Autoimmune inner ear disease (AIED) is a rare disease that is diagnosed after clinical suspicion and response to corticosteroids. AIED manifests as progressive, bilateral, although often asynchronous, sensorineural hearing loss and can be associated with vestibular symptoms. Since its description as a defined disease entity in 1979, the initial mainstay of treatment remains high-dose corticosteroids. Several animal models have been developed to assist in determining efficacy of immunosuppression in AIED, and several clinical studies have also investigated the role of both steroid and steroid-sparing treatments. Here we discuss the basic science and clinical research surrounding the history of immunosuppressive therapy in AIED. Keywords autoimmunity; corticosteroid; hearing loss; immunomodulation; immunosuppression Autoimmune inner ear disease (AIED) was first described by McCabe in 1979 [1]. AIED is one of the few treatable forms of sensorineural hearing loss and is diagnosed on clinical suspicion. Autoimmune sensorineural hearing loss is characterized by bilateral disease, often with the severity of hearing loss being asymmetric. In McCabe's initial report, hearing loss was slowly progressive and nonfluctuating, worsening over the course of weeks to months. Some cases were associated with temporary facial paralysis and tissue destruction. However, vertiginous episodes were rarely observed. A lymphocyte-migration inhibition assay was the only laboratory test available and assessed the ability of inner ear homogenate to inhibit migration of the patient's peripheral blood mononuclear cells (PBMCs). Most importantly, the auditory symptoms responded to immunosuppressive therapy. McCabe's report summarized data from 18 patients seen and treated over the course of 10 years.In 1984, Hughes and colleagues published a clinical profile for autoimmune hearing loss developed from 15 patients with laboratory-suggested AIED [2]. In addition to McCabe's observations, Hughes concluded that AIED may present as a localized primary disease or be present in association with a systemic autoimmune disorder, being referred to as secondary. Approximately 30% of patients with AIED have a systemic autoimmune disease [3]. In contrast to McCabe's initial report, Hughes concluded that hearing loss could begin abruptly, fluctuate over time, and occur with or without vertigo.As reviewed by Hughes and colleagues, treatment at the time was guided by both the experience of the clinician and theoretical management of active autoimmune response [2,4]. Glucocorticoids were, and still remain to be, the first-line therapy for AIED. Those who failed glucocorticoid therapy were then offered other immunosuppressive agents, with plasmaphoresis being reserved for the most resistant cases. In the three decades since the first report of autoimmune hearing loss, research on the molecular mechanisms underlying this disease and investigation of treatment efficacy have advanced clinical understanding and practice. Our goal here is to provide an overview...

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Burnout in modern medicine is becoming more recognized and researched. The objective in this study is to evaluate burnout in a tertiary care academic institution and compare results among faculty, trainees, and advanced practice practitioners (APPs) in a cross-sectional survey using the Maslach Burnout Inventory. Fifty-two surveys were distributed; 44 participants completed the survey (85%): 25 staff physicians (57%), 14 resident physicians (32%), and 5 nurse practitioners (11%). Staff physicians had low emotional exhaustion, moderate depersonalization, and low result for reduced personal accomplishments; trainees reported low emotional exhaustion, high depersonalization, and moderate reduced personal accomplishment; and nurse practitioners reported moderate on all 3 dimensions. There is overall low burnout in this tertiary care academic center of otolaryngologist providers and no difference in rates among the different groups (trainees, APPs, staff). Measures addressing specific deficiencies among dimensions of burnout would be helpful to prevent disintegration of physician satisfaction into burnout.

This study examines associations among publication number, National Institutes of Health (NIH) funding rank, medical school research rank, and otolaryngology department ranks of otolaryngology applicants during the 2018-2019 match cycle. Information regarding 2018-2019 otolaryngology applicants was collected from Otomatch.com and verified via department websites. Information was also collected regarding 2018 NIH funding rank and 2020 US News & World Report research rank of medical schools and otolaryngology departments. T tests and chi-square analyses were performed. Top 40 NIH funding rank, top 40 medical school research rank, and home institution department rank were separately associated with more publications and higher rates of matching into highly reputed otolaryngology departments (all P < .01). Furthermore, applicants who matched into ranked otolaryngology departments averaged significantly more publications ( P < .01). Prospective otolaryngology applicants should take into account NIH funding rank, medical school research rank, and otolaryngology department rank, as they are associated with matching into high-ranking institutions.

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Objectives to Examine the practice characteristics of same-day clinic appointments and the use of same-day appointment scheduling to provide access to care in an otolaryngology–head and neck surgery clinic. Methods Retrospective chart review of same-day clinic appointments from January 1, 2016, to December 31, 2018, in patients aged >19 years at a single academic center. Demographic data, diagnoses, procedures completed, and operations completed were analyzed. Results There were 2696 visits by 2324 patients during the 3-year study period. More men than women (57% vs 43%) made same-day appointments. The mean age was 50.7 years (range, 19-99 years). Sinonasal and otologic diagnoses were the most frequently coded. A total of 1452 procedures were completed on the day of the visit, and 239 operations were completed as a result of the visit. Overall, a broad spectrum of otolaryngology care was delivered within the organizational new patient access goals. Discussion Access to otolaryngology–head and neck surgery care can be challenging. Many patients will seek care when they feel they need it, and patient conditions can change unexpectedly. Offering same-day scheduling can allow patients timely health care and appropriate care. Implications for Practice Same-day appointment scheduling can provide access to care and urgent care for patients. The department of otolaryngology–head and neck surgery has been able to maintain a high rate of providing new patient appointments within 10 days with this method. Further considerations for the impact of same-day scheduling on no-show rates and patient satisfaction can be evaluated.

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