Abstract Objective Otolaryngologic diseases of the head and neck contribute greatly to the global surgery disease burden. With less than 30 ENTs for a population of 13.2 million, Rwanda has significant gaps in otolaryngologic care. This study assessed early implementation outcomes of the first virtual otolaryngology training for primary care providers (PCPs) in Rwanda. Study Design Pre‐Post Intervention. Setting This study was conducted among Rwandan PCPs who participated in a virtual otolaryngology training session, held on Zoom on July 27, 2024. Methods A virtual training led by Rwandan otolaryngologists was developed to teach PCPs about commonly encountered otolaryngology conditions. Preintervention, immediate postintervention, and 1‐month postintervention surveys of attendees measured the training's appropriateness, acceptability, and effectiveness. Results Seventy‐four PCPs attended. There were 49 respondents preintervention, 62 respondents immediately postintervention, and 30 respondents 1‐month postintervention. Twenty‐three of the 30 Rwandan districts were represented. The training was highly appropriate with all respondents agreeing that training topics were relevant to their clinical practices. The training was also highly acceptable, with 80% of respondents preferring the online format over other modalities. Respondents' knowledge assessment scores improved by 10% on average. The majority of respondents felt the training improved their ability to assess, manage, and refer patients with otolaryngology conditions. These perceptions were maintained 1‐month postintervention. Conclusion The first virtual otolaryngology training focused on PCPs in Rwanda was highly appropriate, acceptable, and effective. Given the burden of otolaryngology disease and otolaryngology workforce shortages, virtual training of PCPs is an innovative format in resource‐constrained health systems, such as in Rwanda.
Abstract Objectives Cancer clinical trial (CCT) enrollment remains essential to advancing oncologic care, yet participation disparities persist. While socioeconomic status (SES) and race are associated with lower enrollment across oncology, determinants within head and neck cancer (HNC) are less defined. We evaluated whether SES and geographic distance were associated with HNC CCT enrollment. Study Design Retrospective cohort study. Setting Multidisciplinary HNC clinic at a comprehensive cancer center. Methods Patients evaluated between May 2023 and April 2024 with documented discussion of CCT participation were identified from a prospective database. Eligibility and enrollment status were confirmed by chart review. SES measures included insurance status and zip code–level median income. Travel distance to the trial site was calculated. Univariable and multivariable logistic regression analyses were performed. Results Of 192 patients screened, 169 met eligibility criteria; 59 (35%) enrolled and 110 (65%) declined. In multivariable analysis, female sex was associated with lower odds of enrollment (OR 0.34, 95% CI 0.13‐0.87, P = .025). Greater travel distance independently predicted lower enrollment (OR 0.99 per mile, 95% CI 0.99‐1.00, P = .045). Stage IV disease trended toward lower participation but was not statistically significant. No significant associations were observed for age, race/ethnicity, median income, insurance status, or comorbidity index. Conclusions In this single‐institution cohort, geographic distance and sex were independent predictors of HNC CCT enrollment, whereas SES was not. Structural accessibility may represent a more immediate enrollment barrier within tertiary referral populations. Prospective studies are needed to validate these findings and inform interventions to improve equitable trial participation.
Abstract Objective To evaluate whether the use of an educational video explaining the differences between intracapsular and extracapsular tonsillectomy, as well as their respective risks and benefits, influences parental decision‐making in a pediatric otolaryngology clinic. Methods Flyers with a quick response (QR) code linking to a video that explained intracapsular versus extracapsular tonsillectomy techniques and associated complications were posted in exam rooms of a pediatric otolaryngology clinic in July 2024. Parents were encouraged to view the video. Data were collected for tonsillectomies performed between May 2024 and January 2025, including clinic visit date, patient age and gender, parent at the visit, indication for tonsillectomy, and procedure chosen. Results Of 214 patients, 133 (62%) had clinic visits before flyers were posted and 81 (38%) after. Before the flyers, only 24 (18%) chose intracapsular tonsillectomy, compared to 34 (42%) afterward ( P < .001). Obstructive sleep apnea (OSA) or sleep disordered breathing (SDB) were the most common surgical indications (N = 200, 94%). Patient age and gender, parent at visit, and surgical indication were not significantly associated with the procedure chosen. Discussion These findings suggest educational interventions can influence parental preference for tonsillectomy type. Providing accessible, comprehensible information may support more informed decision‐making, potentially improving surgical outcomes and parent satisfaction. Implications for Practice Integrating concise educational tools into clinic visits offers a practical way to enhance communication and engage families in shared surgical decision‐making. These interventions may also standardize information delivery and reduce variability in how options are presented across providers.
Abstract Objective Assess a longitudinal, education‐centered short‐term surgical trip partnership's impact on knowledge, technical skill, and learner attitudes among otolaryngology residents. Study Design Prospective, pre‐post interventional study. Setting Single institution in Mekele, Ethiopia. Methods In May 2024, 12 otolaryngology residents participated in a 4‐week curriculum of didactics and skills sessions on suture and parotidectomy techniques at Ayder Comprehensive Specialized Hospital. The visiting surgical team administered precurriculum and postcurriculum self‐assessments of confidence rated on Likert scales, multiple choice exams (MCE), and Objective Structured Clinical Examinations (OSCE). To assess long‐term retention of knowledge and skills, the assessments were also administered 9 months after the initial STST. T ‐tests and Wilcoxon signed‐rank tests were used to compare precurriculum and postcurriculum outcomes. Results The study cohort included 3 PGY1, 4 PGY2, and 5 PGY3 who engaged in an average of 2 parotidectomies, 18 hours of study, and 3 hours of skills practice. Participants had significantly greater postcurriculum confidence in using nylon ( P = .048), prolene ( P < .01), monocryl ( P < .01), and PDS ( P < .01) and performing drain stitches ( P = .035) and parotidectomy ( P = .046) at the end of the first STST. After 9 months, there were no significant changes in assessment scores. All participants reported improved suture skills and strongly agreed that the curriculum was manageable along with clinical tasks. Conclusion This study provides a framework for building sustainable partnerships across institutions. The education and assessment formats were feasible and improved subjective and objective knowledge and clinical skills. Continued longitudinal tracking of outcomes and their application towards guiding STST partnerships are warranted.
Abstract Objectives To determine the prevalence and predictors of thyroid gland invasion in Hispanic patients with laryngeal squamous cell carcinoma undergoing total laryngectomy and to assess thyroidectomy‐associated comorbidities. Study Design Retrospective cross‐sectional review. Setting University District Hospital, Puerto Rico Medical Center, San Juan, PR. Methods Records of adults with laryngeal squamous cell carcinoma who underwent total laryngectomy from 2009 to 2022 were reviewed. Tumor characteristics were correlated with histopathologic thyroid gland invasion, and postoperative hypocalcemia was documented. Categorical variables were compared using Fisher's exact or Pearson's chi‐square tests, with effect size reported by Cramér's V ; continuous variables were analyzed with the Wilcoxon‐Mann‐Whitney test. Results Of 105 patients, 8 (7.6%) had thyroid gland invasion. Tumors with invasion were larger (5.0 ± 1.3 vs 3.3 ± 1.4 cm; P = .003) and were associated with thyroid cartilage invasion (100% vs 54.6%; P = .020). Patients with invasion underwent total thyroidectomy more often (75.0% vs 28.9%; P = .013). Postoperative hypocalcemia occurred in 41.9% (44/105) of patients overall and was more frequent after total than after partial thyroidectomy (79.4% vs 23.9%; P < .001). Intravenous calcium replacement was required in 19.0% (20/105) of patients, more often after total thyroidectomy (47.1% vs 5.6%; P < .001). Conclusion Thyroid gland invasion was uncommon but associated with larger tumors and thyroid cartilage invasion. Total thyroidectomy carried a higher risk and greater severity of hypocalcemia. These findings support selective thyroid management during total laryngectomy and provide evidence from an underrepresented Hispanic population.
