(0230) Innovative Tool Improvisation in Otolaryngology in Resource Challenged Environments: A Scoping Review

Introduction: Access to safe surgical care is imperative worldwide. Nonetheless, a lack of equipment or supplies in low or middle-income countries (LMICs) remains a common barrier. This study endeavored to understand how otolaryngologists improvise when the “gold standard” equipment or tool is not readily available.

Methods: A systematic scoping review queried PubMed, Embase, Web of Science, and Scopus databases from 2000 to 2023 using set search terms. Inclusion criteria encompassed studies addressing improvisation of tools or devices within otolaryngology. Studies were excluded if they were not OHNS-related, did not discuss a tool or equipment, and were not based on patients in LMICs.

Results: In total, 18 studies met criteria for inclusion. Most studies took place in Africa (n = 8, 44%), while India was the country most frequently represented (n = 5, 28%). Surgical airway was the most common diagnosis treated (n = 7, 39%), followed by hearing care (n = 5, 28%). Half of the studies were published in the last 5 years (n = 9, 50%). The majority of studies implemented a more cost-effective version of an existing instrument (n = 8, 44%), while others adapted an existing surgical instrument for a novel otolaryngologic use (n = 7, 39%) or utilized new technology to increase access to care (n = 3, 17%).

Conclusions: Cumulative evidence indicates that the high cost and restricted availability of advanced otolaryngological tools serve as motivating factors for improvisation in resource-limited settings. As access to surgical care improves globally, so does the need for adapted equipment to function in often under-resourced areas. Streamlining the improvisation of surgical tools and integrating practical technology can contribute to narrowing disparities and lowering initial clinical costs in otolaryngological care.