Otorhinolaryngology

Publication Analysis 2009-2015
by Kathleen Gransalke, Labtimes 04/2017


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This very small discipline with a long tradition is especially strong in the Benelux. Head and neck cancers are the hottest topics.


Pixabay/RAM

A powder made from kissos (cissus), myrrh and dried roses, against nasal odour caused by polyps. A mixture called “Xirion of Theodore”, consisting of grapes, myrrh and dried roses, against dyspnea or a concoction of egg shells, burned nut flakes and burned palm tree bark as a treatment for nasal cancer. These are the recipes, medieval physicians used to cure their patients, suffering from diseases of the ear, nose and throat, or more inconveniently pronounced, otorhinolaryngeal diseases.

It’s hard to believe but at least since Hippocrates’ times, around 400 BC, diseases of the ear, nose and throat have been diagnosed and treated, with a high time from the 4th to the 14th century in the Byzantine Empire. Hippocrates even dedicated an entire book to nasal polyps. In it, he suggests to start removing polyps with non-invasive procedures, such as hot steam from a cauldron of boiling water or vinegar. If these fail, the physician must resort to more drastic means, using surgical instruments, such as suction tubes, rhinoscopes and cautery instruments. Hippocrates also came up with “inhalation devices like today’s nebulisers and syringes, which seem to be the first nasal sprays in the history of medicine” (Rhinology, 48, 265-72).

After all these centuries, there are still things to be researched in otorhinolaryngology, as attested by our publication analyses. For instance, a 2012 article, a meta-analysis of published papers, looks at the most common foreign bodies in the airways of young children. Can you guess it? It’s nuts and magnets (Int J Pediatr Otorhinolaryngol, 76 Suppl 1:S12-9). And, believe it or not, nasal polyps are still one of otorhinolaryngologists’ favourite topics.

Before we get into more detail of this publication analysis, let’s look at the individual nations’ performance. As usual, for this part of the ranking, we had to rely solely on specialist journals as the database we use for this analysis, Web of Science, does not allow the extraction of relevant otorhinolaryngology articles from multi-disciplinary journals, such as Nature and Science. For the most-cited authors’ ranking, however, no such restriction exists.

Extraordinarily low numbers

When compiling our nations’ performance table, we first noticed that this ranking is extraordinary in many aspects. For one, it has one of the lowest citation numbers of all disciplines we have analysed so far. Although, the number of articles published is comparable to, for instance, rheumatology research (LT 1-2017), total citations and, thus, the citation-per-article ratio are one of the lowest we can remember. Second, some nations, which usually are found way down the table, did surprisingly well. No surprise, however, are the discipline’s top performers, Germany (ca. 19,000 total citations) and England (ca. 18,000 citations). England has, however, a better citation-per-article ratio.

The first surprise follows in sixth spot – Turkey. Do they still rely on old Byzantine traditions? Surely, they managed their top 10 spot with the sheer mass of their output. With an average of 7.6 citations per article, Greece in place 13, in contrast, published articles, which have received considerably more attention. Obviously, the spirit of Hippocrates is still strong in the Greek otorhinolaryngeal community. When focussing our analysis on the citation-per-article ratio, there are not the usual suspects coming off as winners. With 13.2 average citations, Slovenia (21st according to total citations) is the ranking’s number one, followed by The Netherlands (10.1) and, surprise, surprise, Norway (9.7). Please bear in mind that Slovenia’s winning number is based on only 54 articles. Compared to the rest of the world, Europe seems pretty far behind in otorhinolaryngeal research. Although writing more articles, reviews and proceedings papers, European ear-nose-throat researchers gathered less citations in total and, consequently, cannot keep up with their US colleagues in the citation-per-article ratio (6.6 vs 9.1) either.

A small specialist circle

As mentioned, otorhinolaryngeal topics seem to appeal to only a very small circle of specialists. The only research subject that could attract some interest from outside is head and neck cancer; coincidentally, this theme is also dominating the discipline’s most-cited papers list. Not less than three publications, on spots one, two and four in our top five, deal with methods of treatment (currently different forms of chemotherapy or radio­therapy) and the cancer’s molecular biological basis. In third place, polyps make their return with a European position paper on rhinosinusitis and nasal polyps. While the publication with the fifth most citations is about the “psychometric validity of the 22-item sinonasal outcome test” or for short, the SNOT-22 test. Authors found that, indeed, it “can be used to facilitate routine clinical practice to highlight the impact of chronic rhinosinusitis on the patient’s quality of life, and may also be used to measure the outcome of surgical intervention”.

This brings us straight to the most-cited authors ranking but first a few words about our “lines of demarcation”. Of course, all researchers, who made our Respiratory System publication analysis, were automatically excluded. When dealing with ear, nose and throat topics, it’s obvious that some researchers are interested in hearing, taste and smell. Here, we decided that scientists, studying the basic mechanisms of sensory perception are better off in our Basic Neurobiology ranking. Exceptions prove the rule, as we shall see.

Looking at the resulting list of most-cited otorhinolaryngologists, there are again at least three surprises: First of all, there are five women among our top 30 and with Claire Hopkins from Guy’s and St Thomas’ Hospital in London, who missed the top 30 by only four citations, the number could’ve been even higher. Surprising is also that more than half of our top 30 authors are affiliated with institutes in the Benelux, eight researchers work in Belgium, including the ranking’s number one, and nine in The Netherlands.

Head and neck cancer – cancers of the mouth, pharynx, thyroid, larynx – is also the dominating topic among our most-cited authors. Sixteen of our top 30 researchers study this group of diseases. Amongst them, Kevin Harrington in second place, who employs viruses, antibodies and small molecules to find new ways to tackle the cancers. Joining Harrington in the fight against oropharyngeal and orolaryngeal cancers are, amongst others, René Leemans (4th), Christopher Nutting (6th), Lisa Licitra (13th), Vincent Gregoire (21st) and Carlos Suarez (24th). Interestingly, seven of the nine Dutch top 30 authors are head and neck cancer specialists.

Hippocratic topics

Besides cancer, otorhinolaryngologists work on more classical topics, with which already Hippocrates had been confronted: rhinitis, rhinosinusitis, allergies and, you guessed it, polyps. Rhinitis (allergic or non-allergic) is an inflammation of the mucous membrane inside the nose, leading to a stuffy nose and sneezing. Rhinosinusitis, caused for instance, by polyps, is an inflammation of the mucous membrane in the nasal passage and sinuses, leading to a stuffy nose and pain as well as swelling of the eyes, cheeks, nose and forehead. Nine of our top 30 researchers, including our ranking’s number one, Claus Bachert, try to alleviate this pain and let patients breathe freely again. Here, we also find three of our five highly-cited women otorhinolaryngologists. Wytske Fokkens (3rd), Glenis Scadding (15th) and Valerie Lund (18th), who, by the way, is the only designated Professor of Rhinology in Great Britain.

Although earlier stated otherwise, hearing research does make an appearance in our ranking. Not, however, as basic research but in its more clinically relevant form: tinnitus, cochlear implants and hearing aids. Paul van de Heyning (10th), Cor Cremers (22nd), Thomas Lenarz (26th) and Jan Wouters (29th) all collected enough citations to make our top 30.

And last but not least, we have the exception to the previously framed rule: Thomas Hummel (7th), who studies odour and taste perception. He, however, works at the Otorhinolaryngology department of the University of Dresden, Germany, and as an additional reason to include him, has published a significant amount of his research papers in otorhinolaryngeal specialist journals.

Even after aeons, wise men of the world did not solve all otorhinolaryngeal riddles. Will, in true Greek epic-style, heroic ear-nose-throat researchers finally win their battle against the mighty polyp? Or at least, against the evil cancer?


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Last Changed: 28.08.2017




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