Essential Equipment for Baseline Otolaryngology–Head and Neck Surgery Care: A Global Cross-Sectional Survey

CLINICAL QUESTION

How does the relative availability of essential equipment for otolaryngology–head and neck surgery (OHNS) care differ across World Bank income groups?

BOTTOM LINE

Significant disparities exist in access to essential OHNS equipment worldwide, with otologic, rhinology, and pediatric airway tools markedly less available in low- and middle-income countries (LMICs). These gaps may limit the ability to manage common, high-burden conditions and highlight priority areas for targeted investment and advocacy.

BACKGROUND: OHNS conditions contribute substantially to global morbidity, including hearing loss, chronic ear disease, airway emergencies, and head and neck cancer. Many of these conditions are surgically treatable, yet access to specialized equipment remains uneven globally. While general surgical capacity has been studied extensively, specialty-specific infrastructure for OHNS care has been less well characterized, particularly in low-resource settings.

STUDY DESIGN: Cross-sectional, multinational survey assessing otolaryngologists’ perceptions of availability of essential OHNS equipment and ancillary services. Respondents rated equipment availability using a five-point Likert scale ranging from “never” to “always available.” Countries were stratified by World Bank income group classification and World Health Organization (WHO) region.

SETTING: Global survey of practicing otolaryngologists from 194 WHO-recognized countries, representing all six WHO regions and diverse clinical practice environments.

SYNOPSIS: A total of 146 otolaryngologists participated, with 69 from high-income countries (HICs) and 77 from LMICs. Respondents represented academic, public, private, and non-governmental organization-based practices, with similar distributions of facility level and urbanicity across income groups. Significant disparities emerged in the availability of essential OHNS equipment. LMIC respondents reported substantially lower access to otologic equipment, including drills and burrs, tympanomastoidectomy sets, otoendoscopes, and cochlear implants. Many reported that such tools were rarely or never available, despite the high burden of preventable otologic disease in these settings. Access to rhinologic and endoscopic equipment, including nasal endoscopes and functional endoscopic sinus surgery tools, was also significantly reduced in LMICs. Notably, pediatric airway equipment represented a critical gap. Equipment required for pediatric rigid bronchoscopy, direct laryngoscopy, and biopsy was inconsistently available in LMICs, raising concerns for the management of airway foreign bodies and other life-threatening conditions. Even among HIC respondents, pediatric airway tools were not universally available, underscoring broader global challenges. The authors emphasize that these disparities likely reflect cost barriers, competing national surgical priorities, workforce shortages, and uneven policy investment. While reliance on providerreported perceptions and non-random sampling limits generalizability, the study provides the first global snapshot of specialty-specific OHNS equipment availability and identifies clear targets for infrastructure development.

CITATION: Srinivasan T, et al. Essential equipment for baseline otolaryngology– head and neck surgery care: a global cross-sectional survey. Laryngoscope Investig Otolaryngol. 2025;10:e70078. doi: 10.1002/lio2.70078.

COMMENT: This article is a cross-sectional survey on otolaryngologists’ perceptions of the availability of surgical equipment in LMICs. They surveyed 146 otolaryngologists, including 77 from LMICs, and found significant differences in equipment availability between HICs and LMICs. Overall, it highlights the key disparities in the availability of essential equipment for baseline otolaryngology care, especially for pediatric airway and otologic conditions.—Ryan Belcher, MD, MPH