Cognitive biases in otolaryngology: a systematic narrative review

Authors

  • Davis Thomas Pulimoottil Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India
  • Angel Cham Philip Department of Pediatrics, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India
  • Ramiya Ramachandran Kaipuzha Department of Otorhinolaryngology, Jahra Hospital, Al Jahra, Kuwait
  • Irine Aleyamma Thomas Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India https://orcid.org/0000-0002-0189-6393
  • Neenu Anna Joseph Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India
  • Sanu P. Moideen Department of ENT, Smita Memorial Hospital, Thodupuzha, Kerala, India
  • Alka Varghese Department of Ophthalmology, Sultan Qaboos University Hospital, University Medical City, Muscat, Sultanate of Oman
  • Hanan Raroth Chalil Department of Elective Orthopaedics, Nottingham City Hospital, Nottingham, Nottinghamshire, United Kingdom
  • Dhanya Susan Eapen Iwosan Lagoon Hospital, Ikoyi, Lagos, Nigeria
  • Devooty Babu Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India
  • Sanghamithra Sethu Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India
  • Rishana Venkakkunnummal Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India
  • Gadha Murali Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India
  • Niveditha Pramod Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20253002

Keywords:

Cognitive bias, Clinical decision making, Diagnostic errors, Otolaryngology, Operative surgical procedures

Abstract

Cognitive biases are systematic errors in thinking that significantly impact decision-making in surgery, including Otolaryngology. These biases contribute to misdiagnoses, inappropriate treatments and surgical errors, affecting patient outcomes. Despite growing recognition of cognitive biases in medicine, awareness and structured training in cognitive debiasing strategies remain limited. This narrative review systematically examines cognitive biases affecting surgical decision-making in Otolaryngology, categorizes their occurrence in different phases of surgical care and discusses mitigation strategies. A comprehensive literature search was conducted using multiple databases, including MEDLINE, Embase and Scopus, focusing on cognitive biases in surgical fields, particularly Otolaryngology. Studies that explored bias-related diagnostic errors, treatment decisions and mitigation strategies were included. Cognitive biases were classified based on their impact on the diagnostic workup, treatment phase and post-treatment follow-up. A total of 71 cognitive biases were identified as relevant to Otolaryngology. These biases were categorized according to their definitions, sources, examples in Otolaryngology and mitigation strategies. Targeted mitigation strategies, including structured decision-support tools, cognitive forcing strategies and multidisciplinary case discussions, were highlighted. Cognitive biases play a critical role in surgical decision-making in Otolaryngology, often leading to diagnostic and treatment errors. Increased awareness and implementation of cognitive debiasing strategies are essential to improving clinical reasoning and patient outcomes. Future research should focus on the effectiveness of structured interventions and the role of artificial intelligence in mitigating cognitive biases in surgery.

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Author Biographies

Alka Varghese, Department of Ophthalmology, Sultan Qaboos University Hospital, University Medical City, Muscat, Sultanate of Oman

Specialist , Department of Ophthalmology

Hanan Raroth Chalil, Department of Elective Orthopaedics, Nottingham City Hospital, Nottingham, Nottinghamshire, United Kingdom

Resident, Department of Elective Orthopaedics

Dhanya Susan Eapen, Iwosan Lagoon Hospital, Ikoyi, Lagos, Nigeria

Medical Officer

Devooty Babu, Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India

Junior Resident, Department of ENT

Sanghamithra Sethu, Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India

Junior Resident, Department of ENT

Rishana Venkakkunnummal, Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India

Junior Resident, Department of ENT

Gadha Murali, Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India

Junior Resident, Department of ENT

Niveditha Pramod, Department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala, India

Junior Resident, Department of ENT

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Published

2025-09-24

How to Cite

Pulimoottil, D. T., Philip, A. C., Kaipuzha, R. R., Thomas, I. A., Joseph, N. A., Moideen, S. P., Varghese, A., Chalil, H. R., Eapen, D. S., Babu, D., Sethu, S., Venkakkunnummal, R., Murali, G., & Pramod, N. (2025). Cognitive biases in otolaryngology: a systematic narrative review. International Journal of Otorhinolaryngology and Head and Neck Surgery, 11(5), 625–637. https://doi.org/10.18203/issn.2454-5929.ijohns20253002

Issue

Vol. 11 No. 5 (2025): September-October 2025

Section

Review Articles
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