搜索结果：World journal of otorhinolaryngology - head and neck surgery

Facial Plastic Surgery & Aesthetic MedicineVol. 22, No. 3 Viewpoints: COVID-19Free AccessTelemedicine in the Era of the COVID-19 Pandemic: Implications in Facial Plastic SurgeryTom Shokri and Jessyka G. LighthallTom Shokri*Address correspondence to: Tom Shokri, Department of Otolaryngology–Head and Neck Surgery, Penn State Health Milton Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA, E-mail Address: [email protected]Department of Otolaryngology–Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.Search for more papers by this author and Jessyka G. LighthallDepartment of Otolaryngology–Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.Search for more papers by this authorPublished Online:15 May 2020https://doi.org/10.1089/fpsam.2020.0163AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail The global COVID-19 pandemic has placed unprecedented restraints on resource allocation and patient care. The rapidity with which the pandemic has spread has resulted in the depletion of hospital resources and increased health expenditures.1 Additionally, the risk of occupational exposure for health care providers poses a significant barrier to the delivery of timely and effective patient care. Otolaryngologists, including facial plastic surgeons, are particularly at risk given the increased viral load within the upper aerodigestive tract and the aerosol-generating procedures performed.2 Many medical organizations have responded by deferring elective cases and ceasing of nonessential services. Various evidence-based guidelines have been published regarding practice modifications during this time of pandemic, and the literature is continually evolving.3 However, little is known regarding the length of time for which these precautions may be implemented. Physicians are therefore faced with the difficulty of complying with new regulatory restrictions while attempting to provide patient care.While it is important to mitigate risk of infection and further spread of this contagion, safe patient care must continue to be prioritized. This is difficult in the outpatient facial plastic surgery setting in which in-person evaluation and consultation is often instrumental in management. In light of this, alternative approaches toward care must be employed. Telemedicine, the provision of clinical services via the use of communication technology between patient and provider, is one such resource that may be effectively implemented during this time. Telemedicine may refer to transfer of static images or video between patients and physicians via mobile devices or the use of audiovisual telecommunications software to facilitate correspondence in real time.4 Implementation of such services has become progressively feasible with the corresponding increase in availability of smartphones, webcam-enabled personal computers, and high speed internet.The utility of telemedicine has previously been demonstrated in addressing health-care inequities in rural communities or during public health emergencies.4 In response to the current pandemic, the Centers for Medicare & Medicaid Services, as well as most commercial health plans, have amended policies including waiving co-pays in order to encourage utilization of telemedicine services. However, barriers to broad implementation of such services continue to exist, including equipment costs, provider training, and licensing as well as payment and regulatory services. Additionally, ethical considerations such as Health Insurance Portability and Accountability Act compliance must be taken into account. Although establishing these programs in an acute setting poses difficulties, many hospital-based health systems have leveraged already existing telemedical platforms in their response to COVID-19.4 Community-based facial plastic surgeons lacking immediate access to such programs may outsource telehealth services to providers such as American Well or Teladoc Health. These platforms provide synchronous real-time audiovisual-enabled visits and are easy to use for patients, providers, and staff scheduling appointments, allow for patient connectivity via computer, tablet, or smart phone, and abide by patient privacy laws.During the COVID-19 pandemic, additional professional evaluation and management codes have been approved for telemedicine visits. Physicians must obtain patient consent for the visit (often automated in existing platforms); document the type of visit (e.g., phone visit, synchronous face-to-face video visit, etc.); location of physician and patient; confirmation of identity; and components of the evaluation and management service performed. One key limitation is the ability to perform a comprehensive physical exam (palpation, intranasal or intraoral exam, scope evaluations, etc.). Due to this limitation, telemedicine visits are often billed based on the time spent with the patient, documenting the amount of time spent on counseling and coordination of care.Facial plastic surgeons are encouraged to familiarize themselves with the most effective means of integrating telemedical technology within their specific practice setting. For example, live teleconsultation requires coordination of patient and provider schedules, audiovisual equipment with the capacity to stream in a seamless manner, and access to high speed internet. This may be best utilized for initial consultations, in the postoperative settings to evaluate surgical site healing and patient concerns, or during more urgent issues to screen patients to determine whether they need an in-person evaluation. However, a more economical means of telecommunication, store-and-forward telemedicine, may be employed in nonurgent settings or when providers are not readily available.4 Store-and-forward telemedicine allows accumulation of relevant patient data, such as patient complaints or physical findings, through transfer of static images or stored video, which can be transmitted to the receiving consultant to review at a later time. This type of consultation may be most appropriate when implemented in nonurgent scenarios or routine patient follow-up.In our practice, initially only postoperative and follow-up patients would send photos and videos attached to a description of how they feel they are recovering. After review, patients were messaged electronically or set up for either a phone or urgent in-person visit based on the need. It was assumed that most facial plastic surgery patients would not be appropriate for telemedicine. However, our system transitioned to live visits via Zoom and now the American Well platform. We have found that many patients are happy with the experience and appreciate the continuity of obtaining care without having to risk their health by leaving the home during the pandemic. Currently, most patients are seen by synchronous real time audiovisual visits, including initial consultations and follow ups for cosmetic surgery, rhinoplasty, trauma, and cancer reconstructions. Through these platforms, there is also the ability to provide multidisciplinary care. For example, many patients in our facial nerve clinic are being seen during the same session by both the physician and facial therapist. Currently visits that are being deferred are those requiring a procedural component (e.g., chemodenervation, filler, scopes, etc.). Patients requiring urgent evaluation are still being seen in person with donning of appropriate personal protective equipment.Although it is not meant to replace in-person medical care, telehealth allows for mitigation of patient and provider exposure to potential contagions by facilitating compliance with home quarantine. Telemedical resources may also be used in the postoperative setting in order to reallocate hospital resources, decrease critical care utilization and overall hospital stay. Telemedicine has previously been employed within the scope of plastic surgery in the setting of flap monitoring5 and maxillofacial trauma.6 In patients that require extensive postoperative care, such as those undergoing free tissue transfer, programs implementing electronic intensive care unit monitoring may streamline patient care and facilitate the redistribution of health care workers and resources to more deplete areas.5 At this time of large-scale home quarantine, concerns regarding workplace capacity and limitation of subspeciality care may be addressed through application of telemedical protocols as well. These resources may provide rapid access to a facial plastic surgeon for triage of patients with craniomaxillofacial trauma, postoperative complications, or other potentially life-threatening conditions.In summary, telemedicine represents an invaluable tool for facilitating safe and timely patient communication and delivery of health care services for the facial plastic surgeon. While limitations exist, specifically with respect to the capacity to perform comprehensive physical exams or procedures, a generalized consultation with overview of patient concerns, and postoperative findings may be reasonably performed. This may allow for further triage in determining the acuity of concerns necessitating early intervention as well as a decrease in overutilization of health care resources. Physicians are therefore encouraged to familiarize themselves with telemedicine services, available vendors, and reimbursement protocols as detailed in the Centers for Medicare & Medicaid Services Telehealth or Telemedicine Tool Kit.7Author Disclosure StatementNo competing financial interests exist.Funding InformationThe authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.References1. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177–1179. Crossref, Medline, Google Scholar2. Bann DV, Patel VA, Saadi R, et al. Best practice recommendations for pediatric otolaryngology during the COVID- 19 pandemic. Otolaryngol Head Neck Surg. 2020 [E-pub ahead of print]. Google Scholar3. Gardiner S, Hartzell TL. Telemedicine and plastic surgery: a review of its applications, limitations and legal pitfalls. J Plast Reconstr Aesthet Surg. 2012;65(3):e47–e53. Crossref, Medline, Google Scholar4. Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med. 2020 [Epub ahead of print]; DOI: 10.1056/NEJMp2003539. Google Scholar5. Varkey P, Tan NC, Girotto R, et al. A picture speaks a thousand words: the use of digital photography and the Internet as a cost-effective tool in monitoring free flaps. Ann Plast Surg. 2008;60(1):45–48. Crossref, Medline, Google Scholar6. Roccia F, Spada MC, Milani B, et al. Telemedicine in maxillofacial trauma: a 2-year clinical experience. J Oral Maxillofac Surg. 2005;63(8):1101–1105. Crossref, Medline, Google Scholar7. Centers for Medicare & Medicaid Services. General Provider Telehealth and Telemedicine Tool Kit. www.cms.gov/files/document/general-telemedicine-toolkit.pdf Accessed March 30, 2020. Google ScholarFiguresReferencesRelatedDetailsCited byAugmented Virtual Examination for Cosmetic and Functional Rhinoplasty Andre Shomorony, Rachel Weitzman, Yu Han Chen, David Liao, and Anthony P. Sclafani8 January 2024 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 26, No. 1A Knowledge Perception: Physician and Patient Toward Telehealth in COVID-1922 February 2024Telemedicine’s future in the post-Covid-19 era, benefits, and challenges: a mixed-method cross-sectional study26 October 2022 | Behaviour & Information Technology, Vol. 42, No. 15Forecasting cyber security threats landscape and associated technical trends in telehealth using Bidirectional Encoder Representations from Transformers (BERT)Computers & Security, Vol. 133Tele‐mental health during the COVID‐19 pandemic: A systematic review of the literature focused on technical aspects and challenges22 October 2023 | Health Science Reports, Vol. 6, No. 10A Survey on harnessing the Applications of Mobile Computing in Healthcare during the COVID-19 Pandemic: Challenges and SolutionsComputer Networks, Vol. 224Factors Shifting Preference Toward Telemedicine in the Delivery of Skin Cancer Reconstruction Care14 May 2022 | The Laryngoscope, Vol. 133, No. 2Analysis of Outpatient Adherence in 45,237 Patients Referred by an Emergency Department to Surgical Clinics25 October 2022 | World Journal of Surgery, Vol. 47, No. 2Factors Associated With Online Patient-Provider Communications Among Cancer Survivors in the United States During COVID-19: Cross-sectional Study22 May 2023 | JMIR Cancer, Vol. 9A Decade of Telemedicine for Facial Plastic Surgery: Tips and Techniques from 2000 Consultations before the COVID Pandemic25 October 2022 | Plastic & Reconstructive Surgery, Vol. 151, No. 1Primum non Nocere: How to ensure continuity of care and prevent cancer patients from being overlooked during the COVID ‐ 19 pandemic27 June 2022 | Cancer Medicine, Vol. 12, No. 2Fighting Against All Odds: The Case Study of the COVID-19 Pandemic in Iran4 October 2023Reflecting on Plastic Surgery Training During Early COVID-19 Pandemic: Resident Exposure and Telemedicine28 June 2022 | Journal of Craniofacial Surgery, Vol. 33, No. 6SAĞLIK BİLGİ TEKNOLOJİLERİNE YÖNELİK TUTUMLARIN BELİRLENMESİ: BİR ÜNİVERSİTE HASTANESİ ÖRNEĞİ29 July 2022 | Mehmet Akif Ersoy Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, Vol. 9, No. 2Pandemics and facial plastics and reconstructive surgeryOperative Techniques in Otolaryngology-Head and Neck Surgery, Vol. 33, No. 2Technology in the Era of COVID-19: A Systematic Review of Current EvidenceInfectious Disorders - Drug Targets, Vol. 22, No. 4Microfluidics-Based Point-of-Care Testing (POCT) Devices in Dealing with Waves of COVID-19 Pandemic: The Emerging Solution27 April 2022 | ACS Applied Bio Materials, Vol. 5, No. 5Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action Jenna Rose Stoehr, Alireza Hamidian Jahromi, Ezra Leigh Hunter, and Loren S. Schechter11 April 2022 | Transgender Health, Vol. 7, No. 2Best practices for the use of telemedicine25 March 2022 | AORN Journal, Vol. 115, No. 4Telemedicine in cleft surgery: Overcoming geographical barriers and improving health outcomes19 February 2022Telemedicine in Cleft Surgery: Overcoming Geographical Barriers and Improving Health Outcomes21 July 2022Emerging Paradigm of Smart Healthcare in the Management of COVID-19 Pandemic and Future Health Crisis3 June 2022The Benefit of Video Visits in Facial Plastic Surgery Private Practice Kylie Azizzadeh, Julia L. Kerolus, and Paul S. Nassif3 November 2021 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 23, No. 6Oculoplastic Surgeons’ Surgical, Clinical, and Management Experiences During the COVID-19 Crisis21 April 2021 | The American Journal of Cosmetic Surgery, Vol. 38, No. 4Construction and Application of an Intelligent Response System for COVID-19 Voice Consultation in China: A Retrospective Study23 November 2021 | Frontiers in Medicine, Vol. 8Plastic surgery education in the COVID-19 pandemic: hindrance or opportunity?22 May 2022 | Archives of Plastic Surgery, Vol. 48, No. 06Telemedicine as an Alternative Way to Provide Multidisciplinary Cleft Care During the COVID-19 PandemicThe Open Dentistry Journal, Vol. 15, No. 1Impact of COVID-19 on Aesthetic Plastic Surgery Practice in the United KingdomJournal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 74, No. 9A new interventional home care model for COVID management: Virtual Covid IPDiabetes & Metabolic Syndrome: Clinical Research & Reviews, Vol. 15, No. 5The digital doctor: telemedicine in facial plastic surgery25 May 2021 | Current Opinion in Otolaryngology & Head & Neck Surgery, Vol. 29, No. 4Telemedicine, Patient Satisfaction, and Chronic Rhinosinusitis Care in the Era of COVID-1928 October 2020 | American Journal of Rhinology & Allergy, Vol. 35, No. 4The impact of the COVID-19 pandemic on wellness among vascular surgeonsSeminars in Vascular Surgery, Vol. 34, No. 2The Doctor Will “See” You Now – Unmet Expectations of Telemedicine in Plastic Surgery11 March 2021 | Journal of Craniofacial Surgery, Vol. 32, No. 4Slowing the Spread and Minimizing the Impact of COVID-19: Lessons from the Past and Recommendations for the Plastic Surgeon6 May 2021 | Plastic & Reconstructive Surgery, Vol. 147, No. 6Continuation of telemedicine in otolaryngology post-COVID-19: Applications by subspecialtyAmerican Journal of Otolaryngology, Vol. 42, No. 3The Potential for Telemedicine to Reduce Bias in Patients Seeking Facial Plastic Surgery6 October 2020 | Otolaryngology–Head and Neck Surgery, Vol. 164, No. 5Implications of telehealth and digital care solutions during COVID-19 pandemic: a qualitative literature review29 November 2020 | Informatics for Health and Social Care, Vol. 46, No. 1Application of telemedicine and eHealth technology for clinical services in response to COVID‑19 pandemic14 January 2021 | Health and Technology, Vol. 11, No. 2Exploring the adoption of telemedicine and virtual software for care of outpatients during and after COVID-19 pandemic8 July 2020 | Irish Journal of Medical Science (1971 -), Vol. 190, No. 1Virtual Consultations: Young People and Their Parents’ Experience1 April 2021 | Adolescent Health, Medicine and Therapeutics, Vol. Volume 12Public Interest in Cosmetic Surgical and Minimally Invasive Plastic Procedures During the COVID-19 Pandemic: Infodemiology Study of Twitter Data16 March 2021 | Journal of Medical Internet Research, Vol. 23, No. 3Impact of COVID -19 Pandemic on Plastic Surgery Practices in a Tertiary Care Set Up in Southern IndiaNigerian Journal of Clinical Practice, Vol. 24, No. 10The Impact of COVID-19 on Patient Interest in Facial Plastic Surgery22 October 2021 | Plastic and Reconstructive Surgery - Global Open, Vol. 9, No. 10Telemedicine Practices of Facial Plastic and Reconstructive Surgeons in the United States: The Effect of Novel Coronavirus-19 Parsa P. Salehi, Sina J. Torabi, Yan Ho Lee, and Babak Azizzadeh6 November 2020 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 22, No. 6The Financial Impacts of the COVID-19 Crisis on the Practices of Cosmetic/Aesthetic Plastic Surgeons10 September 2020 | Aesthetic Plastic Surgery, Vol. 44, No. 6The rules for online clinical engagement in the COVID eraJournal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 73, No. 12Facial Surgery in the Era of SARS-CoV-2 and Beyond: Challenges, Considerations, and Initiatives20 November 2020 | Plastic and Reconstructive Surgery - Global Open, Vol. 8, No. 11Head and Neck Practice in the COVID-19 Pandemics Today: A Rapid Systematic Review30 September 2020 | International Archives of Otorhinolaryngology, Vol. 24, No. 04Simulated Video Consultations as a Learning Tool in Undergraduate Nursing: Students’ Perceptions20 August 2020 | Healthcare, Vol. 8, No. 3Outpatient Orthopedic Rehabilitation in New York State During the COVID-19 Pandemic: Therapist PerspectivesOrthopedics, Vol. 43, No. 5Implications for Telemedicine for Surgery Patients After COVID-19: Survey of Patient and Provider Experiences17 August 2020 | The American Surgeon, Vol. 86, No. 8Consensus on Criteria for Good Practices in Video Consultation: A Delphi Study27 July 2020 | International Journal of Environmental Research and Public Health, Vol. 17, No. 15Facial Plastic and Reconstructive Surgery During the COVID-19 Pandemic15 June 2020 | Annals of Plastic Surgery, Vol. 85, No. 2SEconomic implications of the COVID-19 pandemic on the plastic surgery communityJournal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 73, No. 7Increase in Video Consultations During the COVID-19 Pandemic: Healthcare Professionals’ Perceptions about Their Implementation and Adequate Management15 July 2020 | International Journal of Environmental Research and Public Health, Vol. 17, No. 14Using Telemedicine and Infographics for Physician‐Guided Home Drain Removal4 June 2020 | OTO Open, Vol. 4, No. 2Interest in Plastic Surgery during COVID-19 Pandemic: A Google Trends Analysis1 October 2020 | Plastic and Reconstructive Surgery - Global Open, Vol. 8, No. 10The Race for a COVID-19 Vaccine: Current Trials, Novel Technologies, and Future Directions1 October 2020 | Plastic and Reconstructive Surgery - Global Open, Vol. 8, No. 10Plastic Surgery and COVID-19 in the GCC: Fears, Lessons Learned, and the Plan for the Future1 September 2020 | Plastic and Reconstructive Surgery - Global Open, Vol. 8, No. 9 Volume 22Issue 3Jun 2020 InformationCopyright 2020, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Tom Shokri and Jessyka G. Lighthall.Telemedicine in the Era of the COVID-19 Pandemic: Implications in Facial Plastic Surgery.Facial Plastic Surgery & Aesthetic Medicine.Jun 2020.155-156.http://doi.org/10.1089/fpsam.2020.0163Published in Volume: 22 Issue 3: May 15, 2020Online Ahead of Print:April 16, 2020 TopicsCOVID-19e-health and telehealth caree-Health and telemedicine awareness programsReconstructive and cosmetic surgery PDF download

As the impact of coronavirus disease 2019 (COVID-19) continues to permeate throughout global healthcare systems, the lives of staff physicians, medical and surgical residents, medical students, and other allied healthcare workers are in constant flux. Priorities for healthcare workers currently center around providing effective patient care, ensuring adequate personal protective equipment, ventilator supply, and hospital capacity. In an effort to increase hospital capacity to account for the surge of critically ill COVID-19 patients and to protect healthcare workers, the American College of Surgeons recommended that all hospitals, “review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures” until further notice.1 The American College of Surgeons recommendation has undoubtedly left surgical residents and trainees in a precarious position. With a dramatic reduction in operative exposure, and in some cases, with a mandate to remain at home, how will surgical trainees maintain their surgical skill and intraoperative knowledge? Fortunately, given significant technological advancements over the past several decades, there remain a number of options for the maintenance of intraoperative knowledge beyond textbook-learning that are easily accessible from home. Computer- and phone-based technologies provide access to intraoperative video recordings, virtual reality operating room simulations, and other interactive surgical platforms. Such applications are widely available and have the potential to satisfy and supplement the learning needs of surgical trainees as defined by surgical education governing bodies.2 Moreover, surgical simulation has the potential to increase objective technical proficiency in the operating room, decrease intraoperative errors, and decrease operative time.3 The aim of the present article is to provide an overview of the available computer- and phone-based platforms accessible at home for surgical trainees who currently have limited surgical exposure given the ongoing COVID-19 pandemic. Such a review may allow surgical trainees and surgical education governing bodies to initiate and create at-home surgical curricula during the COVID-19 pandemic. COMPUTER-BASED PLATFORMS Exponential growth of computer processing power over recent decades has fueled a parallel expansion of computer-based surgical platforms. Currently, over 20 computer-based platforms, ranging over 9 surgical specialties, are available on the internet and are accessible from home. Fifteen computer-based platforms are freely accessible, 1 platform (Incision Academy) is offering a 4-week free trial during the COVID-19 pandemic, and 7 platforms require paid accounts. Two paid platforms present material pertaining to all surgical specialties. The Surgical Council on Resident Education Portal provides an online surgical curriculum with access to over 800 modules, 2,000 multiple choice questions, and 220 narrated intraoperative videos. Approximately 95% of American General Surgery residency programs subscribe.4 It has been demonstrated that residents with an active subscription to the Surgical Council on Resident Education Portal score higher on their American Board of Surgery Qualifying Examination.5 The Journal of Medical Insight is a peer-reviewed surgical video journal that offers annotated intraoperative videos along with supporting primary literature, organized neatly into “chapters.” Each chapter pertains to a specific step of the selected procedure, and offers an opportunity for self-assessment. Access to this platform costs $50 per month or $500 per year for surgical residents. Two platforms focus solely on General Surgery and 6 have content pertaining mostly to General Surgery whereas also having additional modules focused on other surgical specialties. Incision Academy is a European-based online platform that presents live intraoperative video. It details the steps of a given operation, provides primary literature evidence, allows for interactive anatomy learning relevant to the operation, and has a section for self-assessment. They have released a free 4-week trial in light of the COVID-19 pandemic. WebSurg is an online platform that publishes multimedia General Surgery, and Gynecology, content monthly. It is produced by the Institute for Research into Cancer of the Digestive System (France) and is supported by Medtronic and Karl Storz. Over 2000 sequenced and subtitled intraoperative videos in 7 languages are currently available. This platform also offers free live webinars and conference broadcasts. Users must register a free online account for full access. Teach Me Surgery has a large General Surgery section and sections available for other surgical specialties. This is a free platform that organizes over 400 peer-reviewed articles, has over 1000 interactive clinical images, and allows for self-assessment. Similarly, Surgery Squad caters to General Surgery, Ophthalmology, and Obstetrical procedures. It is an interactive, virtual reality platform that allows the user to progress through the key steps of an operation. Five platforms focus primarily on Otorhinolaryngology – Head & Neck Surgery. e-lefENT is a United Kingdom-based, interactive, and self-assessment driven online platform that is mapped to fit the Intercollegiate Surgical Curriculum Programme. It is funded by Medtronic and requires a paid subscription. Headmirror is an online surgical atlas with live, narrated intraoperative videos spanning numerous subspecialties (ie, facial plastic surgery, head and neck surgery, laryngology, otology and neurotology, rhinology and sinus surgery, pediatric otolaryngology). It is free platform maintained by the Otorhinolaryngology – Head & Neck Surgery department at The Mayo Clinic. There are 3 ophthalmology-specific platforms available, 2 of which are free to all users. Eye Tube is an online platform that allows users to view fully narrated live intraoperative videos of ophthalmology procedures (ie, cataract, glaucoma, oculoplastics). It offers a new 3-dimensional channel for intraoperative viewing. eIntegrity is a paid platform sponsored by the National Health Services and the Royal College of Ophthalmologists. Three orthopedic-specific computer-based platforms are available from home. Ortho Oracle is a surgical atlas that contains live, intraoperative videos for the following orthopedic subspecialties: shoulder and elbow, hand and wrist, spine, hip, knee, foot and ankle, and oncology. It is a United Kingdom-based platform that costs 7 euros per month for a full subscription. The full version allows you to take notes on their platform while watching videos and uses International Business Machines Corporation Watson to deliver relevant primary literature. AO Surgery Reference is an online repository for the management of fractures at any anatomic location. It provides free access to interactive modules that progress through key steps (with picture instructions) of preoperative, intraoperative, and postoperative fracture management. Fundamental Surgery requires access to HapticVR technology. Two platforms have been validated in peer-review publications. Simulation General and Thoracic Surgery increased resident knowledge base in thoracic surgery procedures (pre-test: 42.5% vs post-test: 78.6%, P < 0.0001) and enhanced confidence when preparing for live thoracic procedures.6 It is a free platform affiliated with the University of Virginia that incorporates ex-vivo videos aimed at highlighting essential steps and equipment for thoracic operations (eg, Nissen Fundoplication, Repair of Acute Esophageal Perforation, Left Postero-Lateral Thoracotomy). CyberSight is a free online surgical learning platform that includes modules focused on the following topics: cataract surgery, cornea anatomy, glaucoma, pediatric ophthalmologic disease, and strabismus. These courses were developed and delivered by Ophthalmologists from around the world, including UC Davis Eye center, New England College of Optometry, and Middle East Africa Council of Ophthalmology. This platform also includes an online mentoring service that, along with the modules, have been shown to be a viable method for delivering ophthalmology expertise globally.7 Other available platforms include VideoUrology, Toronto Video Atlas of Surgery, Decker Med (paid subscription required), Wise-MD, and Multi-media Manual of Cardio-thoracic Surgery. PHONE BASED PROGRAMS In addition to web-based modalities for surgical simulation, there are educational phone-based platforms. Touch Surgery is a free-trial phone surgical simulation application that includes 12 different surgical specialties (Cardiothoracic Surgery; General Surgery; Global Surgery; Neurosurgery; Obstetrics and Gynecology; Ophthalmology; Oro-maxillofacial Surgery; Orthopedics and Trauma; Otolaryngology Head and Neck Surgery; Plastic, Reconstructive and Aesthetic Surgery; Urology and Vascular Surgery) with over 200 procedures for surgical simulation. Furthermore, there is a self-assessment component to ensure material consolidation. Touch Surgery has been validated by 19 independent peer-reviewed publications. For example, Touch Surgery laparoscopy and intramedullary femoral nail simulations were able to significantly distinguish between expert surgeons and novices (P < 0.001, P < 0.001).8,9 Additionally, studies have reported that users find the surgical simulations to be realistic.8,9 Level Ex developed 4 free interactive animated phone applications entitled Cardio Ex, Pulm Ex, Gastro Ex, and Airway Ex. Although Cardio Ex, Pulm Ex, and Airway Ex focus on medical/anesthesiology simulation, Gastro Ex involves colorectal surgery simulation. Gastro Ex provides users with feedback on accuracy and speed during endoscope, biopsy and cautery tasks. No peer-reviewed publications exist validating Level Ex applications. Two free interactive, video-based surgical simulation applications from Belgium were published in 2016–2017, including My Virtual Surgery and CABG - OPCAB Surgery Training. These applications include surgical simulation from Cardiac Surgery, Vascular Surgery, Plastic Surgery, General Surgery, Obstetrics and Gynecology. All of these applications include opportunities for learner self-assessment. Other surgical simulation phone-based platforms include LapGuru, OrthoGuru, and Ensafe VATS. CONCLUSIONS Amidst the COVID-19 public health crisis, that has infected more than 1 million people in over 180 countries, the educational needs of surgical trainees should not be neglected. Promoting remote learning platforms such as those highlighted in the present review and integrating them into formal curriculum can expand educational opportunities beyond the walls of the hospital. Such measures may mitigate the diminished surgical skill among surgical trainees that is foreseeable in hospitals across the word.

Human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) is an entity with peculiar clinical and molecular characteristics, which mainly arises from the reticulated epithelium lining the crypts of the palatine tonsils and the base of the tongue. The only head and neck site with a definite etiological association between persistent high-risk (HR) HPV infection and development of SCC is the oropharynx. HPV-positive malignancies represent 5-20% of all HNSCCs and 40-90% of those arising from the oropharynx, with widely variable rates depending on the geographic area, population, relative prevalence of environment-related SCC and detection assay. HPV-16 is by far the most common HR HPV genotype detected in oropharyngeal SCC (OPSCC), and the only definitely carcinogenic genotype for the head and neck region. Patients with HPV-induced OPSCC are more likely to be middle-aged white men, non-smokers, non-drinkers or mild to moderate drinkers, with higher socioeconomic status and better performance status than subjects with HPV-unrelated SCC. HPV-induced HNSCCs are often described as non-keratinizing, poorly differentiated or basaloid carcinomas, and are diagnosed in earlier T-category with a trend for a more advanced N-category, with cystic degeneration, than the HPV-unrelated carcinomas. HPV positivity is associated with better response to treatment and modality-independent survival benefit. Treatment selection in HPV-related oropharyngeal carcinoma is becoming a critical issue, and although there is no evidence from randomized, controlled trials to support a treatment de-escalation in HPV-positive SCC, some investigators argue that intensive combined modality strategies may represent an overtreatment.

International Journal of Otorhinolaryngology and Head and Neck Surgery is an open access, international, peer-reviewed journal that publishes original research articles, review articles, and case reports in all areas of otorhinolaryngology. The journal's full text is available online at http://www.ijorl.com. The journal allows free access to its contents. International Journal of Otorhinolaryngology and Head and Neck Surgery is dedicated to bringing otorhinolaryngologists community around the world the best research and key information. The journal has a broad coverage of relevant topics in Otorhinolaryngology and various subspecialties such as Otology, Rhinology, Laryngology and Phonosurgery, Neurotology, Head and Neck Surgery etc. International Journal of Otorhinolaryngology and Head and Neck Surgery is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new surgical techniques. It is published quarterly and available in print and online version. International Journal of Otorhinolaryngology and Head and Neck Surgery complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.

OBJECTIVE: To update the literature and provide a systematic review of image-based artificial intelligence (AI) applications in otolaryngology, highlight its advances, and propose future challenges. DATA SOURCES: Web of Science, Embase, PubMed, and Cochrane Library. REVIEW METHODS: Studies written in English, published between January 2020 and December 2022. Two independent authors screened the search results, extracted data, and assessed studies. RESULTS: Overall, 686 studies were identified. After screening titles and abstracts, 325 full-text studies were assessed for eligibility, and 78 studies were included in this systematic review. The studies originated from 16 countries. Among these countries, the top 3 were China (n = 29), Korea (n = 8), the United States, and Japan (n = 7 each). The most common area was otology (n = 35), followed by rhinology (n = 20), pharyngology (n = 18), and head and neck surgery (n = 5). Most applications of AI in otology, rhinology, pharyngology, and head and neck surgery mainly included chronic otitis media (n = 9), nasal polyps (n = 4), laryngeal cancer (n = 12), and head and neck squamous cell carcinoma (n = 3), respectively. The overall performance of AI in accuracy, the area under the curve, sensitivity, and specificity were 88.39 ± 9.78%, 91.91 ± 6.70%, 86.93 ± 11.59%, and 88.62 ± 14.03%, respectively. CONCLUSION: This state-of-the-art review aimed to highlight the increasing applications of image-based AI in otorhinolaryngology head and neck surgery. The following steps will entail multicentre collaboration to ensure data reliability, ongoing optimization of AI algorithms, and integration into real-world clinical practice. Future studies should consider 3-dimensional (3D)-based AI, such as 3D surgical AI.

OBJECTIVE: The aim of the study was to analyze the 100 most cited publications with Turkish origin in the Web of Science Otorhinolaryngology (ORL) journals. METHODS: The Web of Science database was searched in terms of citations for publications originating from Turkey in ORL journals since 1983. After the identification of the 100 most cited articles, analysis was performed for the first author, institution, city, publication type, subject related to subspecialty, and journals having the most cited articles. Moreover, the number of ORL publications and citations of countries was determined in descending order using the same database. RESULTS: A total of 3948 ORL articles with Turkish origin was identified. The number of citations was 181 for the first and 28 for the last in the 100 most cited articles. As there was more than one article with 28 citations, 101 articles were analyzed. The number of the articles was 76, 22, and 3 for the university, education/research, and state hospitals, respectively. Hacettepe University, Ankara Numune Hospital, and Gazi University were the three leading institutions having the most cited articles, and Ankara was the first city. While 98 of 101 articles were original research, the number of case reports and review articles were 2 and 1, respectively. Thirty-five articles were related to otology, 23 to pediatric ORL, 20 to rhinology and head and neck surgery, and 3 to facial plastic surgery. Laryngoscope, Otolaryngology-Head and Neck Surgery, and International Journal of Pediatric Otorhinolaryngology were the leading 3 journals with the most cited articles coming from Turkey. The evaluation of countries revealed that Turkey was among the first 10 countries in terms of number of ORL articles but fell behind for the number of citations. CONCLUSION: This bibliometric study is the first one regarding the contribution of Turkish authors and institutions to ORL literature. Similar studies might be periodically repeated to determine national development in the field of ORL and place of Turkey in the world.

BACKGROUND: This is an update of a Cochrane review first published in The Cochrane Library in Issue 2, 2002 and previously updated in 2004, 2007 and 2010.Radiotherapy, open surgery and endolaryngeal excision (with or without laser) are all accepted modalities of treatment for early-stage glottic cancer. Case series suggest that they confer a similar survival advantage, however radiotherapy and endolaryngeal surgery offer the advantage of voice preservation. There has been an observed trend away from open surgery in recent years, however equipoise remains between radiotherapy and endolaryngeal surgery as both treatment modalities offer laryngeal preservation with similar survival rates. Opinions on optimal therapy vary across disciplines and between countries. OBJECTIVES: To compare the effectiveness of open surgery, endolaryngeal excision (with or without laser) and radiotherapy in the management of early glottic laryngeal cancer. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 8); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 18 September 2014. SELECTION CRITERIA: Randomised controlled trials comparing open surgery, endolaryngeal resection (with or without laser) and radiotherapy. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We identified only one randomised controlled trial, which compared open surgery and radiotherapy in 234 patients with early glottic laryngeal cancer. The overall risk of bias in this study was high.For T1 tumours, the five-year survival was 91.7% following radiotherapy and 100% following surgery and for T2 tumours, 88.8% following radiotherapy and 97.4% following surgery. There were no significant differences in survival between the two groups.For T1 tumours, the five-year disease-free survival rate was 71.1% following radiotherapy and 100.0% following surgery, and for the T2 tumours, 60.1% following radiotherapy and 78.7% following surgery. Only the latter comparison was statistically significant (P value = 0.036), but statistical significance would not have been achieved with a two-sided test.Data were not available on side effects, quality of life, voice outcomes or cost.We identified no randomised controlled trials that included endolaryngeal surgery. A number of trials comparing endolaryngeal resection and radiotherapy have terminated early because of difficulty recruiting participants. One randomised controlled trial is still ongoing. AUTHORS' CONCLUSIONS: There is only one randomised controlled trial comparing open surgery and radiotherapy but its interpretation is limited because of concerns about the adequacy of treatment regimens and deficiencies in the reporting of the study design and analysis.

Abstract Introduction The novel coronavirus disease 2019 pandemic has rapidly spread worldwide, challenging healthcare resources and communities to an unprecedent degree. Simultaneously, the amount of clinical and scientific information released has overwhelmed journal platforms. Objectives This review aims to summarize the available diagnostic tools and current guidelines to safely assist patients while limiting the exposure of otolaryngologists during this pandemic. Data Synthesis Key articles were retrieved from the following databases: PubMed, Lancet, Springer Nature, BioMed Central, JAMA network and MEDLINE, as well as updated documents from the Spanish Ministry of Health, World Health Organization, Centers for Disease Control and Prevention, Spanish Association of Surgeons, ENT-UK, American College of Surgeons, and American Academy of Otolaryngology-Head and Neck Surgery. The terms used for the search were: COVID-19, Test COVID, Surgery in COVID, 2019-nCoV, ‘coronavirus’, and SARS-CoV-2. A total of 10,245 papers were retrieved. The inclusion criteria for the review included: COVID-19 testing (n = 531), society guidelines for otolaryngology-head and neck surgery patient care in the outpatient clinic (n = 10) and surgical (n = 18) settings. Studies not related to COVID-19 diagnosis were excluded. Conclusion Healthcare institutions around the world are outlining their own protocols regarding laboratory testing and personnel protective equipment usage based upon medical societies recommendations during the COVID-19 pandemic. We have summarized the available laboratory tests and their respective sensitivity and specificity. Moreover, clinical guidelines from different societies were reviewed and summarized to facilitate guidance for otolaryngologists in the operating room and in the clinical settings.

The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques across a variety of otolaryngological sub-specialties suggests an emerging role for rapid prototyping technology in surgical education, procedure simulation, and clinical practice.

This report synthesizes the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Task Force's guidance on the integration of artificial intelligence (AI) in otolaryngology-head and neck surgery (OHNS). A comprehensive literature review was conducted, focusing on the applications, benefits, and challenges of AI in OHNS, alongside ethical, legal, and social implications. The Task Force, formulated by otolaryngologist experts in AI, used an iterative approach, adapted from the Delphi method, to prioritize topics for inclusion and to reach a consensus on guiding principles. The Task Force's findings highlight AI's transformative potential for OHNS, offering potential advancements in precision medicine, clinical decision support, operational efficiency, research, and education. However, challenges such as data quality, health equity, privacy concerns, transparency, regulatory gaps, and ethical dilemmas necessitate careful navigation. Incorporating AI into otolaryngology practice in a safe, equitable, and patient-centered manner requires clinician judgment, transparent AI systems, and adherence to ethical and legal standards. The Task Force principles underscore the importance of otolaryngologists' involvement in AI's ethical development, implementation, and regulation to harness benefits while mitigating risks. The proposed principles inform the integration of AI in otolaryngology, aiming to enhance patient outcomes, clinician well-being, and efficiency of health care delivery.

Abstract Objective Open access (OA) publishing makes research more accessible but is associated with steep article processing charges (APCs). The study objective was to characterize the APCs of OA publishing in otolaryngology‐head and neck surgery (OHNS) journals. Methods We conducted a cross‐sectional analysis of published policies of 110 OHNS journals collated from three databases. The primary outcomes were the publishing model, APC for original research, and APC waiver policy. Results We identified 110 OHNS journals (57 fully OA, 47 hybrid, 2 subscription‐only, 4 unknown model). After excluding 12 journals (2 subscription‐only, 4 unknown model, 5 OA with unspecified APCs, and 1 OA that accepts publications only from society members), we analyzed 98 journals, 23 of which did not charge APCs. Among 75 journals with nonzero APCs, the mean and median APCs were $2452 and $2900 (interquartile range: $1082–3520). Twenty‐five journals (33.3%) offered APC subsidies for authors in low‐ and middle‐income countries (LMICs) and/or on a case‐by‐case basis. Eighty‐five and 25 journals were based in high‐income countries (HICs) and LMICs, respectively. The mean APC was higher among HIC journals than LMIC journals ($2606 vs. $958, p &lt; 0.001). Conclusion APCs range from tens to thousands of dollars with limited waivers for authors in LMICs.

Abstract Transoral robotic surgery (TORS) offers many technical advancements to existing endoscopic and transoral surgical approaches. This has faciliated a safer, less morbid and potentially more effective application of surgery to the management of both benign and malignant diseases in the head and neck. As this surgical approach gains widespread acceptance, it is important for all members of the treatment team to understand the strengths and current limitations especially when TORS is applied for malignant diseases. As of December 2009, Federal Drug Administration (FDA) has approved the use of the da Vinci® surgical system and TORS for selected malignancies of the oral cavity, pharynx and larynx and all benign disease. Of these sites, the greatest experience and longest duration of follow-up has been in the use of TORS for the management of oropharyngeal carcinomas where at least comparable oncologic outcomes and reduced long-term feeding tube dependency rates have been reported. Other anatomic sites where TORS has shown benefit based on preclinical studies and early human experiences include the larynx, hypopharynx, parapharyngeal space and infratemporal fossa for both benign and selected malignant tumors. Experience to date has demonstrated that the improved visualization with the robotic system offers the potential for improved oncologic resection with reduced morbidity. Based on present studies and outcomes data in conjunction with ongoing investigations, it is anticipated that TORS will make a major impact in the way we manage benign and malignant tumors within the head and neck and skull base.

The tumor microenvironment (TME) is comprised of many different cell populations, such as cancer-associated fibroblasts and various infiltrating immune cells, and non-cell components of extracellular matrix. These crucial parts of the surrounding stroma can function as both positive and negative regulators of all hallmarks of cancer development, including evasion of apoptosis, induction of angiogenesis, deregulation of the energy metabolism, resistance to the immune detection and destruction, and activation of invasion and metastasis. This review represents a summary of recent studies focusing on describing these effects of microenvironment on initiation and progression of the head and neck squamous cell carcinoma, focusing on oral squamous cell carcinoma, since it is becoming clear that an investigation of differences in stromal composition of the head and neck squamous cell carcinoma microenvironment and their impact on cancer development and progression may help better understand the mechanisms behind different responses to therapy and help define possible targets for clinical intervention.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to "surgical management of oral cancer" published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.

OBJECTIVES: Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC. MATERIAL AND METHODS: The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies. RESULTS: There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related. CONCLUSIONS: The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.

Head and neck cancer is difficult to diagnose early. We aimed to estimate the diagnosis value of narrow band imaging(NBI) in head and neck cancers. We identified relevant studies through a search of PubMed, Embase and the Cochrane Library. We used a random effect model. Subgroup analysis and meta-regression analysis were performed to estimate the factors which may influence the sensitivity and specificity of the NBI. We included 25 studies with total 6187 lesions. The pooled sensitivity, specificity, positive likelihood rate, negative likelihood rate and diagnostic odds ratios of NBI were 88.5%, 95.6%, 12.33, 0.11 and 121.26, respectively. The overall area under the curve of SROC was 96.94%. The location, type of assessment, type of endoscope system and high definition were not significant sources of heterogeneity (P > 0.05). However, magnification may be related to the source of heterogeneity (P = 0.0065). Therefore, NBI may be a promising endoscopic tool in the diagnosis of head and neck cancer.

The introduction of robot-assisted surgery, and specifically the da Vinci Surgical System, is one of the biggest breakthroughs in surgery since the introduction of anaesthesia, and represents the most significant advancement in minimally invasive surgery of this decade. One of the first surgical uses of the robot was in orthopaedics, neurosurgery, and cardiac surgery. However, it was the use in urology, and particularly in prostate surgery, that led to its widespread popularity. Robotic surgery, is also widely used in other surgical specialties including general surgery, gynaecology, and head and neck surgery. In this article, we reviewed the current applications of robot-assisted surgery in different surgical specialties with an emphasis on urology. Clinical results as compared with traditional open and/or laparoscopic surgery and a glimpse into the future development of robotics were also discussed. A short introduction of the emerging areas of robotic surgery were also briefly reviewed. Despite the increasing popularity of robotic surgery, except in robot-assisted radical prostatectomy, there is no unequivocal evidence to show its superiority over traditional laparoscopic surgery in other surgical procedures. Further trials are eagerly awaited to ascertain the long-term results and potential benefits of robotic surgery.

BACKGROUND: Psychological distress is common in cancer survivors. Although there is some evidence on effectiveness of psychosocial care in distressed cancer patients, referral rate is low. Lack of adequate screening instruments in oncology settings and insufficient availability of traditional models of psychosocial care are the main barriers. A stepped care approach has the potential to improve the efficiency of psychosocial care. The aim of the study described herein is to evaluate efficacy of a stepped care strategy targeting psychological distress in cancer survivors. METHODS/DESIGN: The study is designed as a randomized clinical trial with 2 treatment arms: a stepped care intervention programme versus care as usual. Patients treated for head and neck cancer (HNC) or lung cancer (LC) are screened for distress using OncoQuest, a computerized touchscreen system. After stratification for tumour (HNC vs. LC) and stage (stage I/II vs. III/IV), 176 distressed patients are randomly assigned to the intervention or control group. Patients in the intervention group will follow a stepped care model with 4 evidence based steps: 1. Watchful waiting, 2. Guided self-help via Internet or a booklet, 3. Problem Solving Treatment administered by a specialized nurse, and 4. Specialized psychological intervention or antidepressant medication. In the control group, patients receive care as usual which most often is a single interview or referral to specialized intervention. Primary outcome is the Hospital Anxiety and Depression Scale (HADS). Secondary outcome measures are a clinical level of depression or anxiety (CIDI), quality of life (EQ-5D, EORTC QLQ-C30, QLQ-HN35, QLQ-LC13), patient satisfaction with care (EORTC QLQ-PATSAT), and costs (health care utilization and work loss (TIC-P and PRODISQ modules)). Outcomes are evaluated before and after intervention and at 3, 6, 9 and 12 months after intervention. DISCUSSION: Stepped care is a system of delivering and monitoring treatments, such that effective, yet least resource-intensive, treatment is delivered to patients first. The main aim of a stepped care approach is to simplify the patient pathway, provide access to more patients and to improve patient well-being and cost reduction by directing, where appropriate, patients to low cost (self-)management before high cost specialist services. TRIAL REGISTRATION: NTR1868.