The Global Otolaryngology-Head and Neck Surgery Workforce.

Importance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective: To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, Setting, and Participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main Outcome: The OHNS workforce per capita, stratified by income and region. Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and Relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.

Reliability of Tablet-based Hearing Testing in Nicaraguan Schoolchildren: A Detailed Analysis.

OBJECTIVE: Determine whether an electronic tablet-based Wireless Automated Hearing-Test System can perform high-quality audiometry to assess schoolchildren for hearing loss in the field in Nicaragua. STUDY DESIGN: Cross-sectional. SETTING: A school and hospital-based audiology clinic in Jinotega, Nicaragua. SUBJECTS AND METHODS: Second and third graders (n = 120) were randomly selected for hearing testing in a school. Air conduction hearing thresholds were obtained bilaterally using a Wireless Automated Hearing-Test System at 1000, 2000, and 4000 Hz. Referral criteria were set at more than 25 dBHL at one or more frequencies. A cohort of children was retested with conventional audiometry in a hospital-based sound booth. Factors influencing false-positive examinations, including ambient noise and behavior, were examined. RESULTS: All children with hearing loss were detected using an automated, manual, or two-step (those referred from automated testing were tested manually) protocol in the school (sensitivity = 100%). Specificity was 76% for automated testing, 97% for manual testing, and 99% for the two-step protocol. The variability between thresholds obtained with automated testing was greater than manual testing when compared with conventional audiometry. The percentage of participant responses when no stimulus tone was presented during automated testing was higher in children with false-positive examinations. CONCLUSION: A Wireless Automated Hearing-Test System identified all children with hearing loss in a challenging field setting. A two-step protocol (those referred from automated testing are tested manually) reduced false-positive examinations and unnecessary referrals. Children who respond frequently when no tone is presented are more likely to have false-positive automated examinations and should be tested manually.

Egresos hospitalarios debidos a trastorno de la articulación temporomandibular de 1997 al 2013, CCSS

El siguiente estudio descriptivo analiza los casos reportados sobre trastorno de la enfermedad temporomandibular de la base de datos del Registro de Egresos Hospitalarios del Área de Estadísticas de Salud de la Caja Costarricense del Seguro Social, acontecidos durante los años 1997 al 2013, los cuales fueron analizados por el comportamiento de las variables epidemiológicas de tiempo, lugar y persona; medidas de frecuencia y estadística no paramétrica. La finalidad de este artículo es investigar la casuística que propicie en el profesional en Odontología una herramienta para el diagnóstico precoz, que contribuya al establecimiento individual de medidas de prevención e intervención de los factores de riesgo detectados. Se registró un total de 167 casos de trastorno de la articulación temporomandibular según la Clasificación Internacional de las Enfermedades CIE-10. Dentro de los resultados obtenidos se tiene que la razón fue de 2,71 mujeres por cada hombre egresado con tal trastorno. La tasa por edad obtuvo mayor predominio en la población de 20 a 44 años, y fue de 5,63 X 100.00 habitantes, así como un riesgo relativo para este mismo grupo de 10,64, pero la tasa por localización geográfica en nuestro país fue de 8,37 por cada 100.000 habitantes para el caso concreto de la provincia de Limón.

The following descriptive study analyzes reported cases of temporomandibular disease disorder, according to the database of registered hospital discharged from the Health Statistics Area of the Costa Rican Social Security occurred during the years 1997 to 2013, which analyzed the behavior of the epidemiological variables of time, place and person; frequency measurements and nonparametric statistics. The purpose of this article is to investigate the mix of case that would give the professional in dentistry, a tool for early diagnosis which contributes to the individual establishment of prevention and intervention of risk factors detected. A total of 167 cases of temporomandibular joint disorder were recorded according to the International Classification of Diseases ICD-10. The ratio from the obtained results was 2.71 females for every male graduate with temporomandibular joint disorder. Age rate obtained predominance in the population of 20-44 years being 5.63 X 100.00 inhabitants and a relative risk for this same group of 10.64 and the rate per geographical location in our country was 8.37 per 100,000 inhabitants, this for the case of the Limon province.

Estudio de fracturas de malar, maxilar y mandíbula de los egresos hospitalarios del 2010 a 2015 en la Caja Costarricense de Seguro Social

El objetivo del presente estudio descriptivo es determinar la prevalencia de fracturas malares, maxilares y mandibulares en los pacientes internados en hospitales de la Caja Costarricense de Seguro Social durante los años 2010 al 2015, analizando su relación con edad, sexo y variables epidemiológicas de tiempo, lugar y persona. Se registró un total de 2.729 casos, seleccionados bajo los diagnósticos de fracturas según la Clasificación Estadística Internacional de Enfermedades CIE-10. Dentro de los resultados obtenidos un 40,7 % de las fracturas se relacionó con malares y maxilares vs 59,3%en mandíbula. La causa o etiología más común fue agresión (39%), traumatismo accidental (36%) y accidentes de transporte (24%), se observó mayor prevalencia en el grupo etario de 20 a 59 años con una tasa de 85,02 por 100.000 hab. La distribución de fracturas de acuerdo al sexo fue de 9.1% en mujeres y 90.9% en hombres, con una razón de 10 hombres por cada mujer. Esta problemática produjo al sistema de salud un total 36 años de estancia hospitalaria y 39 años de incapacidad. Es de interés para los tomadores de decisiones en salud conocer el impacto que tiene este tipo de lesiones en la morbilidad de la población al ser un problema de salud pública.

The objective of this research is to determine the prevalence of malar, maxillary and mandibular fractures in patients of the Social Security Hospitals during the years 2010 to 2015 analyzing the relationship between age, sex and epidemiological variables of time, place and person. A total of 2729 cases diagnoses selected under fractures diagnose according to the International Classification of Diseases ICD-10. Among the results a 40.7% of the fractures was recorded in the malar and maxillary area versus a 59.3% in the jaw area. The most common cause or etiology was assault (39%), accidental injury (36%) transport accidents (24%), higher prevalence was observed in the age group of 20-59 years with a rate of 85,02 per 100,000 inhabitants. The distribution of fractures according to sex was 9.1% in women and 90.9% in men, with a ratio of 10 men for each woman. This problem caused the social health system an average 36 years of hospital stay and 39 years of disability. It is of interest to health policy authorities to know the impact of these injuries on the morbidity of the population because it´s a public health problem.

Egresos hospitalarios debidos a enfermedades de las glándulas salivales, CCSS, Costa Rica 1997 al 2015

El siguiente estudio descriptivo analiza los casos informados sobre enfermedades de las glándulas salivales de la base de datos del Registro de Egresos Hospitalarios del Área de Estadística en Salud del la Caja Costarricense del Seguro Social, acontecidos durante los años 1997 al 2015, los cuales fueron analizados por los comportamientos de las variables epidemiológicas de tiempo, lugar y persona; estadística descriptiva. La finalidad de este artículo es investigar la casuística que propicie en el profesional en Odontología una herramienta para el diagnóstico precoz, que contribuya al establecimiento individual de la detección oportuna y las medidas de intervención adecuadas. Se registró un total de 1.606 casos de enfermedades de las glándulas salivales, según la Clasificación Internacional de Enfermedades CIE-10; dentro de los resultados obtenidos, la tasa por grupo de edad se concentró en la población de mayores de 65 años con una tasa de 8,28 x 10.000 habitantes; la tasa por localización geográfica en nuestro país fue de 4,34 por cada 10.000 habitantes en la provincia de Alajuela.

The following descriptive study analyzes the cases reported on diseases of the salivary glands of the database of the Registry of Hospital emerges of the Health Statistics Area of the Caja Costarricense del Seguro Social, which occurred during the years 1997 to 2015, which were analyzed by variables of behavior of epidemiological time, place and person, descriptive statistics. The purpose of this article is to investigate the casuistry that helps the professional in dentistry as tool for the early diagnosis that contributes to the individual establishment of the timely detection and the appropriate intervention measures. A total of 1,606 cases of diseases of the salivary glands were registered, according to the International Classification of Diseases ICD-10. Within the results obtained were the rate by age group were concentrated in the population over 65 with a rate of 8.28 x 10.000 inhabitants. The rate by geographic location in our country was 4.34 per 10,000 inhabitants in the province of Alajuela.

Cost Effectiveness of Childhood Cochlear Implantation and Deaf Education in Nicaragua: A Disability Adjusted Life Year Model.

INTRODUCTION: Cochlear implantation (CI) is a common intervention for severe-to-profound hearing loss in high-income countries, but is not commonly available to children in low resource environments. Owing in part to the device costs, CI has been assumed to be less economical than deaf education for low resource countries. The purpose of this study is to compare the cost effectiveness of the two interventions for children with severe-to-profound sensorineural hearing loss (SNHL) in a model using disability adjusted life years (DALYs). METHODS: Cost estimates were derived from published data, expert opinion, and known costs of services in Nicaragua. Individual costs and lifetime DALY estimates with a 3% discounting rate were applied to both two interventions. Sensitivity analysis was implemented to evaluate the effect on the discounted cost of five key components: implant cost, audiology salary, speech therapy salary, number of children implanted per year, and device failure probability. RESULTS: The costs per DALY averted are $5,898 and $5,529 for CI and deaf education, respectively. Using standards set by the WHO, both interventions are cost effective. Sensitivity analysis shows that when all costs set to maximum estimates, CI is still cost effective. CONCLUSION: Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs.

Prevalence and etiology of hearing loss in rural Nicaraguan children.

OBJECTIVE/HYPOTHESIS: The prevalence and causes of pediatric hearing loss (HL) in the developing world are largely unknown. Infectious sequelae, ototoxic medications, and genetic causes may play a larger role in developing countries. In addition, the significance of GJB2 mutation gene in poorly developed areas remains unclear. The intent of this study is to investigate the prevalence and etiology of HL in children living in a remote, impoverished region of northern Nicaragua. STUDY DESIGN: Cross-sectional study. METHODS: Clinical data from two sources were analyzed: data from screening examinations performed in rural schools in the Department of Jinotega, Nicaragua (group A) and pediatric HL patients seen at the Otolaryngology and Audiology Clinic in Jinotega, Nicaragua (group B). Patients with congenital HL were offered a genetic test for GJB2 mutations. Comparisons were made using parametric (analysis of variance) and nonparametric (Kruskal-Wallis) tests. RESULTS: School-based screening examinations (group A) revealed a high prevalence of significant HL (>30 dB) of 18%. The majority of these children had normal otoscopic examinations (58%). A family history of HL was seen in 24% of children who failed screening exams. Positive family history was more common in patients with HL (P < .01) and in specific schools (P < .05). Clinic-based evaluations (group B) reveal a population with predominantly severe-profound HL. Physical dysmorphism was common, yet identifiable syndromic HL was rare. Although familial HL was common (33%), there were no pathologic GJB2 mutations. Other common risk factors in this population were maternal infection during pregnancy, neonatal distress, low birth weight or prematurity, and gentamicin exposure. CONCLUSIONS: HL in this rural, third world environment is more prevalent, and the etiologies responsible in this study group are different from those encountered in industrialized nations. Poor perinatal health care, infectious causes, gentamicin exposure, and hereditary HL are potentially preventable causes that play a major role in this population.