Objective The objective of this study was to develop an international expert consensus on priority otolaryngology–head and neck surgery conditions and procedures globally for which national health systems should be capable of caring. Study Design The Delphi method was employed via a multiround online survey administered to attending otolaryngologists in an international research collaborative of >180 otolaryngologists in >40 countries. Setting International online survey. Methods In round 1, participants listed the top 15 otolaryngologic conditions and top 15 otolaryngology procedures for their World Bank regions. In round 2, participants ranked round 1 responses in order of global importance on a 5-point Likert scale. In round 3, participants reranked conditions and procedures that did not achieve consensus, defined as 50% of the round 2 Likert responses being ranked as “important” or “very important.” Descriptive statistics were calculated for each round. Results The survey was distributed to 53 experts globally, with a response rate of 38% (n = 20). Fifty percent (n = 10) of participants were from low- and middle-income countries, with at least 1 participant from each World Bank region. Ten consensus surgical procedures and 10 consensus conditions were identified. Conclusion This study identified a list of priority otolaryngology–head and neck surgery conditions and surgical procedures for which all national health systems around the world should be capable of managing. Acute and infectious conditions with preventative and emergent procedures were highlighted. These findings can direct future research and guide international collaborations.

Due to geographic-specific patient and institutional-related barriers to care, data extrapolation and expert opinion on global burden of disease in otolaryngology–head and neck surgery may under- or overestimate the presence and effect of common head and neck conditions. The group of conditions that fail to present to local physicians and/or missed in data extrapolation methods is the unseen burden of disease. This article presents opinions from otolaryngology–head and neck surgery physicians in high- and low/middle-income countries to help explain the contributing factors and ultimately how to use this unseen burden of disease.

Epistaxis in children can be caused by different systemic and local pathologies. Respiratory infections, nasal mucosa dryness, and foreign bodies are some local causes of bleeding from the nose. In developing countries, infestations still contribute a significant proportion of anemia in children. But it is very unusual for leech-causing persistent epistaxis with a consequence of severe anemia. We herein report a rare cause of severe anemia in a 5-year-old child presented to our clinic for persistent epistaxis. A leech was taken out with forceps, and his anemia was treated accordingly.

We thank Dr Djoutsop and her colleagues for their reply and for continuing the growing conversation around global health in otolaryngology-head and neck surgery (OHNS). The global health discourse has unfortunately been historically skewed toward the research, educational, and funding priorities of high-income countries, as demonstrated by the paucity of otolaryngology publications by authors from lowand middle-income countries (LMICs). 1,2 We hope that this study and commentary encourage the otolaryngology field to prioritize LMIC otolaryngologists' perspectives in future global collaboration. As such, we are grateful for the perspective that Dr Djoutsop and her colleagues bring to the growing field of global OHNS.We also aim to advance metric-driven changes in global OHNS care delivery. This study was inspired by the development of bellwether procedures in global surgery. The availability of these procedures-cesarean delivery, laparotomy, and treatment of open fractures-at a first-level hospital system is associated with health systems having the necessary resources to provide a full range of emergency and essential surgical services. 3 The priority conditions and procedures established by our study could serve more broadly to direct priorities in research and capacity building. We encourage regional investigation of disease burdens, as studies such as ours is admittedly not universally extrapolatable from one region to another.We hope that our findings serve as a broad framework to inform research, programs, and health policy. As highlighted by Djoutsop et al, the priority conditions and procedures can be used to compare clinical capacity across settings, serve as a template for clinical competencies internationally, and encourage international collaborators to focus on priorities of local patients and care providers. Furthermore, as highlighted, the presence of emergency and infectious conditions serves as a common ground to collaborate with initiatives in other specialties. While we hope that these results instigate work in education, research, and policy, we realize that this is a starting point. More research and efforts inclusive of LMIC and resource-constrained setting priorities are needed to achieve the vision of high-quality, safe, timely, and affordable care for those with OHNS conditions worldwide.