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Year : 2020  |  Volume : 26  |  Issue : 1  |  Page : 1-3

Physician attachment to stapedectomy: A comparison of survey responses

Department of Otolaryngology, University of Illinois Health Sciences, Chicago, IL, USA

Date of Submission08-Oct-2018
Date of Acceptance11-Jan-2019
Date of Web Publication19-Feb-2020

Correspondence Address:
Dr. Johanna Wickemeyer
University of Illinois Health Sciences, 1855 West Taylor Street, Suite 2.42, Chicago 60612, IL
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/indianjotol.INDIANJOTOL_92_18

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Objective: To demonstrate that surgeons who perform stapedectomies derive intrinsic enjoyment from the procedure. Subjects: An experimental group of 174 otologists/neurotologists who possibly perform stapedectomy, one control group of 145 head/neck oncologists who possibly perform parotidectomy, and a second control group of 365 pediatric otolaryngologists who possibly perform tonsillectomy. Intervention: Observational study using four-question anonymous surveys distributed by electronic mail. Outcome Measures: Responses to surveys by participants during a four-week period. Results: During the four-week survey periods, 84/174 neurotologists (48%) responded, while 33/145 oncologists (23%), and 87/365 pediatric otolaryngologists (24%) responded. Seventy-six of the 80 neurotologists who still performed stapedectomies (95%) enjoyed performing it, slightly more than the 30 of the 33 oncologists who still performed parotidectomies (91%), and appreciably more than the 67/87 pediatric otolaryngologists who still performed tonsillectomies (77%). Twenty-three neurotologists (30%) would sacrifice vacation time to perform additional stapedectomies, slightly more than 8 oncologists (27%) for additional parotidectomies, and more than the 7 pediatric otolaryngologists (10%) for additional tonsillectomies. Ten (13%) of the neurotologists, three (9%) of the oncologists, and one (2%) of the pediatric otolaryngologists would sacrifice five or more vacation days to perform more of the procedures. Conclusions: Our survey suggests that stapedectomy is intrinsically enjoyable.

Keywords: Patient satisfaction, physician burnout, stapedectomy

How to cite this article:
Wickemeyer J, Achim V, Redleaf M. Physician attachment to stapedectomy: A comparison of survey responses. Indian J Otol 2020;26:1-3

How to cite this URL:
Wickemeyer J, Achim V, Redleaf M. Physician attachment to stapedectomy: A comparison of survey responses. Indian J Otol [serial online] 2020 [cited 2021 Sep 22];26:1-3. Available from: https://www.indianjotol.org/text.asp?2020/26/1/1/278742

  Introduction Top

We have observed anecdotally in our otology/neurotology practice of the past 25 years that unhappy patients are wearing, whereas happy patients are uplifting. It is no wonder then that many otolaryngologists, otologists, and neurotologists appear to enjoy performing stapedectomies: the immediate reversal of conductive hearing loss from the stapedectomy can be experienced by the patient while still on the operating table. Moreover, the otologist/neurotologist feels good about it.

Medical literature often cites patient satisfaction, as for example with rhinoplasty, but does not focus on the physician's experience.[1] This study demonstrates the satisfaction surgeons themselves experience when performing a procedure – stapedectomy. Our hypothesis was that stapedectomy is intrinsically so satisfying that the otologist/neurotologist would sacrifice something dear to them in order to perform more of them. Control surveys of head-and-neck oncologists' attachment to parotidectomy, and of pediatric otolaryngologists' attachment to tonsillectomy, are offered for comparison.

  Methods Top

A four-question survey was successfully sent to 174 neurotologists via SurveyMonkey® on December 25, 2017 [Table 1] – stapedectomy]. The United States neurotologists were identified based on E-mail lists professionally available to the senior author. An identically constructed four-question survey [Table 1] – parotidectomy] was successfully sent via SurveyMonkey® to 145 head-and-neck oncology subspecialists, whose E-mail addresses were similarly identified, on March 30, 2018. Finally, another identically constructed four-question survey [Table 1] – tonsillectomy] was successfully sent via SurveyMonkey® to 365 pediatric otolaryngologists on May 6, 2018. There was no overlap between the three E-mail lists. Responses to all surveys were completely anonymous, containing no identifying information on participants, and no demographic data were collected. The responses to each survey were collected over 4 weeks, and responses submitted after that time were not analyzed. Participants were E-mailed only one time, on one date only, with the assurance that the recipients receive no further E-mails. This last stipulation was provided as a further incentive to respond to the survey.
Table 1: Stapedectomy/(Parotidectomy/Tonsillectomy) surveys and responses

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The survey was constructed so that a negative answer to the first question (1 – “Have you preformed any stapedectomies [parotidectomies] tonsillectomies in the past 2 years?”) or to the second question (2 – “Do you enjoy performing stapedectomies [parotidectomies] tonsillectomies?”) would immediately terminate the survey. Positive answers to the initial two questions required participants to complete all the four questions of the survey for the survey to be tallied. Parotidectomy was chosen as one “control operation” because of the esthetic satisfaction of the facial nerve dissection because it is less ablative or destructive than other oncologic procedures and it has anecdotally been reported as a pleasurable operation to perform. Tonsillectomy was chosen as the other “control operation” because it is common, with clearly defined goals.

  Results Top

All duplicate E-mail addresses and all error messages were eliminated from the denominators of survey tallies. In the first 5 days of the stapedectomy survey release, there was a 41% response rate. By 4 weeks, there were 84 responses (48%). On comparison, in the first 5 days of the comparison parotidectomy survey release, there was a 20% response rate. By the end of 4 weeks of the oncologic survey, there were 33 out of 145 responses corresponding to a 23% response rate. For the tonsillectomy survey, 87 of 365 (24%) had responded in 4 weeks. Ninety-five percentage of neurotologists and 91% of oncologists who still performed their operations enjoyed it, whereas 77% of pediatric otolaryngologists still enjoyed performing a tonsillectomy. Enjoyment of stapedectomy was rated a mean of 88 (range 40–100), whereas enjoyment of parotidectomy was rated a mean of 87 (range 62–100) and enjoyment of tonsillectomy was rated a mean of 77 (range 29–100).

Among subspecialists who enjoyed their respective operations, the responses were similar although always weighted toward stapedectomy enjoyment [Table 2]. Seventy-six neurotologists (95%), 30 oncologists (91%), and 67 pediatric otolaryngologists (77%) still enjoyed performing their respective operations. Twenty-three neurotologists (30%), eight oncologists (27%), and seven pediatric otolaryngologists (10%) would give up vacation time in order to perform more stapedectomies, parotidectomies, or tonsillectomies. Ten neurotologists (13%), three oncologists (9%), and one pediatric otolaryngologist (2%) would sacrifice 5 or more vacation days. Four neurotologists (5%), one oncologist (3%), and no (0%) pediatric otolaryngologists would sacrifice 10 or more days.
Table 2: Survey question #4 - value of the stapedectomy/parotidectomy/tonsillectomy experience for subspecialists who enjoy the operations as measured in vacation days sacrificed

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  Discussion Top

These surveys suggest that both otolaryngology subspecialists enjoy performing stapedectomy as well as parotidectomy, and tonsillectomy less so. The majority who had recently performed the procedures (stapedectomy, parotidectomy, and tonsillectomy) rated their enjoyment of the procedure as 88, 87, and 77 out of a possible 100, respectively. Similarly, 30% of neurotologists, 27% of oncologists, and 10% of pediatric otolaryngologists who enjoy performing their respective procedures would sacrifice vacation time in order to perform more of them: ten neurotologists (13%), three head-and-neck subspecialists (9%), and one pediatric otolaryngologist (2%) were willing to sacrifice 5 or more vacation days to perform more of their designated operation. Four neurotologists (5%), one head-and-neck specialist (3%), and no pediatric otolaryngologist (0%) were willing to sacrifice 10 or more vacation days. Despite the similarity of these data, parotidectomy and particularly tonsillectomy trail behind stapedectomy as enjoyable experiences. In addition, the major difference in response rates – 48% compared to 23% and 24% – suggests an unusual interest in stapedectomy.

The survey response rate for the stapedectomy cohort is exceptionally high. A recently published survey of American neurotologists found a response rate of 20% in a survey of 194 neurotologists.[2] Other recent surveys of neurotologists further highlight this unusually high response rate: the 53rd Annual Spring Meeting of the American Neurotology Society (ANS) presented three surveys to members, all of which demonstrated response rates between 3% and 30%: a survey addressing facial nerve monitoring use was sent to members of the ANS, the American Otological Society, and the American Society of Pediatric Otolaryngologists – approximately 10,000 people. This survey received only 273 responses, or <3%.[3] Meanwhile, a survey of use of electronic medical record was sent to 550 ANS members and received 127 responses, or approximately 23%.[4] A survey study focusing on diversity issues was sent to 550 ANS members and received 165 responses for a 30% response rate.[5] All six of these response rates, including our parotidectomy and tonsillectomy surveys, were well below the 41% response rate to the stapedectomy survey in the first 5 days, and of course even further below the 48% response rate at 4 weeks.

Most methods to evaluate subject preferences involve self-rating scales such as the Likert scale. Another approach to preference measures the value of a state or activity by the number of days one is willing to sacrifice for the state or activity in question (e.g., “How many days of life would you give up in order to avoid/shorten/remove this health condition of yours?”).[6] This approach formed the basis of the final question, “Hypothetically, if your income or sick leave allotment went unchanged, how many vacation days would you give up per year to perform additional stapedectomies (parotidectomies) tonsillectomies?” With this question, there were notable differences between the surveys.

Perhaps, there are methodological reasons to doubt comparisons between these surveys. The actual recipients of the stapedectomy survey were the same individuals as those of recent ANS member surveys, yet they answered in comparatively greater numbers. This appears to reflect a difference in interest, but may instead be related to the questionnaire design. The stapedectomy survey recipients also responded in greater percentages than the parotidectomy or tonsillectomy survey recipients. This also suggests a difference in interest, but may be related to other factors which might impose different time/email constraints on the three groups of subspecialists. Even with these limitations in mind, it does appear that surgeons greatly enjoy performing stapedectomy.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Snow J, Wackym P. Ballenger's Otorhinolaryngology Head and Neck Surgery, 17E. Shelton, CT: People's Medical Publishing House BC Becker Inc., 2009. p. 633.  Back to cited text no. 1
Page JC, Cox MD, Hollowoa B, Bonilla-Velez J, Trinidale A, Dornhoffer JL. Trends in intraoperative testing in cochlear implantation. Otolo Neurotol 2018;39:294-8.  Back to cited text no. 2
Maw J. ANS Report on Member use of the Facial Nerve Monitor. 53rd Spring Meeting ANS. National Harbor, MD; 22 April, 2018.  Back to cited text no. 3
Giddings NA. ANS Report Member use of the Electronic Medical Record. 53rd Spring Meeting ANS. National Harbor, MD;22 April, 2018.  Back to cited text no. 4
Toh E. ANS Report on Member Diversity. 53rd Spring Meeting ANS. National Harbor, MD;21 April, 2018.  Back to cited text no. 5
Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ 1986;5:1-30.  Back to cited text no. 6


  [Table 1], [Table 2]


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