historical Perspective.

This article provides a historical overview of disorders of the external ear, focusing on advances in technology, pharmacology, and education that have been beneficial. While the diagnosis and treatment of various conditions involving the external ear canal and auricle continue to evolve, it remains to be seen how the latest challenges will be met.

Evolution of Eustachian tube surgery.

Eustachian tube dysfunction (ETD) is a common condition that lacks a widely accepted treatment. Attempts to address ETD surgically have spanned several centuries and have often fallen short of success. It is probable that occult anatomic position, unclear function, and misunderstood physiology have contributed to the delayed development of effective interventions for ETD. This article traces the evolution of therapeutic interventions of the Eustachian tube through the present day. Reasons for success and failure are highlighted, with implications for the future of Eustachian tube surgery.

Ethical challenges in geriatric care.

The growth of the elderly population presents numerous challenges to the practicing otolaryngologist. This commentary reviews some of the issues that come up in dealing with geriatric patients, reiterates some classic ethical principles, and looks to some philosophers who have addressed relevant issues over the past centuries. It is based on a presentation "Ethical Challenges in Geriatric Otolaryngology," delivered at the annual meeting of the American Society of Geriatric Otolaryngology on April 30, 2008.

Satisfaction and gender issues in otolaryngology residency.

OBJECTIVE: To evaluate the otolaryngology residency experience with attention to operative experience, career guidance, and gender. STUDY DESIGN AND SETTING: Otolaryngology residents were anonymously surveyed by mail about their residency experience. The 22-item survey was scored on a 5-point ordinal Likert scale. Responses were analyzed with respect to gender and postgraduate year (PGY) level. RESULTS: Complete surveys were returned by 261 otolaryngology residents (24% female). PGY level correlated with confidence that surgical skills were appropriate (P = 0.003), establishment of solid career network (P = 0.003), and confidence that surgical abilities are adequate for practice (P = 0.028). Female residents reported less confidence that surgical skills were appropriate (P = 0.050) and that surgical abilities were adequate for postresidency practice (P = 0.035). Women were encouraged to enter private practice more often (P = 0.012), were less likely to have a solid career network ( P = 0.025), and were less confident about being able to run their own practice (P = 0.036) CONCLUSIONS: Significant differences exist for several questions regarding surgical confidence and career issues, even after correction for PGY level.

Otolaryngology residents' objectives in entering the workforce.

OBJECTIVES: To determine the priorities of current otolaryngologists-in-training in considering their first employment opportunities. STUDY DESIGN: Twenty-one-item survey measuring the importance of various first job issues, with all items scored on a five-point Likert-type ordinal scale. METHODS: The resident membership of the American Academy of Otolaryngology-Head and Neck Surgery was anonymously surveyed by means of mail-in questionnaires. Results were stratified by years of training. RESULTS: Responses from 242 of 1174 mail-in surveys (21% response rate) exhibited a wide distribution of responses for all 21 questions. The availability of free time to spend with one's family was regarded by more than half of the respondents to have the highest overall importance. As years of training increased, priorities shifted toward geographic location, away from issues such as the on-call schedules. The availability of research time and resources received the overall lowest priority, with more than half of the respondents ranking it as only somewhat important or lower. CONCLUSIONS: Otolaryngologists-in-training feel strongest about the availability of free time to spend with their families as they finish formal training and consider employment opportunities. By acknowledging the concerns of graduating residents, including the ability to pursue their primary interests when they start working, we can better adapt conditions to create a more comfortable and stable entry into the workforce.

Hodgkin's disease of the head and neck in human immunodeficiency virus-infected patients.

INTRODUCTION: Hodgkin's disease can occur in immunocompromised patients. However, the head and neck manifestations of Hodgkin's disease in human immunodeficiency virus (HIV)-infected patients remain ill defined. The aim of this study was to describe Hodgkin's disease of the head and neck in HIV-infected patients and compare it with noninfected patients. MATERIALS AND RESULTS: Sixteen patients presented with Hodgkin's disease of the head and neck to the King's County Hospital Center, Brooklyn, New York, beginning in January of 1991. Five patients were infected with HIV. Hodgkin's disease involved the head and neck regions in 90.5% of cases, occurring in 100% of HIV-infected and in 81% of noninfected patients. Manifestations of Hodgkin's disease were isolated to the head and neck region in only 20% of HIV-infected and in 27% of noninfected patients. Lymphatic structures were involved in all cases with head and neck involvement. Systemic or group B symptoms (fever, night sweats, fatigue, and weight loss of more than 10% of normal body weight) were present in 40% of HIV-infected patients and in 27% of noninfected patients. Advanced stage disease (Stage III/IV) was diagnosed in 80% of HIV-infected patients compared with 45% of noninfected patients. The mixed cellularity subtype was most common in HIV-infected patients (75%), whereas the nodular sclerosis subtype predominated in noninfected patients (50%). CONCLUSIONS: The data combined with our report of the literature suggest that the course, presentation, and outcome of Hodgkin's disease is markedly altered in HIV-infected patients. An aggressive approach to the diagnosis and management is suggested in this patient population.