Background Transsphenoidal surgery is the gold standard for pituitary adenoma resection. Although rare, a serious complication of surgery is worsened vision post-operatively. Objective To determine whether, in patients undergoing transsphenoidal surgery for pituitary adenoma, intraoperative monitoring of visual evoked potentials (VEP) is a safe, reproducible, and effective technological adjunct in predicting postoperative visual function. Methods The PubMed and OVID platforms were searched between January 1993 and December 2020 to identify publications that (1) featured patients undergoing transsphenoidal surgery for pituitary adenoma, (2) used intraoperative optic nerve monitoring with VEP and (3) reported on safety or effectiveness. Reference lists were cross-checked and expert opinion sought to identify further publications. Results Eleven studies were included comprising ten case series and one prospective cohort study. All employed techniques to improve reliability. No safety issues were reported. The only comparative study included described a statistically significant improvement in post-operative visual field testing when VEP monitoring was used. The remaining case-series varied in conclusion. In nine studies, surgical manipulation was halted in the event of a VEP amplitude decrease suggesting a widespread consensus that this is a warning sign of injury to the anterior optic apparatus. Conclusions Despite limited and low-quality published evidence regarding intra-operative VEP monitoring, our review suggests that it is a safe, reproducible, and increasingly effective technique of predicting postoperative visual deficits. Further studies specific to transsphenoidal surgery are required to determine its utility in protecting visual function in the resection of complex pituitary tumours.

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Introduction Despite a recent drive to increase diversity, the global academic workforce is skewed in favor of authors from high‐income countries, and women are under‐represented in the published medical literature. Objectives To explore the trends in authorship of three high‐impact otolaryngology journals over a ten‐year period (2011–2020). Methods Journals selected: JAMA Otolaryngology–Head and Neck Surgery , The Laryngoscope and Rhinology. Articles were reviewed from four issues per journal per year, and data was collected on: time of publication; subspeciality; number of authors; sex of first and last authors; country of practice of first author and country where each study was conducted. Trends were examined though univariate and multivariate logistic regression models. Results 2998 articles were included. 93.9% of first authors and 94.2% of studies were from high‐income countries. Women were first authors in 31.5% ( n = 912) and senior authors in 18.4% ( n = 524) of articles. Female first authorship significantly increased between 2011 and 2020 however female senior authorship remained the same. There have been no significant changes in the proportion of published articles from low‐and middle‐income countries (LMIC) over time ( p = .65). Amongst the LMIC articles, 72% came from Brazil, Turkey or China and there were no published papers from countries with a low‐income economy (gross national income per capita of $1085 or less). Conclusions Although female first authorship has increased in the last decade, there has been minimal other demographic change in authorship over this time. High‐impact otolaryngology journals poorly represent academia in low‐and‐middle income countries. There is a need for increased advocacy promoting gender and geographical research equity in academic medicine. Level of Evidence III.

Purpose of reviewIdentify patient-perceived barriers to head and neck cancer care and compare differences in barriers by country income status.Recent FindingsOf the 37 articles, 51% (n = 19) were from low- and middle-income countries (LMICs), while 49% (n = 18) were from high-income countries. Of the papers from high-income countries, unspecified head and neck cancer (HNC) subtype (67%, n = 12) were the most common cancer type, while upper aerodigestive tract mucosal malignancies (58%, n = 11) were more common in LMICs (P = 0.02). Based on World Health Organization barriers, level of education (P =  < 0.01) and alternative medicine use (P = 0.04) were greater barriers in LMICs compared to high-income countries. At least 50% of articles listed barriers at all three ‘Three Delays’ timepoints. There were no significant differences by country income status for the ‘Three Delays’ timepoints of deciding to seek care (P = 0.23), reaching the healthcare facility (P = 0.75), or receiving care (P = 1.00).SummaryPatients face barriers to care for head and neck cancer regardless of country income status. There is overlap in several barriers and a need for systemic improvement in access. The differences in education and alternative medicine may guide region-specific interventions to improve the provision of head and neck services.