Gender Disparity in Non-ACGME (Accreditation Council for Graduate Medical Education) Otolaryngology Fellowship Leadership.

OBJECTIVE: Women are underrepresented among practicing otolaryngology physicians with increasing disparities in leadership roles and higher levels of professional attainment in academic medicine. The purpose of this study is to determine the gender gap among fellowship directors within specific otolaryngology subspecialties, and how this compares to disparities among all academic appointments held by otolaryngologists. Additionally, we seek to better understand how years practiced, H-index, professorship status, and academic productivity differ between men and women in fellowship director roles. DESIGN: Cross-sectional. Publicly available data from non-ACGME accredited otolaryngology fellowships was collected from department websites and Doximity including gender, years of practice, and professor status of fellowship directors. Scopus was used to find H-index for identified fellowship directors. Fisher's Exact tests were used to determine if significant gender disparity existed between each fellowship and academic otolaryngology as whole. H-index and years of practice were plotted for men and women comparing the slope of lines of best fit as a measure of academic productivity. SETTING: Non-ACGME accredited otolaryngology fellowships in the US. PARTICIPANTS: Fellowship directors in non-ACGME accredited otolaryngology fellowships. RESULTS: Among 174 fellowship positions in our analysis, head and neck (17.3% women), laryngology (17.2% women), rhinology (5.7% women), and facial plastics (8.1% women) had significantly lower overall women representation compared to academic otolaryngology (36.6% women) (p < 0.05). As fellowship directors, women were significantly more productive than men given years practiced and H-index (p = 0.008). CONCLUSIONS: Gender disparities among otolaryngologists are amplified in the role of fellowship directors compared to broader academic otolaryngology. This is true despite women in these roles demonstrating higher academic productivity.

Implementation of Free Mucosal Graft Technique for Sellar Reconstruction After Pituitary Surgery: Outcomes of 158 Consecutive Patients.

BACKGROUND: Cerebrospinal fluid (CSF) leak is a common complication after surgeries involving sellar reconstruction. Various techniques, including the nasoseptal flap, have been developed to limit postoperative CSF leak. However, the nasoseptal flap causes complications owing to donor site morbidity. A free mucosal graft may be just as effective in reducing CSF leaks as well as reducing postoperative nasal discomfort. This study aimed to assess operative outcomes of free mucosal graft after pituitary resection. METHODS: A retrospective chart review was performed for patients who underwent endoscopic endonasal resection of pituitary adenomas. The following data were collected: demographic data, intraoperative CSF leak, postoperative CSF leak, other complications, and mucosal graft healing at 1 month. Also, the Sinonasal Outcome Test-22 was administered preoperatively and 1 month and 3 months postoperatively. RESULTS: Charts of 158 patients were reviewed, including patients who underwent no mucosal reconstruction, free mucosal graft reconstruction, and nasoseptal flap reconstruction. There was a 7.4% postoperative CSF leak rate in patients who underwent no reconstruction (n = 27), whereas postoperative CSF leak rate was 0.82% in patients undergoing free mucosal graft reconstruction (n = 122) (P < 0.05). Sinonasal Outcome Test-22 scores for patients with free mucosal graft reconstruction showed no significant worsening postoperatively. CONCLUSIONS: The free mucosal graft is a simple and effective means of sellar reconstruction in patients undergoing endonasal endoscopic pituitary resection, and its efficacy is similar to nasoseptal flaps. The free mucosal graft technique does not worsen sinonasal morbidity postoperatively.