Cognitive biases in otolaryngology: a systematic narrative review

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.