Ten Top Topics That Neuro-Otologists Think General Practitioners and Family Medicine Specialists Must Know: A Multi-Center Study Using Delphi Method


In order to decrease medical errors and improve organized, targeted education pre- and post-graduation, we intended to detect 10 most important concepts that neuro-otologists believe family physicians and general practitioners must know. A multi-center study based on Delphi’s method was designed and conducted in three stages. Of 31 topics gathered by expert panel, 10 top priorities were ranked based on 50 neuro-otologists’ opinion over the country. Early diagnosis and management of sudden sensorineural hearing loss, foreign body removal from external ear canal, proper management of otitis extern, and management of emergency situations in chronic otitis media gained the highest scores among all. Also, some topics, such as managing serous and acute otitis media, differentiating peripheral vs. central vertigos, and early hearing screening at birth were among top topics, contrary to others, such as surgery in only hearing ears, or hearing losses after COM surgeries. Almost all of the top-ranked topics are among critical/organ saving, or most prevalent medical concerns in all of the world. Sudden deafness, complicated COM, and mis-diagnosing vertigo may be organ/life threatening, while foreign bodies or inflammations of external ear, acute or serous otitis media, and congenital hearing loss are among the most prevalent medical problems worldwide, with numerous malpractices in their diagnosis and management. Regarding educational and practical priorities should be considered a basic step in neurotology field, and targeted programming policies.

1. Harden RM, Laidlaw JM. Effective continuing education: the CRISIS criteria. Med Educ 1992;26:407-22.
2. Parry KM. Effective continuing education. Med Edu 1990;24: 546-450.
3. Jafarinejhad F, Hakimian M, Sabury M, Alavi A. What is the skill lab? Abstract book of 5th national congress in medical education. Iranian J Med Edu 2002;7:42.
4. Amiresmaili MR, Nekoei-Moghadam M, Moosazadeh M, Pahlavan E. Challenges of General Practice Education in Iran: A Qualitative Study. Strides Dev Med Educ 2013;9:118-31.
5. Arash A, Alizadeh S, Broomand N. General practitioners assessment of continuing education programs in Golestan University of medical sciences. Res Med Educ 2015;7:64- 70.
6. Vakil H. Problems and challenges of programming in medical in country (in Persian). J Contin Med Edu 1992;2:5-9.
7. Fath al-Ulumi MR, Fattahi Bafghi A, Safavid Naeeni SA, Mirza Taheri M, Safavid Naeeni M. Evaluation of general practitioners' knowledge about acute otitis media. Res Med 2006;30:235-9.
8. Carrie A. The 8 most common root causes of medical errors. (Accessed March 16, 2021, at HCAHPS/Communication on Medication/,
9. Brooks MA. Medical education and the tyranny of competency. Perspect Biol Med 2009;52:90-102.
10. De Meyrick J. The Delphi method and Healtth Research. Health Educ 2003;103;7-16.
11. Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. Inf Manag 2004;42:15-29.
12. Broomand N, Arash A, Hesari Z. Views of General Practitioners and Clinical Medical School Faculty to Adapt the Educational needs of Continuing Medical Education programs. J Med Edu Dev 2020;15:206-16.
13. Hall NJ, Rees CM, Rhodes H, Williams A, Vipond M, Gordon A et al. Consensus exercise identifying priorities for research in the field of general surgery of childhood in the UK. BJS Open 2021;5:zraa062.
14. Mahmoudi M, Vahidshahi K, Shahbaznejad L. Examine faculty and general practitioners' opinions on essential practical skills that a general practitioner should know. Iran J Med Educ 2005;5.
15. Mohammad Jafari H, Vahidshahi K, Mahmoudi M, Abbaskhanian A, Shahbaznejad L, Ranjbar M, et al. Investigating the effect of codified continuing. education programs on the knowledge of general practitioners. Koomesh 2008;9:255-62.
16. Guevara N, Mahdyoun P, Pulcini C, Raffaelli C, Gahide I, Castillo L. Initial management of necrotizing external otitis: errors to avoid. Eur Ann Otorhinolaryngol Head Neck Dis 2013;130:115-21.
17. Voultsos P, Oliva A, Grassi S, Palmiero D, Spagnolo AG. Are errors in otorhinolaryngology always a sign of medical malpractice? Review of the literature and new perspectives in the SARS-CoV-2 (COVID-19) era. Acta Otorhinolaryngol Ital 2020;40:157-63.
18. Danino J, Muzaffar J, Metcalfe C, Coulson C. Patient safety in otolaryngology: a descriptive review. Eur Arch Otorhinolaryngol 2017;274:1317-26.
19. Peter C Weber, Daniel G Deschler. Sudden sensorineural hearing loss in adults: evaluation and management. Up to Date, 2022
20. Wang Y, Ren T, Jing J, Gao N, Zhao H, Wang J. Clinical features and prognostic factors of pediatric idiopathic sudden hearing loss from moderate to profound degree. Am J Otolaryngol 2021;42:103027.
21. Amiri Davan M, Sonbolestan SM, Okhovvat Sh, Nemati Sh, Khabazian M. Evaluation Of Some Epidemiologic Parameters, Risk Factors, Clinical And Audiological Characteristics Of 48 Patients With Sudden Sensorineural Hearing Loss. Tehran Univ Med J (TUMJ) 2006;64;37-44.
22. Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngol Head Neck Surg 2019;161:S1-S45.
23. Awad Z, Huins C, Pothier DD. Antivirals for idiopathic sudden sensorineural hearing loss. Cochrane Database Syst Rev 2012;8:CD006987.
24. Flint PW, Haughey BH, Lund VJ, Robbins KT, Thomas JR, Lesperance MM, et al. Cummings Otolaryngology Head and Neck Surgery,7th ed. Philadelphia, PA: Elsevier/Saunders, 2020
25. Yelland MJ. The efficacy of oral cotrimoxazole in the treatment of otitis externa in general practice. Med J Aust 1993;158:697-9.
26. Donne AJ, Davies K. Foreign Bodies in the Ear, Nose and Throat. (Chap 34). In: Watkinson J, Clarke R, eds. Scott Brown’s Otorhinolaryngology and Head and Neck Surgery, 8th ed. United States: CRC Press; 2018:315-17.
27. Dance D, Riley M, Ludemann P. Removal of ear canal foreign bodies in children: what can go wrong and when to refer. BC Med J 2009;45:20-4.
28. Hasbun R. Epidemiology of bacterial meningitis in adults. Up to Date, 2022
29. Sharma N, Jaiswal AA, Banerjee PK, Garg AK. Complications of Chronic Suppurative Otitis Media and Their Management: A Single Institution 12 Years Experience. Indian J Otolaryngol Head Neck Surg 2015;67:353-60.
30. Jain A, Arora N, Meher R, Passey JC, Bansal R. Intracranial complications of CSOM in pediatric patients: A persisting problem in developing countries. Int J Pediatr Otorhinolaryngol 2017;100:128-31.
31. Suzuki HG, Dewez JE, Nijman RG, Yeung S. Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines. BMJ Open 2020;10:e035343.
32. Chua ML, Wee JT, Hui EP, Chan AT. Nasopharyngeal carcinoma. Lancet 2016;387:1012-2.
IssueVol 61 No 6 (2023) QRcode
Otology Medical education Continuing medical education Graduate medical education

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Motasaddi Zarandi M, Nemati S, Daneshi A, Hashemi SB, Eftekharian A, Rajati M, Kouhi A, Nasirmohtaram S, Kazemnejad Leyli E, Khoshbakht M. Ten Top Topics That Neuro-Otologists Think General Practitioners and Family Medicine Specialists Must Know: A Multi-Center Study Using Delphi Method. Acta Med Iran. 2023;61(6):347-354.