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ENT Journal at the crossroads: Personal perspectives from an editorial board member

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August 22, 2018
by Mainak Dutta, MS, FACS

The relevance of a biomedical journal depends on how efficiently it culls and assimilates the happenings of practical significance from around the world in its discipline and provides undistorted information to its readers. While otolaryngology, itself an intrinsically heterogeneous discipline made more so by diversity ranging from students to allied health professionals to clinicians to researchers, is fast embracing cutting-edge advances, the practicing otolaryngologist and the student or resident may be overwhelmed by the amount of new data. Therefore, it seems timely to reassess the role of Ear, Nose and Throat Journal in delivering new information and translating research into the language of otolaryngologists-in-practice.

In recent years, ENT Journal has focused on publishing clinical studies and case series rather than single case reports unless they offer extraordinary insights. The change was inevitable and occurred after similar policies had been adopted at most other otolaryngology journals. ENT Journal was known previously for the variety of case reports it used to consider.

In our early residency years, those of us outside the United States were aware of one American journal with free online access that published a plethora of interesting clinical pieces-ENT Journal. We habitually perused those articles to get a taste of the diversity and aberrations in otolaryngology clinics. Many of our successes with writing were through that journal. It provided us an international platform to publish case reports that resulted from our initial efforts at medical writing. The journal has had a significant impact in nurturing the passion for creative thinking and medical writing among residents and young professionals.

The journal's present policy of favoring clinical studies over case reports follows the current trend of embracing evidence-based medicine as the platform for decision making regarding patient care, planning, and management. Case reports occupy the nadir of the strength of evidence. Moreover, their role in understanding disease pathophysiology and influencing management protocol is limited. Although they are not always mere documents of clinical curiosity, the effect of the surge of stronger evidence cannot, and should not be ignored.

In addition, all journals share a compulsion to compete with other journals, and to elevate the journal's metrics. The true value of the impact factor in determining a journal's overall standard and its hierarchical position might be debated. However, without a more suitable, universal alternative, the impact factor continues to decide a journal's “impact” and, consequently, the authors' preference for submission. Hence, almost all major otolaryngology journals have decided either not to consider case reports, or they are extremely stringent in accepting them.

ENT Journal is still accepting case reports but with utmost discretion. Consequently, its impact factor has more than doubled in the past few years, from 0.424 in 2009 to 1 in 2014, 0.932 in 2015, and 0.919 in 2016/17. The fact that case report publication has not stopped completely acknowledges their value and the journal's historical mission of providing important, path-breaking insights in understanding disease, and encouraging all professionals to contribute to advancing the field.

Indirectly, the policy of “accepting with discretion” also prevents reports of true merit from being relegated to “predator” journals and lost forever. However, we continue to encourage authors to expand case reports into more meaningful case series before submission.

One key challenge that the journal has faced is the previous prolonged delay from manuscript acceptance to publication. That delay has been reduced from 4 years-when the previous editor-in-chief died unexpectedly, leaving the journal with many more accepted manuscripts than could be published in a reasonable time-to the current 1.5 years. By the end of 2018, the wait should be reduced to less than 1 year. At present, manuscripts are expedited to circumvent the delay only when they offer time-sensitive contributions that are likely to have an immediate impact on the care of a substantial number of patients.

One way in which the journal has reduced the publication delay has been by publishing Online Exclusives on its website (www.entjournal.com) in conjunction with each issue that is published in print. This publishing model, by incorporating more articles in a given issue, has been advantageous in expediting publication, and it presents no disadvantage to authors or readers. These articles are highlighted through publication of their abstracts in the print portion of the issue, and they are indexed in PubMed/MEDLINE and other major biomedical databases.

In addition to good clinical studies, ENT Journal welcomes scholarly review articles. The importance of well-constructed, informative reviews cannot be overemphasized. They provide comprehensive discussions on topics of relevance, history, future trends, and cutting-edge technologies. No journal is complete without a commitment to good, meaningful reviews, especially when a large segment of its followers are residents and students. Scholarly reviews often are time-sensitive and eligible for expedited publication.

One of the best aspects of ENT Journal is its free access. The journal's costs are covered by advertising; this model is called “controlled circulation.” This approach allows free access to readers (in print for U.S. readers, as well as online or in a digital version for all readers) and does not require authors to pay to publish (as they do in open-access journals). It also helps to optimize journal circulation. This is especially significant for poor and developing nations where journal subscriptions and/or costs allowing publishing and access are not borne by institutions or libraries, but rather by individual doctors with limited funds. ENT Journal stands out among the contemporary otolaryngology journals by providing unconditional, universal access with free publishing, and by disseminating high-quality papers with admirable production quality.

Another feature that has been a consistent strength is the ENT Clinics departments. They are essentially clinical nuggets, consisting of concise case reports; but more than that, they deal with clinical nuances and practice pearls for problems often encountered in day-to-day rounds and practice. Brief and succinct, they are easy to read and remember, and they offer a plethora of variations and information on decision making in patient care. Although low in evidence value, their variety has made them the undoubted favorite among journal readers. Moreover, they guarantee a continuing component of clinically relevant case reports in every issue.

ENT Journal has come a long way in recent years to play a major role in disseminating current knowledge in otolaryngology and has distinguished itself among journals through its clinics and other special features. The journal's leadership is committed to its continued improvement. Suggestions from our readers are welcome and appreciated, and they may be sent to the editor for consideration.

Member, Ear, Nose & Throat Journal, Editorial Board, Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, West Bengal, India
Ear Nose Throat J. 2018 August;97(8):E46