Addressing inequities in the otolaryngology academic publishing: A call to action

Article processing charges (APCs) for open access (OA) journals perpetuate inequities in scientific knowledge. High APCs systematically restrict low- and middle-income country (LMIC) researchers from contributing to research knowledge, preventing the dissemination of high-value, high-quality, and sustainable LMIC-driven solutions. Otolaryngology journals are no exception. The authors propose solutions to rectify the inequities in academic publishing because of APCs, including innovative solutions adopted by several major journals. Addressing these inequities requires medical society and journal editorial board leadership to ensure equitable APC policies

Paediatric airway foreign-body removal equipment availability in sub-Saharan Africa

Sub-Saharan Africa (SSA), home to over 1 billion people, has only one paediatric otolaryngology fellowship program and nine fellowship-trained paediatric Otolaryngology Head and Neck Surgery (OHNS) specialists covering seven countries. Seven of these specialists estimated an average of 40+ patients per month are in need of critical surgical airway management in their respective countries and that 2–25 deaths per year (mainly paediatric) occur in their country from lack of access to foreign body removal equipment. Investing in paediatric airway infrastructure and capacity would largely benefit the health system in SSA, where the current lack of equipment alone leads to unmeasured morbidity and mortality. As a region of the world with the largest paediatric populations, sub-Saharan Africa’s need is all the more pressing given the disproportionately low number of medical specialists, institutions and resources. Collaborative approaches in procurement and maintenance of high-quality, cost-effective equipment are crucially desirable factors in both low- and middle-income countries (LMICs) and high-income countries (HICs). We, as the Global OHNS Initiative, urge for multi-stakeholder engagement and collaboration to forge lasting change

Challenges facing otolaryngologists in low- and middle-income countries during the COVID-19 pandemic.

The COVID-19 pandemic poses significant challenges for otolaryngologists practicing in low- and middle-income countries (LMICs). This commentary highlights some of the particular challenges in low resource settings, including limited testing, insufficient personal protective equipment, small numbers of surgeons, and competing socio-economic demands. The commentary focuses on specific examples from around the world to draw attention to these challenges and also highlight examples of success and innovation. Amidst the crisis an opportunity exists for otolaryngologists from around the world to share resources, ideas, and innovations to best serve patients and improve the health system globally for the future

Essential equipment and services for otolaryngology care: a proposal by the Global Otolaryngology-Head and Neck Surgery Initiative.

PURPOSE OF REVIEW: To highlight the need for comprehensive resource lists to provide baseline care of otolaryngologic conditions; to present a proposed list of essential equipment and services that may be applied toward surgical systems research, policymaking, and charitable efforts in global otolaryngology-head and neck surgery. RECENT FINDINGS: To provide effective and high-quality surgical care across care settings, there must be a global standard for equipment and ancillary services necessary to provide baseline care. Though there have been efforts to devise resource standards via equipment lists and appraisal tools, these have been limited in scope to general surgery, emergency care, and a few other subspecialty surgical contexts. Recent efforts have brought attention to the significant burden imposed by otolaryngologic conditions such as hearing loss, otitis media, head and neck cancer, head and neck trauma, and upper airway foreign bodies. Yet, there has not been a comprehensive list of resources necessary to provide baseline care for common otolaryngologic conditions. SUMMARY: Through an internal survey of its members, the Global Otolaryngology-Head and Neck Surgery Initiative has compiled a list of essential equipment and services to provide baseline care of otolaryngologic conditions. Our efforts aimed to address common otolaryngologic conditions that have been previously identified as high-priority with respect to prevalence and burden of disease. This expert-driven list of essential resources functions as an initial framework to be adapted for internal quality assessment, implementation research, health policy development, and economic priority-setting

Human Papillomavirus–Associated Head and Neck Malignancies in Sub-Saharan Africa: A Systematic Review

PurposeThe proportion of head and neck cancers (HNCs) with human papillomavirus (HPV) positivity in sub-Saharan Africa (SSA) is poorly characterized. Characterizing this has implications in staging, prognosis, resource allocation, and vaccination policies. This study aims to determine the proportion of HPV-associated HNC in SSA.Materials and methodsThis systematic review included searches from PubMed, EMBASE, Web of Science, African Index Medicus, Google Scholar, and African Journals Online. All English publications reporting the proportion of HNC specimens from SSA patients who tested positive for HPV and/or p16 were included. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Case Series Studies.ResultsIn this systematic review of 31 studies and 3,850 patients, the overall p16 positivity was 13.6% (41 of 1,037 patients tested) with the highest proportion among oropharyngeal cancers (20.3%, 78 of 384 patients) and the overall HPV polymerase chain reaction positivity was 15.3% (542 of 3,548 samples tested) with the highest proportion among nasopharyngeal cancers (16.5%, 23 of 139 patients). Among the 369 HPV strains detected, the most common genotypes were HPV 16 (226 patients, 59.2%) and HPV 18 (78, 20.4%).ConclusionHPV was found to be associated with a significant proportion of HNC in SSA. The genotypes reported suggest that the nine-valent vaccine and gender-neutral vaccination policies should be considered. Given that these studies may not accurately capture prevalence nor causation of HPV in HNC subsites, additional research is needed to provide a more thorough epidemiologic understanding of HPV-associated HNC in SSA, including risk factors and clinical outcomes

Research Equity in Otolaryngology–Head and Neck Surgery

Equitable research collaborations benefit the quality and relevance of global otolaryngology–head and neck surgery research. However, analyses of existing global health literature have shown disproportionate representation by foreign authors. To avert this inequity and improve global otolaryngology–head and neck surgery research, we propose a framework that emphasizes local representation and capacity building in research