'First reports': the importance of being certain.

The workload of a journal editor and staff is demanding to say the least. These individuals are charged with preparing each issue carefully and expediently so that articles, editorials, reviews, case reports, and letters are published correctly and in a timely fashion. The editor and, to a lesser extent, the editorial board members and specifically the reviewers bear the additional burden of trying to ensure--as best they can--the scientific integrity and accuracy of manuscripts published, to maintain the credibility of the journal and medical record. The important issue of duplicate publication is but one example that has been of paramount concern to many editors in recent years. However, claims of priority can sometimes be problematic for editors, as well.

For example, we read with interest the case by Martin and colleagues (1) reporting a schwannoma of the epiglottis. Although this entity is rarely encountered in the larynx, we questioned the claim made by the authors that this was a first report. A perusal of the older issues of the Index Medicus (pre-MEDLINE) that took approximately an hour, under the subject heading "epiglottis," yielded one article (2) also claiming to be the first report of schwannoma of the epiglottis. A search of the IndMED database revealed a more contemporary article (3) on the same topic.

Goethals and Lillie (2) report removing a schwannoma (neurilemoma) from the left upper posterior surface of the epiglottis in a 23-year-old man presenting with hoarseness and dysphagia. Histologically, the tumor was composed of Schwann cells arranged in rows with elongated, spindled, palisading nuclei. Arora et al (3) reported the expulsion of a schwannoma of the epiglottis in a 30-year-old man reporting dry cough and a foreign body sensation prior to expulsion of the almond-size tumor. Indirect laryngoscopy revealed the tumor stalk arising from the right epiglottic border. Stalk specimens revealed spindle-shaped Schwann-like cells surrounded by loose stroma.

Although we expect that most cases of false "firstedness" are inadvertent, such false claims have at least a few undesirable consequences. For instance, the earlier work of others is not given proper credit. Additionally, the chronology of the medical record becomes confusing with the presence of multiple "first-reported cases" on the same topic. And while probably a harmless mishap, when discovered, such errors may be particularly embarrassing to authors making false claims.

This example underscores the importance of the admonition to authors in the "Instructions to Authors" for EAR, NOSE & THROAT JOURNAL, which states the following: "A search of the literature should not exclude sources published before 1966 (pre-MEDLINE) if they are pertinent to the current manuscript." Furthermore, authors should not rely solely on MEDLINE and PubMed when making a claim of a first report. Also, it would be helpful to specify the search strategy in the text of manuscripts making priority claims.

Our intent is not to malign or embarrass the authors, but to emphasize the importance of an adequate literature search when preparing a manuscript. The fact that many journals are not even indexed or are non-English journals complicates a search for rare cases. However, authors are encouraged to be diligent and thorough in searches to substantiate a claim of priority. Apart from searches in multiple electronic databases, other avenues to discover additional cases might include review of older bound indexes, the bibliography section of related papers, and consultation with colleagues. Employing the assistance of reference librarians or individuals who can translate foreign language articles can also be extremely helpful. While perfection cannot be expected or achieved, it is essential to do an adequate literature search prior to claiming priority.

References

(1.) Martin PA, Church CA, Chonkich G. Schwannoma of the epiglottis: First report of a case. Ear Nose Throat J 2002;81:662-3.

(2.) Goethals PL, Lillie JC. Neurilemoma of the epiglottis: Report of a case. Arch Otolaryng 1961 ;74:181-4.

(3.) Arora R, Agarwal KK, Solanki RL, et al. Spontaneous explusion of schwannoma of epiglottis. Indian J Otolaryng Head Neck Surg 1997;49:274-5.