Rhinology’s Persistent Gender Gap

Ascending the escalators in the main conference hall at RhinoWorld in 2019 as a third-year medical student, I became acutely aware of the sea of nearly identical black-and-navy suits surrounding me. I was there to present a project I had stumbled upon almost by chance, and until then, I hadn’t given much thought to the gender makeup of the rhinology workforce. Yet, at this international gathering, it was impossible to hide the reality that the workforce was overwhelmingly male. Just before I got off the escalator, I spotted a female attending I recognized descending the opposite way in a brightly colored suit, and it made me smile.

There was no way I could have predicted making the same observation nearly seven years later as I walked into my first interview for a rhinology and endoscopic skull base surgery fellowship. It was a big interview day, and there were fewer than a handful of women there, including myself. It was a surprising revelation that I hadn’t felt since that escalator ride as a medical student. The day ended with a definitive conclusion as I texted my residency confidante: “I really am applying into a field of nose bros.”

“It’s not that bad!” I remarked to some female faculty while discussing gender parity at the American Rhinologic Society fellow sinus course, where many of the incoming rhinology fellows had gathered for teaching and hands-on dissection. Yet, as I looked around the room of my colleagues drilling the skull bases of cadaveric heads, the numbers begged to differ, even in 2026.

Gender equity was something I spent very little time contemplating during the rest of my medical training. While women accounted for fewer than a quarter of medical students in the 1970s, changes through the early 2000s brought medical school enrollment to gender parity, and, by 2019, women accounted for slightly more than half of medical students (NEJM. https://doi.org/10.1056/NEJMsr2028487).

While otolaryngology residency had not quite reached the same threshold, it was much closer than many other surgical subspecialties. By 2022, almost 40% of otolaryngology residents identified as women (JAMA Otolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2023.1130). And yet, once the broad swath of otolaryngologists–head and neck surgeons splintered into their self-identified tribes, larger differences emerged.

The percentage of female rhinology fellowship graduates has hovered around 21% for the last two decades (Am J Rhinol Allergy. https://doi.org/10.1177/19458924251324238). While it’s surprising that no meaningful difference in gender representation has appeared in the subspecialty since 2002, it gives credence to that haunting sense of déjà vu I experienced both as an undifferentiated medical student looking around on the escalator and as a resident about to embark on my career in rhinology.

The question remains, then: While the overall medical graduate and otolaryngology workforce have reached or surpassed gender parity, why does the field of rhinology remain so far behind?

Part of it may be a self-fulfilling prophecy. When female trainees enter spaces and conferences, particularly in their chosen subspecialty where there are fewer female role models, they may not envision themselves in that field. As a result, a cycle persists, leaving the percentage at 21% even as the number of talented female otolaryngologists increases the ranks of residents.

Then, there are always assumptions and conversations about hobbies and natural talent guiding one to the field. A common assumption, unsurprising given the hours staring at a screen, is the connection between gendered norms of prowess at mastering video games and endoscopic surgery. Having never graduated beyond the first level of Crash Bandicoot 3 on the PlayStation, I would have been doomed if this correlation were always true. Yet, as a junior resident with an endoscope, I felt like I could finally see, even while I struggled with the angles of the microscope or differentiating layers of soft tissue.

The other looming hypothesis is skull base surgery. While rhinologists struggle with gender equity, their neurosurgical colleagues have an even tougher uphill battle. A database review of all board-certified neurosurgeons in 2019 found only 4.3% to be women who had completed a skull base surgery fellowship (Neurosurg Focus. doi: 10.3171/2023.8.FOCUS23473). Given the importance of training in endoscopic skull base surgery in modern rhinology fellowships, this emphasis on a multidisciplinary field where female skull base surgeons are even rarer may be another contributing factor to the gender gap.

Ultimately, in nearly all discussions of gender parity in subspeciality surgical fields, the nebulous discussion of culture comes up. “Culture” becomes the explanation of severe gender disparities in procedural subspecialties, and in many fields, there are the unspoken and notable barriers for women. Despite being only 21% of the field, rhinology has a group of brilliant female leaders who have shaped the subspecialty. The culture of rhinology remains inclusive and grounded.

In my discussions with rhinologists across the country, I could not find a more thoughtful or welcoming field of surgeons, who are open to change and innovation. A group that both pushes the boundaries and prioritizes work–life balance. A field that, mostly, did not bat an eye after I began my fellowship personal statement by quoting Taylor Swift lyrics. So, for any trainees who contemplated the subspecialty but could not see themselves in the field, think again. It’s high time for a female Renaissance in Rhinology.    

Dr. Rahman is a rhinology and endoscopic skull base surgery fellow in the department of otolaryngology–head and neck surgery at the Medical University of South Carolina in Charleston, S.C.