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Advances in Continuous
and Discrete Models
Ren et al. Advances in Continuous and Discrete Models (2025) 2025:47
https://doi.org/10.1186/s13662-025-03870-7
R E S E A R C H Open Access
Bibliometric analysis on the research focus of
otolaryngological surgery
Liyan Ren1,YanliYin
1, Fang Wang1,HongboZhu
1,LiHan
1, Tao Liang1and Fumin Ping1*
*Correspondence: pfum@163.com;
fumin_ping66@outlook.com
1Affiliated Hospital of Hebei
Engineering University, Handan,
Hebei, China
Abstract
An investigation was carried out to assess the scholarly impact of scientific papers in
otolaryngological surgery from 2010 to 2023 using their frequency of citations as a
measure. The investigation focused on the 100 most cited papers, collecting data on
the year of publication, country of origin, journal source, paper type, and research
field. The publications were distributed across 55 out of the 160 journals in the field,
and each piece received citations ranging from 131 to 1775. Most (54.1%) of these
papers were classified within medicine. The United States became the primary source
country for these papers, providing 68 publications. A peak of 20 papers were
published in 2011, marking the highest amount. In the US, the journal
“Otolaryngology Head And Neck Surgery” has the impact factor 7.8 and has
significantly advanced the field. With nine publications, R.M. Rosenfeld was found to
be the author with the most publications. Overall, the probability of a paper
referenced on otolaryngological surgery is influenced by factors such as the language
in which it is published, the country it originates from, and the journal it is sourced
from. These factors demonstrate the complex nature of academic influence in this
field.
Keywords: Bibliometrics analysis; Journal impact factor; Otolaryngological surgery;
Publications; Research trend
1 Introduction
Significant advancements have occurred in otolaryngological surgery, encompassing a
range of procedures that specifically address the intricate anatomy of the ear, nose, throat,
and related structures [33]. Otolaryngological surgery, or ENT (Ear, Nose, and Throat)
surgery for short, is a subspecialty of general surgery that focuses on the diagnosis and
surgical treatment of disorders involving the ears, nose, and throat. Various surgical pro-
cedures in this intricate discipline can treat disorders affecting the ears, nose, throat, and
other structures. A comprehensive understanding of the delicate anatomy and physiology
of these essential sensory organs is crucial for the complex procedures of otolaryngologi-
cal surgery [10,11].
A wide range of medical issues can be effectively treated by otolaryngological surgery.
This includes basic illnesses such as chronic sinusitis and hearing loss, as well as more
complicated procedures, including facial reconstruction and tumor excisions. A wide va-
riety of otolaryngology surgical procedures will be explored in this paper, which will help
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Ren et al. Advances in Continuous and Discrete Models (2025) 2025:47 Page 2 of 14
to illuminate the ever-changing field of otolaryngology [19,28]. Naresh [25]investigates
how an Internet of Things-based health monitoring system processes ECG signals us-
ing the discrete wavelet transform (DWT). The time-frequency localization capabilities
of DWT are essential for effective nonstationary signal analysis. Preprocessing, feature
extraction, signal capture, and real-time IoT-based transmission to cloud servers are all
included in the system design.
Data reduction and signal clarity have improved, according to performance measure-
ments. Sri [44] investigates the application of adaptive wavelet transform (AWT) in wear-
able sensor Internet of Things systems for children’s health to provide accurate health
assessments and real-time monitoring. The approach consists of data collection, wavelet
filter preprocessing, feature extraction, machine learning algorithm classification, and IoT
integration to enhance diagnostic capabilities and enable timely interventions in pediatric
healthcare. Sitaraman [43] examines how AI-driven systems change healthcare data man-
agement, emphasizing data collection, processing, storage, and application development.
To improve accuracy, speed, and dependability, it emphasizes the integration of technolo-
gies like distributed file storage, NoSQL databases, and parallel computing. Bhavya [2]
examined electronic health data to see if administering ceftriaxone and intravenous cal-
cium to babies may be associated with higher mortality. According to the results, 3.8%
of neonatal patients who got ceftriaxone and IV calcium within 48 hours passed away,
whereas 1.95% of patients who received IV calcium and 1.54% who received fluids did so.
The mortality rate was 5.47% for older neonates. Both older babies and newborns showed
an elevated risk of mortality.
The introduction of state-of-the-art surgical instruments has transformed the field of
otolaryngologal surgery. The effects of technical advancements on surgical results, pa-
tient recovery, and overall procedural efficacy will be examined in this study, including
topics such as minimally invasive techniques, robots in complex procedures, and endo-
scopic sinus surgery [19]. The impact factor in otolaryngology research differs from the
citation counts of individual papers because of things like high-impact influence, impact
factor fluctuation, and article specificity. Large-impact publications can attain large cita-
tion counts within moderate or lower impact factors; however, the impact factor is deter-
mined by average citations.
The study aimed to identify the most significant works in the field by compiling a list of
thetop100most referred papers in otorhinolaryngology journals. Italsosoughttoanalyze
characteristics of these papers to identify the features that set an ENT paper apart from
others in the area.
2 Clinical implications and patient outcomes
Clinical implications of otolaryngological surgery are a crucial part of this analysis. Eval-
uation of patient outcomes, enhancements to quality of life, and incorporation of patient-
centric methods into surgical decision-making are all part of this.
Even though otolaryngological surgery is making great strides forward, there are still
obstacles. This work discusses the present constraints, possible improvement areas, and
future research directions. It also covers emerging technology ethics and incorporating
evidence-based practices [12,24].
As we explore the intricate world of otolaryngological surgery in this review, we aim
to provide a detailed analysis of where the discipline stands and how to move forward
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Ren et al. Advances in Continuous and Discrete Models (2025) 2025:47 Page 3 of 14
[13]. This review combines current research and clinical experiences to add to the body of
knowledge, stimulate discussion, and encourage additional innovations in otolaryngologi-
calsurgicalprocedures[9].Inkeeping with current healthcare trends,surgicalinnovations
like minimally invasive procedures, precision instruments, and patient-specific implants
improve patient-centered care by offering individualized approaches, lowering physical
trauma, speeding up recovery, and advancing personalized medicine.
Procedures thatfall under the umbrella of otolaryngological surgery rangefrom the very
simple(tonsillectomy,adenoidectomy) to the somewhat complex (cochlearimplants, skull
base surgery, facial reconstructive surgery, etc.). Rhinology, laryngology, otology/neuro-
tology, and head and neck surgery are all specialized fields under the medical discipline
of otolaryngology. Rhinology focuses on the study of the nose and sinuses, laryngology
focuses on the voice box and larynx, otology/neurotology focuses on the ear and its neu-
rological connections, and head and neck surgery focuses on tumors and structural ab-
normalities in the head and neck region.
A comprehensive field assessment of otolaryngological problems in South Korea was
conducted in 1991 using otoscopic findings and nasal examination results as the primary
basis for the study. Thus the prevalence of chronic sinusitis (CS) was 1.01%, nasal septal
deviation (NSD) was observed in 22.38% of patients, perennial allergic rhinitis (PAR) af-
fected 1.14% of patients, and chronic otitis media (COM) was present in 2.19% of patients
[16]. In contrast, data on the frequency of a disease occurrence derived from medical vis-
its to a hospital are straightforward and quick to collect. In 2005 the annual prevalence
of COM was 1.15 % based on hospital visits and 7.2 % based on PAR; however, there is
a large discrepancy between these figures and the more precise statistics acquired from
field surveys [7].
2.1 Common otolaryngological procedures
When conservative measures fail to reduce the frequency or severity of tonsillar infec-
tions or blockage, surgical removal of the tonsils and adenoids may be considered. Rhino-
plasty improves the nose’s aesthetic and functional function, whereas septoplasty corrects
a deviated nasal septum, which improves breathing. Tympanoplasty restores the eardrum,
whereas myringotomy creates a small incision in the eardrum,typically to treat ear infec-
tions. Endoscopic sinus surgery improves drainage, removes blockages, and treats chronic
sinusitis [26,37]. Otolaryngologists must participate in training programs to stay current
on new technologies, such as robotic systems and endoscopic equipment. Workshops,
mentorship,and simulation-basedtrainingboost confidenceandproficiency with cutting-
edge technology, eventually improving surgical accuracy and patient safety.
Surgery on the vocal cords to remove abnormal growths (polyps or nodules) or examine
the larynx (laryngoscopy) are examples of procedures in this field. Cochlear implants are
invasive medical devices that assist individuals with profound deafness or hearing impair-
ment in partially restoring their auditory capabilities. Otolaryngological surgeons some-
times undertake reconstructive treatments on the face and neck in cases of trauma, con-
genital abnormalities, or malignancies.
2.2 Technological advancements
Significant technological breakthroughs have been made in otolaryngological surgery.
There are now essential tools that allow for minimally invasive surgeries with decreased
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Ren et al. Advances in Continuous and Discrete Models (2025) 2025:47 Page 4 of 14
recovery times, such as endoscopic techniques, laser surgery, and robotic-assisted treat-
ments. Robotic-assisted surgery and minimally invasive endoscopic techniques are two
technological developments that have improved surgical precision while lowering recov-
ery durations andpostoperative problems. These methods improve the results of surgeries
like sinus surgery and tumor removal by reducing the risk of infection, scarring, and blood
loss. Modern imaging techniques, including MRI and CT scans, allow for more exact pre-
operative planning [32,38]. Complex otolaryngological procedures require postoperative
care that includes infection control, pain management, support for respiratory function,
airway patency, aspiration avoidance, nutritional support, and specialized rehabilitation
such as speech and hearing therapy to ensure a full recovery.
Although otolaryngological surgery has made significant advancements, it still faces
challengesrelatedtothedelicatenatureoftheheadandneck, potentialcomplications,and
the crucial role of patient involvement in postoperative treatment. The delicate head and
neck area, which contains important structures, presents difficulties for otolaryngologists.
Because of technological innovations like augmented reality, robotic-assisted surgery, and
high-definition endoscopy, surgeons can now see structures, plan strategies, and manip-
ulate tissues with more accuracy and stability. Cosmetic surgery and patient consent are
two other areas where ethical concerns should be carefully considered.
Innovations in otolaryngological surgery are based on research and involve ongoing in-
tegration of technology, personalized medicine, and new techniques. New areas of study,
like regenerative medicine, may help the field overcome obstacles and open up new op-
portunities [39].
This discipline of medicine addresses a wide range of conditions, including ear infec-
tions, sinus issues, voice and swallowing problems, and head and neck cancers. Audio-
metric testing, imaging studies, and endoscopy are all part of the comprehensive diagnos-
tic procedure in otolaryngology. Medication, therapy, hearing aids, and assistive gadgets
are all examples of nonsurgical interventions [40]. The field of otolaryngology encom-
passes a wide variety of surgical operations,fromthemoreroutinetonsillectomyand sinus
surgery to the more involved cochlear implant, facial reconstruction, and thyroid surg-
eries. Precision and recovery times have been greatly enhanced by technological break-
throughs, such as minimally invasive methods and robotic-assisted surgery. Collaboration
withotherprofessionals,suchasaudiologists, speech therapists, oncologists, andothers,is
an interdisciplinary part of otolaryngological care. International collaborations involving
researchers from different nations increase global recognition, cross-disciplinary ideas,
and network visibility, increasing citation rates. These networks facilitate more dissemi-
nation and higher-quality research by connecting it to various academic networks. Head
and neck anatomy is quite delicate, one of the field’s challenges [45], placing a premium
on rehabilitation and postoperative care. Improvements in patient care and outcomes are
consistently achieved via the dedication and skill of otolaryngologists during therapy and
surgery for a wide range of head and neck diseases.
2.3 Dynamic and evolving field
The dynamic field of otolaryngological surgery plays a crucial role in enhancing the well-
being of individuals suffering from head and neck issues. Otolaryngological surgery is at
the cutting edge of medical innovation because of the teamwork of talented surgeons,
new technologies, and continuous research [31]. As medical science advances and these
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Ren et al. Advances in Continuous and Discrete Models (2025) 2025:47 Page 5 of 14
patients continue to live longer [3], the pediatric otolaryngologist is no longer the sole
provider of otolaryngologic care for DS patients. Hence otolaryngologists must feel at
ease when caring for and treating these patients. Our paper aims to offer a brief, up-to-
date overview of this entity’s most common otolaryngologic symptoms. The ear makes it
hard for the primary care physician to detect effusions and puts the kid at risk for ceru-
men impaction, which can cause conductive hearing loss (CHL). Primary care doctors
play a critical role in the early detection of ear effusions. Telemedicine consultations en-
able prompt referrals and therapy, and training in otoscopy techniques, tympanometers,
and collaboration with otolaryngologists improves accuracy. Children with Down syn-
drome are more prone to chronic hearing loss (CHL) because of structural anomalies and
frequent ear infections. Untreated CHL necessitates early discovery and management be-
causeitcanimpaircognitiveandlanguagedevelopment, cause social isolation, and restrict
educational chances.
Consequently, Shott [41] suggested that otolaryngologists check up with children who
have stenotic canals every three months until the canals fully develop, around the ages
of two or three, to ensure no effusions go unnoticed. Also, patients with cerumen im-
paction should have their ears debrided regularly to make the tympanic membrane easier
to see. There is certainly more than one mechanism contributing to the higher incidence
ofchronicearillness in children with Down syndrome. It is unclear what the typicalpreva-
lence of chronic ear disease is in children. Among children aged 2–6 examined monthly
with otoscopy and tympanometry by Casselbrant et al. [6], 53% showed evidence of a mid-
dle ear effusion in the first year, rising to 61% in the second.
The surgical removal of otolaryngological cystic diseases, such as lymphangiomas,
plunging ranulas, branchial cleft cysts, thyroglossal duct cysts, salivary mucoceles, auric-
ular hematomas, and cervical lymphoceles, has consistently been the preferred method
of management. Nevertheless, it is essential to carefully consider the potential surgical
hazards before choosing this approach. It is crucial to assess the potential for surgical
consequences, such as nerve damage, the return of the cyst, and aesthetic considerations,
while making decisions.
Implementing nonsurgical therapies could be beneficial in reducing these risks. These
techniques can aid in the prevention of surgical complications. Significantly, although it
is highly effective in treating ear, nose, and throat cysts, recurrence remains a frequent
problem even after multiple aspiration treatments.
Ogita [27] made a significant breakthrough in nonsurgical treatment by introducing
OK-432 therapy for lymphangiomas. Originally designed for cancer immunotherapy, OK-
432 has demonstrated potential in treating cystic diseases in otolaryngology [47]. The
immune-enhancing effects of OK-432 are believed to arise from strong local inflamma-
tion, which boosts the synthesis of several cytokines. OK-432 is widely recognized for its
effectiveness in relieving symptoms related to pleuritis and carcinomatous peritonitis, in-
cluding ascites and pleural effusion. Injecting OK-432 into the peritoneal or pleural cavity
has decreasedfluid accumulation in the abdomen (ascites) and the lungs (pleural effusion)
while encouraging scar tissue formation within the cavity. Experts widely concur that OK-
432 therapy is highly helpful in managing lymphangiomas [27,34]. Unfortunately, there
is a lack of trials examining the efficacy of OK-432 in treating otolaryngological cystic
disorders such as plunging ranula, thyroid cyst, auricular hematoma, salivary mucocele,
thyroglossal duct cyst, and branchial cleft cysts. The researchers sought to investigate fur-
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Ren et al. Advances in Continuous and Discrete Models (2025) 2025:47 Page 6 of 14
ther the utilization of OK-432 for treating otolaryngological cystic diseases, analyzing its
indications, effectiveness, and constraints [18,29,34].
Litigation involving alleged medical negligence has far-reaching consequences for the
quality of healthcare available to patients and how doctors work. Prior research has as-
sessed malpractice litigation to educate and develop risk management strategies [15,23].
Previous research on medical negligence in thyroidectomies has been done but lacked
case-specific information.Accordingto the most current analysis, malpractice claims with
thyroidectomy are rare and do not incur indemnity payments. Furthermore, information
about damages, paralysis type (unilateral vs. bilateral), and specialized training was miss-
ing. Otolaryngologists have taken on a more prominent position in the surgical procedure
and treatment of thyroid diseases, replacing general surgeons as the preferred specialists
for thyroidectomies [36,42,46].
2.4 Exploration and validation of the potential role of community health workers
(CHWs)
Nevertheless, otolaryngologists with specific knowledge managed and guided the evalu-
ation procedure. Moreover, there has been no assessment of persons with different levels
of expertise to authenticate these findings. Before applying this screening procedure on
a larger scale, it is crucial to establish the efficacy of community health workers (CHWs)
and other nonspeciality-trained professionals (NPs). Criteria such as the accuracy, con-
sistency, and dependability of CHWs’ and NPs’ assessments are necessary for effective
screenings. Identification of referral conditions, training quality, patient results, patient
satisfaction, follow-up adherence, and screening cost-effectiveness are all components
of an efficient evaluation. Evaluations conducted by nonspecialists encounter difficulties
such as a lack of otolaryngology expertise and a limited understanding of complex symp-
toms, which may result in incorrect diagnoses or needless referrals. Support from oto-
laryngologists, standardized procedures, and thorough training are necessary to address
issues. Due to the automated nature of portable audiometry instruments, even individuals
without training in audiology or otolaryngology can still acquire accurate findings from
hearing tests. Otolaryngology clinicians in low-resource settings can greatly benefit from
CHWs’ capacity to gather this objective data dependably in addition to endoscopically
recorded images of the ear drum. Otolaryngologists in the area might employ CHWs as
a screening tool to determine whether individuals seeking specialized care have hearing
loss before they even set foot in their offices [40].
Additionally, schools can test students using these technologies to find those with treat-
able otologic pathology so that they can be referred to an otolaryngologist. When tertiary
healthcare providers in low- and middle-income countries are overwhelmed, the capacity
of community health workers to direct patients to otolaryngologists’ clinics can substan-
tially affect public health. This study aims to evaluate the efficacy of otolaryngologists
practicing in rural areas compared to community health workers (CHWs) who do hearing
examinations utilizing mobile phones [40].
3 Materials and methods
This study conducted a bibliometric analysis that did not require the participation of
human subjects [17]. Personalized medicine, genomic research, AI diagnostics, robotic
surgery, telemedicine, minimally invasive procedures, interdisciplinary research, global
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research output trends, and patient-centered outcomes are emerging technologies that
couldbe examined in future bibliometric analyses inotolaryngology. These analyses could
offer valuable insights for future clinical practices. Therefore obtaining approval from the
institutional review board was unnecessary.
3.1 Search strategy
In November 2023, we used the Scopus database to search for research papers in oto-
laryngology and otolaryngological surgery. The search phrases used were “otolaryngol-
ogy”, “ENT”, “otolaryngological”, “otolaryngological surgery”. We conducted a comprehen-
sive search for all documents in the database published from 2010 forward. The search
results were ranked according to the number of citations, with papers with more citations
earning better rankings [48].
3.2 Data extraction
Weconducteda thorough investigation utilizingthe Scopus database to better understand
otolaryngology and otolaryngological surgery research. Citation outcomes in otolaryngo-
logical surgery can be greatly impacted using data sources other than Scopus, such as Web
of Science or PubMed. At the same time, Web of Science offers a worldwide perspective
of otolaryngological research and incorporates interdisciplinary studies. PubMed con-
centrates on medical research, which could increase citations. This investigation covered
160 journals in the 2022 Journal Citation Reports Science Edition by Thompson Reuters,
based in New York, USA. This search, carried out in November 2023, covered 14 years
from 2010 to November 2023, encompassing a wide range of academic publications. Sig-
nificant progress has been made in specialized fields like otolaryngology because of the
United States’ strong biomedical research infrastructure, backed by important organiza-
tions such as the NIH. A worldwide audience can read research conducted in English.
Still, it might not accurately reflect global research trends because of language difficulties,
a lack of local journals, or disparate citation styles. The selection process for the top 100
most cited papers was conducted with great attention to detail. Comprehensive data was
compiled for each paper, encompassing various aspects such as the journal title, impact
factor (based on the 2022 The Journal Citation Report), authorship data, authors’ country
of origin, publication years, research classifications (basic science or clinical), paper types
(original studies or reviews), and specific research domains (such as otology and neurotol-
ogy, rhinology and/or endoscopic skull base surgery, head and neck surgery, laryngology,
and general ENT surgery). Yin et al. [48] defined the selection method and data collecting
as rigorous and done by two individuals. In addition, a study was conducted to investigate
the relationship between the year of publication and the number of citations for the top
100 publications, providing insights into temporal patterns [48].
Moreover, this exhaustive analysis also yielded valuable information about the journals
responsible for publishing the most prominent works in the field. With its vast data and
sophisticated capabilities, Scopus is a well-liked database for citation analysis. It includes
multidisciplinary journals that are not included in PubMed’s index. Its shortcomings in-
clude a limited scope for biomedical and biological sciences themes and a lack of compre-
hensive citation monitoring features for interdisciplinary subjects.
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Figure 1 Flowchart of literature selection and the steps of bibliometric analysis included in this study
3.3 Statistical analysis and visualization
Basic descriptive statistics were used to present the data without any statistical signif-
icance tests performed. The authors’ keywords were analyzed and visualized using the
VOSviewer program (version 1.6.19). The citation metrics were examined usingHarzing’s
Publish or Perish (GUI edition). To find pertinent research, comprehend the significance
of topics, journals, and authors, and identify trends unique to otolaryngology rather than
more general biomedical issues, the study examined citation metrics in otolaryngology
using recent methodologies, keyword analysis, top-cited papers, and geographic analysis.
4Results
From 2010 to 2023, 29,641 papers were published in the 160 journals categorized under
otolaryngology in the 2022 Journal Citation Report Science Edition. Figure 1shows the
comprehensive information on the 100 most cited papers in otolaryngology, including
the paper titles, author names, publication years, journal titles, countries of origin, num-
ber of citations, and citation density. The citation density gauges the average number of
citations a publication receives annually, indicating its findings’ scholarly significance. By
comparing publications, journals, and authors and identifying new patterns it evaluates
the significance and impact of investigations. A high citation density indicates current,
significant research that directs otolaryngology improvements. All 100 papers were pub-
lished in English, covering 55 of 160 journals in this category. Of these papers, 96 were
published in 2010–2015 and 2018–2023, but just 6 were published during 2016–2017. In
2011, there were 20 papers, the highest number of publications among the top 100 (Fig. 2).
The papers have citation counts ranging from 131 to 1775, averaging 280.3. Publication
language greatly influences paper visibility andcitation counts, especially in nations where
Englishisnottheprimary language. The most common language is English, although mul-
tilingual publications can help with problems like underrepresentation, translation diffi-
culties, and language obstacles. The total number of citations reached 28,030, with an
average of 4443.19 per author and 2156.15 citations each year. All papers in the list con-
sisted solely of original research papers (n = 100), excluding other genres such as reviews,
conferencepapers, or book chapters. Thesepapers’ main nations of origin were the United
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Figure 2 Demonstrating distribution of the top 100 most cited papers according to the years they are
published
States, with Canada and the United Kingdom following closely (Fig. 6). The publication
“Otolaryngology-Head and Neck Surgery” in the United States was the leading publisher
of these highly cited papers, followed by “Otolaryngology–Head and Neck Surgery” and
“JARO Journal of The Association for Research in Otolaryngology” (see the figures). The
literature selection and the steps of bibliometric analysis are shown in Fig. 1.
4.1 Time of publication
The 100 papers that have been cited the most frequently were written in 2010 and 2011.
The annual number of papers on otolaryngological surgery is seen in Fig. 2. From 2010 to
2023, there were different trends in the number of publications, reaching a peak in 2011
with 20 publications, 2010 with 16 publications, 2013 with 13 publications, 2012 with 10
publications, and 2020 with 9 published studies with high citations. The search terms and
citationanalysistimeframegreatlyinfluencethepresenceofsubfieldssuchasneurotology
and laryngology in the results. While broad search criteria capture essential studies but
preventflooding results with irrelevant publications, perhapsunderrepresentingspecialist
areas, a restricted focus on the time frame 2010–2023 may exclude influential studies.
According to citation metrics, publications receive 2156.15 citations each year.
4.2 Source of publications
Figure 3depicts the top five journals that focus on otolaryngological surgery. “Otolaryn-
gology–Head and Neck Surgery” (United States) produced 15 papers, whereas “JARO –
Journal of the Association for Research in Otolaryngology” and “Otolaryngology–Head
and Neck Surgery” contributed 12 and 6 papers, respectively.
4.2.1 Authors
We looked at the authors and discovered that the top ten authors with the most publi-
cations in the area of otolaryngological surgery are Rosenfeld, R.M., Schwartz, S.R., Nna-
cheta,L.C., Walsh,S.A., Chandrasekhar,S.S.,Goedegebure, A., Gurgel, R.K., Hackell,J.M.,
Klaver, C.C.W., Nijsten, T.E.C. (Fig. 4). Following a cluster analysis of the 100 included
publications, as depicted in Fig. 5, we discover author collaboration in the publication of
otolaryngological surgery— citations per author amount to 4443.19 according to metrics
of all citations.
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Figure 3 Demonstrating distribution of the top 100 most cited papers according to the journal sources in
which they are published
Figure 4 Demonstrating authors published as first authors and corresponding authors of the top 100 most
cited papers
4.2.2 Countries
The publication of the included papers involved contributors from 34 different nations.
The ten most productive countries with publication and document output are shown in
Fig. 6. The United States supplied the most publications (68), followed by Canada (21), the
United Kingdom (10), Netherlands (9), and China (8), as seen in Fig. 3. The USA, followed
by Canada and the Netherlands, was the nation that cooperated with other nations the
most. According to a cluster analysis of the 100 included papers in Fig. 7, the top three
hotspot countries are the United States, Canada, and the Netherlands.
5 Discussion
The importance and influence of a medical paper in the literature can sometimes be de-
termined by its citation count, which indicates how frequently it has been referred to in
later publications. This metric considers not just the topic of the papers but also its im-
pact on the work of other authors who reference it in their study. Nevertheless, it is crucial
to acknowledge that the quantity of citations and the impact factor of a journal may not
consistently indicate the true quality of the original work. Various factors, such as the es-
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Figure 5 Demonstrating authors’ collaboration for the top 100 most cited papers
Figure 6 Demonstrating distribution of the top 100 most cited papers according to the country in which
they are published
Figure 7 Map demonstrates collaboration between the different countries of the top 100 most cited papers
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tablished credibility of the author(s) and the journal reputation in which the research is
published, can significantly impact the number of citations received. This study aimed to
compile a list of the top 100 most referenced publications in otorhinolaryngological jour-
nals to identify the most influential works. In addition, the attributes of these publications
were examined to determine the specific aspects that make an ENT paper noteworthy to
other researchers in the field.
However, using only citation analysis to assess the significance of a paper, an author’s
trackrecord,orajournal’soverall performancehas limitations. This approach does not in-
clude the inclusion of self-references, citations in educational materials such as textbooks
and lectures, and the possibility that writers may cite papers from a journal in which they
are attempting to publish their work [14,20–22]. Furthermore, the time delay inherent in
citation analysis disadvantages the most recently published publications [4,5,22]. Despite
continued attempts to improve research quality and promote evidence-based practice, it
is worth noting that most of the top 100 cited papers were published from 2010 to 2023.
The year with the most publications was 2011, with 20 studies.
Furthermore, our study encountered constraints in classifying journals in the Scopus
database. More precisely, the focus was exclusively on journals that published papers re-
lated to otolaryngological surgery. This approach may have missed influential papers for
ENT doctors published in different journals.Furthermore,therewas a clear inclinationto-
ward publications published in journals written in English. Though they have drawbacks,
including self-citation bias, linguistic prejudice, quality vs. quantity, and social influence,
citation counts are an often-used indicator of the impact of research. These prejudices re-
flect conflict, ignore important research conducted in non-English locations, and falsely
boost citation counts.
Moreover, it is crucial to recognize the phenomenon known as the “snowball effect” in
citation patterns, when authors exhibit a greater tendency to cite publications that have
already been mentioned, leading to an escalation in citation counts. Among the top 100
publicationsinotolaryngological surgery,the number of citations varied from 131 to 1775.
Each paper was considered a “citation classic” based on the commonly accepted criterion
of having at least 100 citations [8,22]. The characteristics of the top 100 papers on oto-
laryngological surgery were comparable to those found in other fields. The majority of
publications were sourced from the United States, which aligns with the results of reviews
on anesthesia, plastic surgery, general surgery, andorthopedic surgery [1,22,30,35]. This
suggests that authors from the United States may have a favorable position when pub-
lishing works in international publications. When comparing the publishing number per
million population, certain European countries perform equally or above the USA. Other
reviews similarly observed the prevalence of clinical publications [1,22]. When examin-
ing the dominant subspecialties in ENT (Ear, Nose, and Throat), otology and neurotology
stand out as the most significant in the top 100 rankings. Surprisingly, there was no cor-
relation between the impact factor of journals and the number of citations. However, it is
important to note that all papers in the top 100 list came from only 55 out of 160 journals
published in the field of otolaryngological surgery in the 2013 Journal Citation Report Sci-
ence Edition. This highlights the importance of the published journal in determining the
probability of a paper being referenced.
To summarize, this analysis of the 100 most referenced papers in otolaryngological
surgery highlights the significant influence of the publishing journal and the place of origin
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Ren et al. Advances in Continuous and Discrete Models (2025) 2025:47 Page 13 of 14
ontheprobability of being cited. Subsequent bibliometric investigations havethepotential
to confirm these findings or detect changes in the attributes of prominent publications.
Abbreviations
ENT, Ear Nose Throat; ECG, Electrocardiogram; DWT, Discrete wavelet transform; AWT, Adaptive wavelet transform; IoT,
Internet of Things; CS, Chronic sinusitis; NSD, Nasal septal deviation; COM, Chronic otitis media; PAR, Perennial allergic
rhinitis; MRI, Magnetic resonance imaging; CT, Computed tomography; CHL, Chronic hearing loss; CHW, Community
health workers; NPs, Nonspeciality-trained professionals; VOS, Visualization of similarities; JARO, Journal of The Association
for Research in Otolaryngology.
Author contributions
LR, YY, FW, HZ are responsible for designing the framework, analyzing the performance, validating the results, and writing
the paper. LH, TL, FP are responsible for collecting the information required for the framework, providing software, critical
review, and administering the process. All authors read and approved the final manuscript.
Funding
This work was funded by project “Research on the application of checklist management combined with SOP in
otolaryngology surgery cooperation” (project ID: 20230207).
Data Availability Statement
No datasets were generated or analyzed during the current study.
Code availability
Not Applicable.
Declarations
Competing interests
The authors do not have any conflicts of interests.
Received: 26 September 2024 Accepted: 2 January 2025
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