SAGE Otolaryngology: Recent Episodes
SAGE Publications Ltd.
Welcome to the official free Podcast from SAGE Publications for Otolarygology.
SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets with principal offices in Los Angeles, London, New Delhi, and Singapore.
Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Jennifer L. Spiegel, MD, and Associate Editor Jacob Hunter, MD, to discuss the significance of advanced standard software tools for cochlear implants that allows a detailed analysis, as outlined in the paper "Angular Insertion Depth for Cochlear Implantation: A Comparative Analysis on Precision of CT, MRI, and x-Ray" which published in the July 2026 issue of Otolaryngology–Head and Neck Surgery.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Ahmad Sedaghat, MD, and Associate Editor Jakob Fischer, MD, to discuss the overall symptom severity score that provides a global assessment of symptom burden associated with chronic rhinosinusitis, as outlined in the paper "Psychometric Validation of the Overall Symptom Severity Score for Chronic Rhinosinusitis" which published in the June 2026 issue of Otolaryngology–Head and Neck Surgery.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Lee P. Smith, MD, and Associate Editor Christopher Johnson, MD, to discuss the study and approach used to establish a reliable rabbit model of airway stenosis and test how effective nebulized ciprofloxacin/dexamethasone is at reducing airway obstruction , as outlined in the paper "Evaluating the Efficacy of Nebulized Ciprofloxacin-Dexamethasone Using a Novel Model of Airway Stenosis" which published in the May 2026 issue of Otolaryngology–Head and Neck Surgery.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Saikrishna Gourishetti, MD, and Associate Editor Michael Brenner, MD, to discuss the investigation of whether performing cleft lip repair at an earlier age affects the likelihood of developing hypertrophic scarring, as outlined in the paper "Optimal Timing of Cleft Lip Repair: Correlation With Scar Formation and Revision Rates" which published in the March 2026 issue of Otolaryngology–Head and Neck Surgery.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Kyle M. Hatten, MD, and Associate Editor Patrick Tassone, MD, to discuss the importance of the investigation findings in HPV associated oropharyngeal squamous cell carcinoma and smoking risk factors in oropharyngeal cancers, as outlined in the paper "Does Smoking Influence Outcomes in Human Papillomavirus—Associated Oropharyngeal Cancer Treated with Transoral Robotic Surgery?" which published in the April 2026 issue of Otolaryngology–Head and Neck Surgery.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Romaine F. Johnson, MD, MPH, and Associate Editor M. Boyd Gillespie, MD, to discuss whether childhood obesity is associated with increased severity of obstructive sleep apnea during adolescence, as outlined in the paper "Association Between Weight Gain Trajectories and Severe Obstructive Sleep Apnea Among Adolescents" which published in the February 2026 issue of Otolaryngology–Head and Neck Surgery.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Mohamad R. Chaaban, MD, and Associate Editor Dana L. Crosby, MD, to discuss the growing evidence that suggests there may be a meaningful connection between chronic rhinosinusitis and obesity as outlined in the paper "Assessing the Impact of GLP-1R Agonists in Post-sinus Surgery Management," which published in the January 2026 issue of Otolaryngology–Head and Neck Surgery.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Michael J. Brenner, MD, and Associate Editor Christipher M. Johnson, MD, to discuss the challenges of financial stress patients face when they undergo common otolaryngology procedures, as outlined in the paper "Out-of-Pocket Costs and Surprise Billing in Otolaryngology: A National Database Analysis," which published in the December 2025 issue of Otolaryngology–Head and Neck Surgery.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author John P. Dahl, MD, PhD, MBA, and Associate Editor Marissa Ryan, MD, to discuss their findings in "TI-RADS and Bethesda Classification System Correlate With Predicting Pediatric Papillary Thyroid Carcinoma," which was published in the October 2025 issue of Otolaryngology–Head and Neck Surgery.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Rick Friedman, MD, PhD, and Associate Editor James G. Naples, MD, to discuss their findings in "Microsurgical Outcomes in 1000 Patients With Cerebellopontine Angle Tumors: A Comprehensive Cohort Analysis," which was published in the November 2025 issue of Otolaryngology–Head and Neck Surgery.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Colin T. Huntley, MD, and Associate Editor Boyd Gillespie, MD, to discuss how long-term changes in body mass index (BMI) following hypoglossal nerve stimulation (HGNS) impact surgical success as outlined in the paper "Impact of Postoperative Weight Changes on Hypoglossal Nerve Stimulation Success for Obstructive Sleep Apnea," which published in the September 2025 issue of Otolaryngology- Head and Neck Surgery.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc is joined by co-authors Margo McKenna, MD, and Maria Colandrea, DNP NP-C, to discuss the implications for non-otolaryngologists of the Clinical Practice Guideline "Adult Sinusitis Update," which published as a supplement to the August 2025 issue of Otolaryngology–Head and Neck Surgery. A plain language summary of the guideline was published in the August 2025 issue as a companion to the full guideline.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc is joined by co-authors Marc G. Dubin, MD, and Spencer C. Payne, MD, to discuss the Clinical Practice Guideline "Adult Sinusitis Update," which published as a supplement to the August 2025 issue of Otolaryngology–Head and Neck Surgery. The guideline addresses diagnostic accuracy for adult rhinosinusitis, use of ancillary tests to confirm diagnosis and guide management, and systemic and topical therapy.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc is joined by author Omar Karadaghy, MD, MSCI, and Associate Editor Sean Massa, MD, to discuss impact of surgical margin status in HPV-related oropharyngeal squamous cell carcinoma in "Impact of Margins on Outcomes in HPV-Related Oropharyngeal Squamous Cell Carcinoma Treated With Surgery Only," which published in the July 2025 issue of Otolaryngology–Head and Neck Surgery. They talk about the potential for improved patient care by re-examining the standards for surgical margins.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by authors Meghan Wilson, MD, and Jason Blakeley Hensler, MD, to discuss information on when to consider moving forward with surgical interventions for those who are evaluated and diagnosed with chronic rhinosinusitis. Based on the 2025 “Clinical Practice Guideline: Surgical Management of Chronic Rhinosinusitis” and is a companion publication to the full guideline.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Bradford A. Woodworth, MD, and Associate Editor Dana L. Crosby, MD, MPH, to discuss how lipopolysaccharide can be used to generate a model of acquired cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction in murine nasal airways as outlined in the paper “Lipopolysaccharide Causes Acquired CFTR Dysfunction in Murine Nasal Airways,” which published in the May 2025 issue of Otolaryngology–Head and Neck Surgery. They talk about CFTR as a potential driving process in recalcitrant chronic rhinosinusitis.
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Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author David Goldenberg, MD, to discuss role of estrogen in developing thyroid malignancy as outlined in the paper “Elevated Risk of Thyroid Malignancy in Biological Males Taking Estrogen Hormone Therapy” which published in the April 2025 issue of Otolaryngology–Head and Neck Surgery. They talk about the risk of thyroid cancer for biological males taking estrogen compared to men not undergoing hormone therapy and women.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Gresham T. Richter MD, and Associate Editor John P. Dahl, MD, PhD, MBA, to discuss the outcomes of not admitting pediatric supraglottoplasty patients as outlined in the paper “Is Outpatient Supraglottoplasty Possible? Examination of Perioperative Comorbidities and Outcomes” which published in the March 2025 issue of Otolaryngology–Head and Neck Surgery. They talk about the necessity of keeping patients at the hospital for different comorbidities and situations.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Lee M. Akst, MD, and Associate Editor Christopher M. Johnson, MD, to discuss diagnosis of, treatments, and solutions for refractory chronic cough as outlined in the paper “Refractory Chronic Cough: A State-of-the-Art Review for Otolaryngologists” which published in the February 2025 issue of Otolaryngology–Head and Neck Surgery. They discuss both the paper's findings and their own experiences caring for patients with this condition.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by first author Shiven Sharma, JD, and Associate Editor Michael J. Brenner, MD, to discuss what the specialty can learn about medical malpractice in the field for quality improvement as outlined in the paper “Medical Malpractice in Otolaryngology within the United States: A LexisNexis-Based Demographic Analysis” which published in the January 2025 issue of Otolaryngology–Head and Neck Surgery. They talk about the database used, how trends were identified, and how the findings can influence change in otolaryngology practices.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Priyesh N. Patel, MD, and Associate Editor Peter M. Vila, MD, MSPH, to discuss the role of the operating room and its necessity in treating skin cancer defects as outlined in the paper “Cost-Effectiveness Analysis of Operating Room and In-Office Reconstruction of Skin Cancer Defects” which published in the December 2024 issue of Otolaryngology–Head and Neck Surgery. They weigh the effects of operating room on efficiency, patient satisfaction, and procedure success.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by author Rohani Omar MRCP, MD(Res) and Associate Editor John P. Dahl, MD, PhD, MBA, to discuss causes, especially genetic causes, of pediatric hearing loss as outlined in the paper “Etiology of Childhood Profound Sensorineural Hearing Loss: The Role of Hearing Loss Gene Panel Testing” which published in the November 2024 issue of Otolaryngology–Head and Neck Surgery. They discuss the paper's investigation of gene panel testing for hearing loss in children.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Julie E. Strychowsky MD, MAS, FRCSC, and Associate Editor Michael J. Brenner, MD, to discuss methods for improving the efficiency of ORs for surgeons as outlined in the paper “Improving Operating Room Efficiency in Otolaryngology–Head and Neck Surgery: A Scoping Review” which published in the October 2024 issue of Otolaryngology–Head and Neck Surgery. They discuss the importance of finding ways to save time and cost for operating rooms in order to serve more patients and reduce physician burnout.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by author Ahmad R. Sedaghat MD, PhD, and Associate Editor Dana L. Crosby, MD, MPH, to discuss the possibility of chronic rhinosinusitis when allergies are assumed as outlined in the paper “When It's Not Allergic Rhinitis: Clinical Signs to Raise a Patient's Suspicion for Chronic Rhinosinusitis” which published in the September 2024 issue of Otolaryngology–Head and Neck Surgery. They compare the symptoms of chronic rhinosinusitis to those of allergies or related conditions, and where there is overlap.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by author John Pang, MD, and Associate Editor Tristan Tham, MD, to discuss circulating tumor DNA (ctDNA) detection as a new technique to identify minimal residual disease in patients with solid tumors as outlined in the paper “ctDNA as an Adjunct to Posttreatment PET for Head and Neck Cancer Recurrence Risk Assessment” which published in the August 2024 issue of Otolaryngology–Head and Neck Surgery. They compare ctDNA to the traditional PET to assess best methods.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Jonathon O. Russell MD, FACS, and Associate Editor Raymond Liu Chai, MD, to discuss the pros and cons of two approaches to thyroidectomy as outlined in the paper “Long-term Quality of Life After Thyroidectomy: Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Transcervical Approach” which published in the July 2024 special issue of Otolaryngology–Head and Neck Surgery. They compare the quality of life for patients under two methods including scarring and self consciousness.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Diana N. Kirke, MD, MPhil, and Associate Editor Lee M. Akst, MD, to discuss the potential for deep learning models to detect voice disorders as outlined in the paper “The Use of Deep Learning Software in the Detection of Voice Disorders: A Systematic Review” which published in the June 2024 special issue of Otolaryngology–Head and Neck Surgery. They compare the accuracy of different models and inputs and ponder the possibility of real-world implentation.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by lead authors Heather M. Weinreich, MD, MPH and Carrie L. Nieman, MD, MPH to provide a patient and primary care provider-focused overview of the “Clinical Practice Guideline: Age-Related Hearing Loss” which published in the May 2024 issue of Otolaryngology–Head and Neck Surgery. They discuss the pearls and pitfalls in screening and treating hearing loss for the patient and non-otolaryngologist providers.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by lead authors Betty S. Tsai Do, MD, and Matthew L. Bush MD, PhD, MBA, for a discussion of some key points of the “Clinical Practice Guideline: Age-Related Hearing Loss” which published in the May 2024 issue of Otolaryngology–Head and Neck Surgery. They discuss the recommendations for screening of hearing loss and the pros and cons for different treatment options of age-related hearing loss.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Anne C. Kane, MD, and Associate Editor Michael J. Brenner, MD for a discussion of the article “Otolaryngology Applicant Perspectives on In-person and Virtual Residency Interviews", which published in the April 2024 issue of Otlaryngology-Head and Neck Surgery. They discuss the pros and cons of conducting residency interviews either in-person or virtually, including the impacts of in-person interviews on underrepresented applicants.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by author Cecelia C Damask, DO and author Christine M. Reger, DNP, CRNP for a discussion of the implications for non-otolaryngologists of the “Clinical Practice Guideline on Immunotherapy for Inhalant Allergy,” which published in the March 2024 issue of Otolaryngology–Head and Neck Surgery. They discuss how allergies impact patients' lives and how immunotherapy can improve their symptoms.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by lead author Richard K. Gurgel, MD, MSC, and author Stacey L. Ishman, MD, MPH for a discussion of the implications for otolaryngologists of the “Clinical Practice Guideline on Immunotherapy for Inhalant Allergy,” which published in the March 2024 issue of Otolaryngology–Head and Neck Surgery. They discuss how the CPG came together over two years and what they discovered comparing different types of immunotherapy and the effects on different patient populations.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Michael J. Brenner, MD and Associate Editor and senior author John P. Dahl, MD, PhD, MBA for a discussion of the article “Reducing Pediatric Posttonsillectomy Opioid Prescribing: A Quality Improvement Initiative,” which published in the February 2024 issue of Otolaryngology–Head and Neck Surgery. They discuss how the researchers were able to reduce the numbers of opioid doses given to pediatric patients after adenotonsillectomy through standardized processes for prescribing.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Jacob Hunter, MD, and senior author Jay F. Piccirillo, MD, for a discussion of the article “Identifying Predictors of Treatment Response in Meniere's Disease: A Clinical Severity Staging System,” which published in the January 2024 issue of Otolaryngology–Head and Neck Surgery. Their conversation highlights how decreased vertigo severity, reduced comorbidity burden, and absence of hearing loss are associated with conservative treatment response in Meniere's disease.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Jacob Hunter, MD, and co-author Anil K. Lalwani MD, for a discussion of the article “The Association of Hearing Loss With Active Music Enjoyment in Hearing Aid Users,” which published in the December 2023 issue of Otolaryngology–Head and Neck Surgery. Their conversation highlights the effect of hearing aids on active music enjoyment in individuals with varying levels of hearing loss.
Article: https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ohn.473
Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Babak Givi, MD, and lead author Leila J. Mady MD, PhD, MPH, to discuss “Gender Differences Among Head and Neck Microvascular Reconstructive Surgeons,” which published in the November 2023 issue of Otolaryngology–Head and Neck Surgery. The research used a survey that was sent to facial plastic and maxillofacial surgeons, in addition to microvascular surgeons, to gain a comprehensive understanding of what causes gender differences in the subspecialty. One takeaway of note was that there were no gender differences when it came to training and practice patterns. Another revealed gender differences when explaining changes in practice—for men, the reasons related to career advancement; for women, the reasons related to burnout, usually related to work-life balance and especially if they have children.
Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Raymond L. Chai, MD, and lead author Julia E. Noel, MD, to discuss “Time-Driven Activity-Based Cost Comparison of Thyroid Lobectomy and Radiofrequency Ablation,” which published in the October 2023 issue of Otolaryngology–Head and Neck Surgery. Dr. Noel and her coauthors used time-driven activity-based cost methodology to drill down the details that reveal radiofrequency ablation (RFA) is a more cost-effective treatment modality. They looked at the entire treatment cycle for both lobectomy and RFA— from initial visit in clinic through the procedure and postoperative visit—to determine cost data for the hospital.
Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts Associate Editor Michael J. Brenner, MD, and lead author Ryan N. Heffelfinger, MD, for a conversation about the article “Recovery Benefit With Total Intravenous Anesthesia in Patients Receiving Rhinoplasty,” which published in the September 2023 issue of Otolaryngology–Head and Neck Surgery. This wide-ranging discussion covers outcomes of less nausea and vomiting for patients receiving TIVA, cost of TIVA, and data related to the environmental impact of TIVA vs. inhalational agents.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Thomas Q. Gallagher, DO, and lead author Sarah Nuss, BS, for a discussion of the article “Developing Consensus on Priority Pediatric Otolaryngology-Head and Neck Surgery Conditions and Procedures,” which published in the August 2023 issue of Otolaryngology–Head and Neck Surgery. This study was done in collaboration with the Global OHNS Initiative and used the Delphi method to capture consensus lists through survey participants representative of the seven World Bank regions.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, Associate Editor James “Whit” Mims, MD, and lead author Ameen Amanian, MD, MSE, discuss “The Evolution and Application of Artificial Intelligence in Rhinology: A State of the Art Review.” The article, published in the July 2023 issue of Otolaryngology-Head and Neck Surgery, provides a good introduction to what AI can do within the context of rhinology. One podcast highlight fleshes out the AI nomenclature and provides examples within rhinology of machine learning and deep learning, both of which fall under the AI domain. AI for diagnosis and AI for treatment outcomes are explained as are the limits of AI within the high stakes of patient care, including how AI will never replace the personal touch only clinicians can provide.
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Join Editor in Chief Cecelia E. Schmalbach, MD, MSc, for a compelling discussion of “Individuals Experiencing Homelessness: A Systematic Review of Otolaryngology-Related Health Needs and Community-Based Interventions,” which published in the June 2023 issue of Otolaryngology-Head and Neck Surgery. Associate Editor Michael J. Brenner, MD; senior author Antoine Eskander MD, ScM, FRCSC; and lead author and recent graduate Dorsa Mavedatnia, MD, take part in the discussion of this literature review on otolaryngology health needs and interventions for populations, both adult and pediatric, experiencing homelessness.
Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts a rich discussion of “Current Management of Subcondylar Fractures: A Systematic Review,” which published in the May 2023 issue of Otolaryngology-Head and Neck Surgery. Lead author Kalpesh Vakharia, MD, and Associate Editor Babak Givi, MD, join Dr. Schmalbach in a conversation that delves into the approaches used for subcondylar fractures when treating facial trauma. This systematic review provides a resource for surgeons and demonstrates a need for more research in this area.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts a discussion on “Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients,” which published in the April 2023 issue of Otolaryngology–Head and Neck Surgery. Joining the conversation are authors Maggie A. Kuhn MD, MAS, and M. Boyd Gillespie MD, MSc, and Associate Editor Lee M. Akst, MD. This ECS is the result of a multidisciplinary team comprising experts who reached consensus on recommendations that fill existing clinical practice knowledge gaps. Also discussed are the statements that did not reach consensus, particularly those around the use of reactive and prophylactic feeding tubes.
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Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts this podcast on the article “Sponsorship and Negotiation for Women Otolaryngologists at Midcareer: A Content Analysis,” which published in the March 2023 issue of Otolaryngology–Head and Neck Surgery. Coauthors Janice L. Farlow, MD, PhD, and Sonya Malekzadeh, MD, along with Associate Editor Chau T. Nguyen, MD, join Dr. Schmalbach for a compelling discussion around the need for midcareer women otolaryngologists to gain knowledge about sponsorship and negotiation. Click here to read the full article.
Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts this podcast on “Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy,” which published in the February 2023 issue of Otolaryngology–Head and Neck Surgery. Joining Dr. Schmalbach in conversation are lead author and chair of the expert panel, Stacey L. Ishman, MD, MPH, and coauthor Stephen C. Maturo, MD. This ECS focuses on pediatric patients (between ages 2 and 18) with persistent OSA and on those with recurrent OSA who underwent previous tonsillectomy or adenotonsillectomy, but OSA came back. Rich discussion occurs around how consensus statements concentrate on quality opportunities that exist and areas on which experts agree to put forth best practices.
Join Otolaryngology–Head and Neck Surgery’s Editor in Chief Cecelia E. Schmalbach, MD, MSc, as she discusses the article “Reimbursement Trends in Pediatric Otolaryngology From 2000 to 2020: A CMS Physician Fee Schedule Analysis” with senior author Jay R. Shah, MD, and Associate Editor Thomas Q. Gallagher, DO. This engaging conversation touches on Common Procedural Terminology (CPT) codes, relative value units, reevaluation of CPT codes, and trends in reimbursements.
This podcast highlights a systematic review to determine safety of cochlear implantation in pediatric patients 12 months and younger. This research was published in the December 2022 issue of Otolaryngology–Head and Neck Surgery,the official journal of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF)
The results of this systematic review and meta-analysis involving 269 studies suggest that cochlear implantation in patients 12 months and younger is safe with similar rates of complications to older cohorts.
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This podcast highlights original research published in the November official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objectives were to offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. In conclusion, systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell’s palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. Click here to read the full article.
This podcast highlights original research published in the October official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objectives were to identify anatomic contributions to chronic rhinosinusitis (CRS) necessitating revision endoscopic sinus surgery (RESS), and to create a clinical acronym to guide imaging review prior to RESS that addresses pertinent sites of disease and potential sites of surgical morbidity. In conclusion, the REVISIONS acronym was developed as a tool to distill the unique anatomic contributions of primary endoscopic sinus surgery failure into a format that can be easily incorporated in preoperative radiologic review and surgical planning to optimize outcomes and minimize complications. Click here to read the full article.
This podcast concludes the remarkable tenure of John H. Krouse, MD, PhD, MBA, editor in chief of Otolaryngology–Head and Neck Surgery and OTO Open, the official journals of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF), and welcomes the incoming leadership of Cecelia E. Schmalbach, MD, MSc, as the new editor in chief.
In his final podcast, Dr. Krouse ushers in a new era as he discusses with Dr. Schmalbach her plans for the future of both AAO-HNSF journals.
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This podcast highlights original research published in the August official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective was to evaluate nodule height-to-width ratio as a continuous variable predicting likelihood of thyroid malignancy.
In conclusion, our results support the association between greater height-to-width ratio and malignancy but suggest that a multilevel rather than binary variable improves prediction. The likelihood ratios at different intervals give a more nuanced view of how height-to-width ratio predicts malignancy. With continuing review of guidelines for thyroid nodule biopsy, it is important to consider these data for any point total attributed to shape.
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This podcast highlights original research published in the July official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective was to determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology.
In conclusion, the prevalence of incidental mucosal changes in a general asymptomatic population on radiology needs to be considered when making a diagnosis of chronic rhinosinusitis.
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This podcast highlights original research published in the June official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
There has never been a time in our society when we have been as willing and open in our discussions around issues of racial and ethnic inequalities, discrimination, systemic racism, and socioeconomic disparities.
Within this dialogue on health inequalities, one soon comes to realize the strong interplay of bioethics, social justice, and systemic racism on health care and outcomes. Ethical questions pertaining to the rights of individual participants in research, criteria for inclusion and recruitment into studies, and the development of trusting relationships among communities, health systems, and governmental agencies continue to challenge us in achieving our goals of reducing health disparities and improving health care outcomes for our patients.
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This podcast highlights original research published in the May official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Infants with posterior tongue-tie (PTT) can have substantial difficulty with breastfeeding and bottle-feeding. This study aimed to address the dearth in investigational objective data surrounding PTT release to better quantify the postoperative impacts of frenotomy for ankyloglossia.
In conclusion, when measured 10 days after frenotomy for PTT, infants improve feeding parameters using an objective bottle-feeding system. Similar improvements are seen with patient-reported outcomes when PTT is released. Posterior tongue-tie is a valid clinical concern, and surgical release can improve infant and maternal symptoms.
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This podcast highlights original research published in the April official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
There is little research on the rate and risk factors for revision tonsillectomy after primary intracapsular tonsillectomy. Our study aimed to determine the revision rate following intracapsular tonsillectomy, identify patient characteristics that may increase the probability of revision surgery, and report the tonsillar hemorrhage rate after revision.
In conclusion, patients below age 4 years and patients with gastroesophageal reflux disease may be at increased risk of undergoing revision tonsillectomy after primary intracapsular tonsillectomy. These factors should be considered when selecting an intracapsular technique for primary tonsillectomy in pediatric patients.
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This podcast highlights original research published in the March 2022 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The aim of this study was to evaluate the hearing outcome of cochlear implantation in patients deafened by Ménière’s disease.
In conclusion, cochlear implant in patients deafened by Ménière’s disease significantly improves word recognition scores regardless of whether medical or surgical treatment is used prior to implantation. The potential improvement in word recognition scores decreases after age 70 years.
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This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations", published as a supplement to the February 2022 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations", published as a supplement to the February 2022 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children.
Click here to read the Guideline.
This podcast highlights original research published in the January 2022 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The aging US population requires an increasing volume of otolaryngology–head and neck surgery services, yet the otolaryngologist physician workforce remains static. Advanced practice providers (APPs), including physician assistants and nurse practitioners, improve access across the continuum of primary and subspecialty health care.
In conclusion, the demand for health care services in otolaryngology care will increasingly exceed otolaryngologist surgeon workforce capacity. APPs are valuable partners in meeting growing needs of the population. While further data are needed to determine the optimal models of high-quality care, it is clear that APPs will be play an ever-greater role in shaping the specialty. Successful growth in otolaryngology–head and neck surgery requires a culture that supports effective integration of APPs across diverse practice settings. Progress also requires open-mindedness on the part of both providers and patients in embracing evolving models of care.
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This podcast highlights original research published in the December 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Subglottic stenosis (SGS) is a known complication of granulomatosis with polyangiitis (GPA). We investigated the impact of medical and surgical interventions on the surgical dilation interval and characterized patients with glottic involvement.
In conclusion, although GPA is classically thought to affect the subglottis, it also involves the glottis in a subset of patients. These patients have greater complaints of dysphonia and require more frequent surgery. Systemic therapy may increase dilation intervals. In this preliminary study, patients taking leflunomide demonstrated an improvement, highlighting the need for further study of immunosuppression regimens in the treatment of GPA-associated SGS.
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This podcast highlights original research published in the November 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective was to review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis.
In conclusion, the majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life.
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This podcast highlights original research published in the October 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Pathologic extranodal extension (ENE) is an important adverse feature for human papillomavirus (HPV)–negative head and neck squamous cell carcinoma (HNSCC), but the prognostic significance of microscopic ENE (ENEmi) and role of adjuvant concurrent chemoradiation (CRT) for ENEmi remain unclear. This study evaluates (1) the prognostic significance of ENEmi in HPV-negative HNSCC and (2) whether adjuvant CRT is associated with improved overall survival (OS) for these patients.
In conclusion, for patients with HPV-negative HNSCC, pN+ with ENEmi is associated with worse OS than pN+ without ENE. However, for patients with ENEmi, concurrent CRT is not associated with improved OS relative to RT. The optimal adjuvant paradigm for ENEmi requires additional investigation.
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This podcast highlights original research published in the September 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Traumatic brain injury (TBI) is the leading cause of acquired long-term disability during childhood, and it may result in wide range of negative developmental consequences. Auditory dysfunction is generally recognized to be a possible sequela of pediatric TBI. Unfortunately, few contemporary studies have quantified the association between head injury and hearing loss in the pediatric population.
In conclusion, findings suggest a notable association between TBI and hearing loss. Children with a history of TBI are 2.67 times more likely to have concurrent hearing complaints.
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This podcast highlights original research published in the August 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective was to evaluate the presence of bitter taste receptors (T2Rs) in the middle ear and to examine their relationship with chronic ear infections.
In conclusion, T2Rs were found within the middle ear of every patient sampled; the rs1376251 allele of TAS2R50 appears to be related to chronic ear infections. These receptors are an intriguing target for future research and possible drug targeting.
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This podcast highlights original research published in the July 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Nurse practitioners and physician assistants form a growing advanced practice provider (APP) group. We aim to analyze the trends and types of services provided by APPs in otolaryngology.
In conclusion, due to increasing numbers, APPs are accounting for more patient visits and procedures over time. The physician workforce and the numbers of procedures performed per physician have remained relatively stable from 2012 to 2017. Increasing complexity of patients seen and a broader range of procedures offered by work-experienced or postgraduate-trained APPs may further improve access to health care in the face of possible physician shortages.
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This podcast highlights original research published in the June 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective was to characterize the relationship between objective tympanogram values and patient-reported symptoms and associations with common comorbid conditions.
In conclusion, patients with symptoms of ETD may have a TPP within a range typically considered normal per conventional standards. This suggests that the currently accepted interpretation of tympanometry findings may be insensitive for the diagnosis of less severe cases of ETD.
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This podcast highlights original research published in the May 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Part 1 objective: To assess the prevalence of distress and burnout in otolaryngology trainees, including associations with relevant sociodemographic and professional factors, and to compare these results with those of attending otolaryngologists.
Part 2 objective: To ascertain the prevalence of and associations with distress and professional burnout among academic otolaryngology attending physicians.
Part 1 conclusion: Otolaryngology trainees experience significant work-place distress (49%) and burnout (35%). Gender, HW, and NOC had the strongest associations with distress and burnout.
Part 2 conclusion: Distress or professional burnout occurs in more than a quarter of academic otolaryngology attending physicians, whereas the prevalence of depression or anxiety is approximately 10%. The number of hours worked per week had the strongest association with distress and burnout. These findings may be used to develop and implement programs to promote physician well-being and mitigate professional burnout.
Click here to read the full part 1 article.
Click here to read the full part 2 article.
This podcast highlights original research published in the April 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The first pediatric tracheostomy tube change often occurs within 7 days after placement; however, the optimal timing is not known. The primary objective was to determine the rate of adverse events of an early tube change. Secondary objectives compared rates of significant peristomal wounds, sedation requirements, and expedited intensive care discharges.
In conclusion, the first tracheostomy tube change in children can occur without adverse events on day 4, resulting in fewer significant peristomal wounds and earlier intensive care discharge.
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This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations", published as a supplement to the April 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this specialty-specific guideline is to identify quality improvement opportunities in postoperative pain management of common otolaryngologic surgical procedures. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations", published as a supplement to the April 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this specialty-specific guideline is to identify quality improvement opportunities in postoperative pain management of common otolaryngologic surgical procedures. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation.
Click here to read the Guideline.
This podcast highlights original research published in the March 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective was to evaluate the association between race/ethnicity and insurance status on the access to early cochlear implantation.
In conclusion, racial/ethnic and insurance disparities in pediatric cochlear implantation can be observed at the population level. To address these racial and insurance inequalities, a multidisciplinary care team is needed and priorities should be given to research endeavors and policy interventions that target these disparities.
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This podcast highlights original research published in the February 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Building a diverse otolaryngology workforce—one that mirrors society—is critical.
In conclusion, structural inequities are woven into the fabric of society and medicine, and these effects are often invisible to those who do not bear the brunt of them.
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This podcast highlights original research published in the January 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective was to investigate differences in epidemiology of oropharyngeal squamous cell carcinoma (OPSCC) with regards to human papillomavirus (HPV), race, and socioeconomic status (SES) using the National Cancer Database (NCDB).
In conclusion, significant differences in HPV status exist between socioeconomic and racial groups, with HPV-negative disease more common among blacks and lower SES. When controlling for HPV status, race and SES still influence outcomes in oropharyngeal cancers.
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This podcast highlights original research published in the December 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Auditory complaints are commonly reported following traumatic brain injury (TBI). However, few studies have examined patient-reported auditory symptomatology and quality-of-life metrics in individuals with TBI. We hypothesize that following TBI, individuals can experience auditory symptoms even with hearing thresholds in the normal range.
In conclusion, despite hearing thresholds in the normal range, some individuals with TBI experience decrements in auditory quality of life, even in the absence of TBF.
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This podcast highlights original research published in the November 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Eustachian tube dysfunction (ETD) is a common diagnosis among adults presenting for outpatient care. We sought to determine national utilization and the associated cost of invasive procedures for adult ETD.
In conclusion, several nasal and otologic procedures are associated with a diagnosis of adult ETD at substantial cost. Development of therapeutic alternatives should be sought to mitigate the need for invasive procedures to treat this condition.
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This podcast highlights original research published in the October 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this review was to evaluate clinicians’ adherence to these guidelines’ recommendations as measured in the literature.
In conclusion, adherence to recommendations in the AAO-HNSF guidelines varies widely. These findings highlight areas for further guideline dissemination, research about guideline adoption, and quality improvement
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This podcast highlights original research published in the September 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective was to investigate the outcomes of pediatric tracheostomy as influenced by demographics and comorbidities.
In conclusion, pediatric tracheostomy requires substantial health care resources with length of stay escalating over recent years. Age, race, region, discharge destination, and comorbidities were associated with differences in length of stay.
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This podcast highlights original research published in the August 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Human papillomavirus (HPV)–positive oropharynx squamous cell carcinoma (OPSCC) is known to have improved survival over HPV-negative disease. However, it is largely unknown whether HPV status similarly affects survival in patients presenting with distant metastatic disease. We queried the National Cancer Database for OPSCC with distant metastasis.
In conclusion, HPV-positive OPSCC has improved survival in the setting of distant metastatic presentation as compared with HPV-negative disease and shows greater responsiveness to treatment.
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This podcast highlights original research published in the June 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Surgical care is increasingly shifting to freestanding ambulatory surgical centers (ASCs). The extent to which otolaryngologists use ASCs has implications for patient safety and health care spending. This study characterizes trends in utilization and resultant financial implications for common otolaryngologic procedures performed at ASC and hospital outpatient departments (HOPDs).
In conclusion, otolaryngologists shifted outpatient surgical care from HOPDs to ASCs between 2010 and 2017, with resultant reductions in Medicare expenditures. Further research is necessary to examine the impact of this shift on patient safety.
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This podcast highlights two original research papers published in the July 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The first paper is: "Olfactory Dysfunction: A Highly Prevalent Symptom of COVID-19 With Public Health Significance". The objective of this study was to review the scientific evidence about anosmia in COVID-19. In conclusion, current evidence shows that OD is highly prevalent in COVID-19, with up to 80% of patients reporting subjective OD and objective olfactory testing potentially showing even higher prevalence. OD is frequently accompanied by taste dysfunction. Up to 25% of COVID-19 patients may experience sudden-onset OD as the first symptom. A large proportion of COVID-19 OD cases may resolve over the period of a few weeks.
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The second paper is: "The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis". The objective was to determine the pooled global prevalence of olfactory and gustatory dysfunction in patients with the 2019 novel coronavirus (COVID-19). In conclusion, olfactory and gustatory dysfunction are common symptoms in patients with COVID-19 and may represent early symptoms in the clinical course of infection. Increased awareness of this fact may encourage earlier diagnosis and treatment, as well as heighten vigilance for viral transmission. To our knowledge, this is the first meta-analysis to report on the prevalence of these symptoms in COVID-19 patients.
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This podcast highlights original research published in the May 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective was to identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology–Head and Neck Surgery clinical consensus statements.
In conclusion, this expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.
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This podcast highlights original research published in the April 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to demonstrate whether race, education, income, or insurance status influences where patients seek medical care and the cost of care for a broad range of otolaryngologic diseases in the United States.
In this study, significant racial and socioeconomic discrepancies exist in the utilization and cost of health care for otolaryngologic conditions in the United States.
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This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Ménière’s Disease", published as a supplement to the April 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of Ménière’s disease. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Ménière’s Disease", published as a supplement to the April 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of Ménière’s disease. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
Click here to read the Guideline.
This podcast highlights original research published in the March 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to characterize the temporal trajectory of body image disturbance (BID) in patients with surgically treated head and neck cancer (HNC).
In conclusion, in this cohort of patients surgically treated for HNC, BID worsens posttreatment before returning to pretreatment (baseline) levels at 9 months posttreatment. However, 4 in 10 patients will experience a protracted course with persistent posttreatment body image concerns, and half will experience a significant increase in BIS scores relative to pretreatment levels.
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This podcast highlights original research published in the February 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Hospital-acquired aspiration pneumonia remains a rare but potentially devastating problem. The best means by which to prevent aspiration in a cancer hospital population has not been evaluated. The aim of this study was to evaluate the impact of dysphagia screening on aspiration pneumonia rates in an acute care oncology hospital.
In conclusion, nursing-initiated dysphagia screening did not decrease aspiration pneumonia rates. The causes of aspiration-associated pneumonia were heterogeneous. Aspiration of intestinal contents is a more common source of hospital-acquired pneumonia than oropharyngeal dysphagia.
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This podcast highlights original research published in the January 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Although neck impairment has been described following surgical resection, limited studies have investigated its prevalence in nonsurgical treatment. The purpose of this study is to determine the prevalence and predictors of neck disability following head and neck cancer (HNC) treatment and to explore its association with quality of life (QOL).
In conclusion, this study revealed a high prevalence of neck disability following nonsurgical treatment. While neck disability is an established sequela of surgical resection, the impact of nonsurgical treatment has gone unrecognized. Early identification and intervention to prevent progression of neck disability are crucial to optimize QOL.
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This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Nosebleed (Epistaxis)", published as a supplement to the January 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient’s quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Nosebleed (Epistaxis)", published as a supplement to the January 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient’s quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds.
Click here to read the Guideline.
This podcast highlights original research published in the December 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Despite increased concern with the opioid epidemic, literature remains scant regarding narcotic prescription and use following tonsillectomy.
In conclusion, patient-reported narcotic use is significantly lower than the amount prescribed after tonsillectomy for benign disease. Providers can use these data to adjust narcotic-prescribing patterns while maintaining appropriate pain management for patients undergoing tonsillectomy.
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This podcast highlights original research published in the November 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH).
In conclusion, our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.
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This podcast highlights original research published in the October 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Balloon sinuplasty (BS) is a surgical management option in the treatment of chronic rhinosinusitis. The purpose of this study was to examine BS utilization among children with a national database.
In conclusion, rates of BS performance in the pediatric population have not increased over time. Results showed no difference in readmission rates between BS and ESS. BS was associated with higher costs as compared with ESS. The role of BS in the pediatric chronic rhinosinusitis population remains unclear.
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This podcast highlights original research published in the September 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to recognize that thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; Bethesda III) have different risks of malignancy based on genetic mutation and to consider molecular testing of nodules with AUS/FLUS to help avoid unnecessary morbidity or cost.
In conclusion, not all molecular mutations in thyroid nodules with AUS/FLUS have a high risk of malignancy. Of note, patients with BRAF and RET mutations in our population had a 100% risk of malignancy. Patients with PAX, HRAS, or NRAS mutations had a high risk of malignancy, while patients with KRAS mutations had a lower risk of malignancy. Further studies are needed to determine if the presence of certain molecular mutations can help personalize care and aid in the decision for thyroid surgery.
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This podcast highlights original research published in the August 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Although the literature adequately identifies the current gender inequality that exists in academic otolaryngology and describes the barriers to advancement of women in academic medicine, there is little information regarding the daily details of how successful women in academic otolaryngology achieve work-life balance. This study was designed to better understand how women in academic otolaryngology achieve work-life balance while negotiating family and childrearing commitments, clinical workload, and scholarly activity, as well as to highlight coping strategies and behaviors that women have used to achieve these successes.
The conflicting demands between home and professional life are one of the barriers to recruiting, promoting, and retaining women in academic otolaryngology. Fostering a better environment for work-life balance is critical to promote the advancement of women in otolaryngology and otolaryngology leadership.
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This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Sudden Hearing Loss (Update)", published as a supplement to the August 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This guideline update provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with sudden hearing loss. It focuses on sudden sensorineural hearing loss in adult patients aged ≥18 years and primarily on those with idiopathic sudden sensorineural hearing loss. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and patient quality of life. The guideline update is intended for all clinicians who diagnose or manage adult patients who present with sudden hearing loss.
Click here to read the Guideline.
This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Sudden Hearing Loss (Update)", published as a supplement to the August 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This guideline update provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with sudden hearing loss. It focuses on sudden sensorineural hearing loss in adult patients aged ≥18 years and primarily on those with idiopathic sudden sensorineural hearing loss. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and patient quality of life. The guideline update is intended for all clinicians who diagnose or manage adult patients who present with sudden hearing loss.
Click here to read the Guideline.
This podcast highlights original research published in the July 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to compare outcomes for patients undergoing a transmastoid approach versus a middle fossa craniotomy approach with plugging and/or resurfacing for repair of superior semicircular canal dehiscence. Outcome measures include symptom resolution, hearing, operative time, hospital stay, complications, and revision rates.
In conclusion, both the transmastoid approach and the middle fossa craniotomy approach for repair of superior canal dehiscence offer symptom resolution with minimal risk. The transmastoid approach was associated with shorter hospital stays and lower recurrence rate as compared with the middle fossa craniotomy approach.
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This podcast highlights original research published in the June 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to determine the role of cognitive testing in predicting age-appropriate audiometric responses among children aged 30 to 42 months.
In conclusion, the DAYC-2 is a useful screen to identify children likely to complete an age-appropriate audiogram.
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This podcast highlights original research published in the May 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objectives of this study were to (1) analyze unsolicited patient complaints (UPCs) among otolaryngologists, (2) identify risk factors for UPCs, and (3) determine the impact of physician feedback on subsequent UPCs.
In conclusion, systematic monitoring and respectful sharing of peer-comparative patient complaint data offers an intervention associated with UPCs and concomitant malpractice risk reduction. Collegial feedback over time increases the response rate, but a small proportion of physicians will require directive interventions.
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This podcast highlights original research published in the April 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Obstructive eustachian tube dysfunction (OETD) affects up to 5% of adults; however, available treatment strategies have limitations. It was previously reported that balloon dilation of the eustachian tube (BDET) with the eustachian tube balloon catheter + medical management (MM) results in a significantly higher proportion of subjects with normalized tympanograms versus MM alone at 6- and 24-week follow-up. The current analysis extends these initial findings by investigating the durability of BDET + MM treatment outcomes through 52 weeks.
In conclusion, the present study suggests that the beneficial effects of BDET + MM on tympanogram normalization and symptoms of subjects with refractory OETD demonstrate significant durability that is clinically relevant through 52 weeks.
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This podcast highlights original research published in the March 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objectives of this study were (1) to determine the short-term effectiveness of oral steroids in women with benign vocal fold lesions and (2) to determine the effectiveness of adjuvant oral steroids in women undergoing voice therapy for benign vocal fold lesions.
In conclusion, a short course of oral steroids did not benefit women with phonotraumatic vocal fold lesions. In addition, steroids had little beneficial effect when used adjunctively with voice therapy in this patient cohort.
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This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Tonsillectomy in Children (Update)", published as a supplement to the February 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This update of a 2011 guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children <15 years of age based on the most recent published data. This guideline is intended for all clinicians in any setting who interact with children who may be candidates for tonsillectomy.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Tonsillectomy in Children (Update)", published as a supplement to the February 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This update of a 2011 guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children <15 years of age based on the most recent published data. This guideline is intended for all clinicians in any setting who interact with children who may be candidates for tonsillectomy.
Click here to read the Guideline.
This podcast highlights original research published in February 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to understand the effects of positron emission tomography/computed tomography (PET/CT) evaluation on patients with previously untreated head and neck squamous cell carcinoma (HNSCC) with clinical evidence of regional lymph node involvement.
In conclusion, when added to more conventional patient evaluation, PET/CT results in changes to the TNM categories, but overall staging and treatment were less frequently affected. Whether PET/CT should be used routinely for patients with stage III and IV HNSCC is still subjective and merits further study.
Click here to read the full article.
This podcast highlights original research published in the January 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Vestibular symptoms such as dizziness and vertigo are common after head injury and may be due to trauma to the peripheral vestibular system. The pathophysiology of peripheral vestibular symptoms following head injury without temporal bone (TB) fracture, however, is not well understood. Herein, this study investigates the histopathology of the peripheral vestibular system of patients who sustained head injury without a TB fracture.
In conclusion, otopathologic analysis of patients with a history of head injury without TB fracture demonstrated peripheral vestibular otopathology. Future studies are necessary to determine if otopathology findings are directly attributable to head injury.
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This podcast highlights original research published in the December 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This retrospective study uses a large national claims-based database to analyze recent practice patterns related to balloon catheter dilation (BCD) of the sinuses.
In conclusion, BCD, especially in the office, has risen in popularity since the introduction of Current Procedural Terminologycodes in 2011. This study reveals significant differences in demographics and comorbidities between patients undergoing BCD and those undergoing FESS. Such disparities may highlight the need for better-defined indications for use of this technology.
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This podcast highlights original research published in the November 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this study was to (1) determine 1-year period prevalence of suicidal ideation, suicide attempt, and completed suicide among patients newly diagnosed with a first occurrence of head and neck cancer (HNC). (2) Characterize stability and trajectory of suicidal ideation over the year following cancer diagnosis. (3) Identify patients at risk of suicidal ideation.
In conclusion, suicide prevention strategies are clearly needed as part of routine clinical care in head and neck oncology, as well as their integration into clinical practice guidelines for HNC.
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This podcast highlights original research published in the October 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this study was to determine the incidence of posttracheostomy tracheal stenosis and to investigate variables related to the patient, hospitalization, or operation that may affect stenosis rates.
In conclusion, greater than 10 days of orotracheal intubation prior to tracheostomy and endotracheal tube cuff pressure ≥30 mm H2O were associated with greater rates of subsequent tracheal stenosis. The only patient-related factor associated with tracheal stenosis was obesity. Surgical variables associated with increased rates of subsequent stenosis included placement of a tracheostomy tube size >6, use of percutaneous technique, and failure to create a Bjork flap.
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This podcast highlights original research published in the September 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this study was to characterize industry payments to otolaryngologists in 2016 versus 2014 and 2015.
In conclusion, industry compensation to otolaryngologists is increasing and increasingly unequal, although it is still less than that in most other specialties. In otolaryngology, the Open Payments Database has not decreased physician-industry relationships as intended.
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This podcast highlights original research published in the August 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to determine factors that influence cost variability in septoplasty with inferior turbinate reduction.
For septoplasty with inferior turbinate reduction, the greatest driver of cost variation was operative time. Resident involvement correlated with increased time and cost. Supply costs had a much smaller impact. When subanalyzed by resident year, junior resident–involved cases were significantly longer than no-resident cases.
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This podcast highlights original research published in the July 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to determine if balloon catheter dilation of sinus ostia affects the severity or frequency of headache among patients who have barometric pressure–related “sinus” headache.
Subjects with sinus pressure headache without evidence of mucosal thickening on computed tomography had no significant difference in outcomes between active treatment (balloon dilation of sinus ostia) and placebo (nasal dilation). Further study on the etiology and effective treatment of barometric pressure / “sinus” headache is needed.
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This podcast highlights original research published in the June 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Professional burnout is a barrier to physician wellness. Burnout is prevalent across medicine, and otolaryngology as a specialty ranks near the mean. We review burnout levels in various subgroups of otolaryngology, including academic chairs, faculty, and residents. Risk factors of burnout are discussed, which differ by subgroup. Finally, we propose measures that could help minimize burnout and promote healthy and satisfying careers.
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This podcast highlights original research published in the May 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this study is to identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures.
Evidence does not support the use of perioperative antibiotics for most otolaryngologic procedures. Antibiotic overuse and variability among providers may be due to lack of formal practice guidelines. This review can help otolaryngologists understand current evidence so they can make informed decisions about perioperative antibiotic usage.
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This podcast highlights a state-of-the-art literature review published in the April 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in otolaryngology–head and neck surgery. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite national efforts in VTE prevention, guidelines do not exist for otolaryngology–head and neck surgery in the United States.
Otolaryngologists should consider an individualized and risk-stratified plan for perioperative thromboprophylaxis in every patient. The risk of bleeding must be weighed against the risk of VTE when deciding on chemoprophylaxis.
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This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)", published as a supplement to the March 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)", published as a supplement to the March 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia.
Click here to read the Guideline.
This podcast highlights original research published in the March 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Objectives: (1) Evaluate changes in subjective symptoms in patients following transmastoid canal plugging for superior semicircular canal dehiscence (SSCD) syndrome. (2) Quantify changes in hearing in patients who have undergone transmastoid canal plugging for SSCD syndrome.
In our study, patients with SSCD demonstrated excellent hearing outcomes and resolution of most otologic symptoms after surgical repair. Transmastoid canal plugging, which has been described to date only in smaller case series, is a safe and effective alternative to the traditional middle cranial fossa approach.
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This podcast highlights original research published in the February 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This study was performed to determine whether the efficacy and safety of medical management of uncomplicated peritonsillar abscess (PTA) presenting in the emergency department is equivalent to medical plus surgical therapy.
In conclusion, compared to ST, MT appears to be equally safe and efficacious, with less pain, opioid use, and days off work, especially if patients with PTA present without trismus. MT for PTAs reduces the possibility of surgical complications, as well as the cost and inconvenience associated with ST.
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This podcast highlights original research published in the January 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Home oximetry is commonly used to screen for obstructive sleep apnea (OSA) in children; however, normal oxygen desaturation levels by disease severity are not well known. It was our objective to determine if oxygen saturation levels differed by OSA severity category in children and if these differences were similar for preteen children and adolescents.
In conclusion, adolescents have longer sleep times and higher obstructive apnea-hypopnea indexes than preteens, but oxygen saturations and desaturation indices were similar. This supports current triage algorithms for children with OSA, as we found no significant age-based differences
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This podcast highlights original research published in the December 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to determine the rate of residual cholesteatoma during planned second-look procedures in pediatric patients following primary cholesteatoma resection using endoscopic and microscopic operative approaches.
In conclusion, residual cholesteatoma rates during planned second-look procedures were similar between the study groups. Use of the endoscope led to a lower rate of mastoidectomy for cases with similar disease extent.
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This podcast highlights original research published in the November 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to characterize the relationship between industry payments and use of paranasal sinus balloon catheter dilations (BCDs) for chronic rhinosinusitis. Physicians with Medicare claims with Current Procedural Terminology codes 31295 to 31297 were identified and cross-referenced with industry payments. Multivariate linear regression controlling for age, race, sex, and comorbidity in a physician’s Medicare population was performed to identify associations between use of BCDs and industry payments. The final analysis included 334 physicians performing 31,506 procedures, each of whom performed at least 11 balloon dilation procedures.
Payments by manufacturers of BCD devices were associated with increased use of BCD for chronic rhinosinusitis. On separate analyses, the number of payments for food and beverages as well as that for speaker and consulting fees was associated with increased BCD use. This study was cross-sectional and cannot prove causality, and several factors likely exist for the uptrend in BCD use.
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This podcast highlights original research published in the October 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The US Food and Drug Administration (FDA) clears moderate-risk devices via the 510(k) process based on substantial equivalence to previously cleared devices; evidence of safety and effectiveness is not required. We characterized the premarket evidence supporting FDA clearance of otolaryngologic devices.
The FDA cleared most moderate-risk otolaryngologic devices for marketing via the 510(k) process without clinical evidence of safety and effectiveness. Otolaryngologists should be aware of limitations in premarket evidence when considering the adoption of new devices into clinical practice.
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This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Evaluation of the Neck Mass in Adults", published as a supplement to the September 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise. Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis. Unfortunately, despite substantial advances in testing modalities over the last few decades, diagnostic delays are common.
Currently, there is only 1 evidence-based clinical practice guideline to assist clinicians in evaluating an adult with a neck mass. Additionally, much of the available information is fragmented, disorganized, or focused on specific etiologies. In addition, although there is literature related to the diagnostic accuracy of individual tests, there is little guidance about rational sequencing of tests in the course of clinical care. This guideline strives to bring a coherent, evidence-based, multidisciplinary perspective to the evaluation of the neck mass with the intention to facilitate prompt diagnosis and enhance patient outcomes.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Evaluation of the Neck Mass in Adults", published as a supplement to the September 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise. Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis. Unfortunately, despite substantial advances in testing modalities over the last few decades, diagnostic delays are common.
Currently, there is only 1 evidence-based clinical practice guideline to assist clinicians in evaluating an adult with a neck mass. Additionally, much of the available information is fragmented, disorganized, or focused on specific etiologies. In addition, although there is literature related to the diagnostic accuracy of individual tests, there is little guidance about rational sequencing of tests in the course of clinical care. This guideline strives to bring a coherent, evidence-based, multidisciplinary perspective to the evaluation of the neck mass with the intention to facilitate prompt diagnosis and enhance patient outcomes.
Click here to read the Guideline.
This podcast highlights original research published in the September 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective for this study was to describe the cost, length of stay, and incidence of postoperative hemorrhage associated with Down syndrome (DS) patients undergoing tonsillectomy in a national sample of inpatient children.
Across the United States, children with DS hospitalized for tonsillectomy have an increased length of stay and cost of care. These data also suggest an increased risk of postoperative hemorrhage during the initial admission without an increased risk of respiratory complications.
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This podcast highlights original research published in the August 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked.
Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist.
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This podcast highlights original research published in the July 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
A pilot study of an anonymous, voluntary, event reporting system made available to all members of the American Academy of Otolaryngology—Head and Neck Surgery was performed. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index was used to classify error types. Descriptive statistics were used to summarize submissions to the database.
This preliminary descriptive analysis of a novel otolaryngology patient safety event reporting tool shows that this platform brings unique value to the identification of errors and adverse events in our specialty. Most reported events were classified as errors resulting in harm. The most common type of reported event was a technical error, most often resulting in a nerve injury.
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This podcast highlights original research published in the June 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This State of the Art Review aims (1) to define recent qualifications of otolaryngology resident applicants by focusing on United States Medical Licensing Examination (USMLE) scores, Alpha Omega Alpha (AOA) status, and research/publications and (2) to summarize the current literature regarding the relationship between these measures and performance in residency.
The consistent decline in applications for otolaryngology residency is concerning and reflects a need for change in the current stereotype of the “ideal” otolaryngology applicant. This includes consideration of additional selection measures focusing on noncognitive and holistic qualities. Furthermore, otolaryngology faculty should counsel medical students that applying in otolaryngology is not “impossible” but rather a feasible and worthwhile endeavor.
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This podcast highlights original research published in the May 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This study evaluates oncologic results and safety of neural monitored, staged thyroid cancer surgery for management of advanced thyroid cancer.
In conclusion, a neural monitored, staged surgical approach was conducted without significant adverse events in this small sample and represents and effective alternative strategy option to simultaneous bilateral surgery in the management of thyroid cancer with extensive neck metastases.
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This podcast highlights original research published in the April 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective for this study was to evaluate changes in distribution of reported thyroid nodule fine-needle aspiration (FNA) cytopathology results since implementation of the Bethesda classification and revised 2015 American Thyroid Association (ATA) guidelines for selecting nodules for biopsy.
We observed a significantly increased proportion of indeterminate cytology and corresponding decrease in benign nodules compared with an earlier sample, predominately from an increase in AUS/FLUS. Multiple factors are likely involved, including selection of sonographically suspicious nodules for biopsy based upon 2015 ATA guidelines coupled with cytopathological interpretation by a new generation of cytopathologists trained in the era of Bethesda reporting; further study is required to make a definitive conclusion.
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This podcast discusses the implications for primary care providers and patients of "Clinical Practice Guideline (Update): Benign Paroxysmal Positional Vertigo", published as a supplement to the March 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This update of a 2008 guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV.
The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline (Update): Benign Paroxysmal Positional Vertigo", published as a supplement to the March 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This update of a 2008 guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV.
The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed.
Click here to read the Guideline.
This podcast highlights original research published in the March 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective for this study was to determine which complications, as defined by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, correlate with 30-day mortality in surgery for malignancies of the head and neck. NSQIP data from 2005 to 2014 were queried for ICD-9 codes head and neck malignancies. Multivariate logistic regression was used to examine the correlation of individual complications with 30-day mortality.
The NSQIP database has been extensively validated and used to examine surgical complications, yet there is little analysis on which complications are associated with death. This study identified complications associated with increased risk of 30-day mortality following head and neck cancer surgery. These associations may be used as a measure of complication severity and should be considered when using the NSQIP database to evaluate outcomes in head and neck surgery.
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This podcast discusses the implications for primary care providers and patients of "Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty", published as a supplement to the February 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty", published as a supplement to the February 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age.
Click here to read the Guideline.
This podcast highlights original research published in the February 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Complementary and alternative medicine, or integrative medicine, has become increasingly popular among patients with head and neck cancer. Despite its increasing prevalence, many patients feel uncomfortable discussing such therapies with their physicians, and many physicians are unaware and underequipped to evaluate or discuss their use with patients. The aim of this article is to use recent data to outline the decision making inherent to integrative medicine utilization among patients with head and neck cancer, to discuss the ethical implications inherent to balancing integrative and conventional approaches to treatment, and to highlight available resources to enhance head and neck cancer providers’ understanding of integrative medicine.
Integrative medicine is gaining popularity for the management of cancer and is most commonly used for symptom management. A number of randomized controlled trials provide data to support integrative therapies, yet physicians who treat head and neck cancer may be faced with ethical dilemmas and practical barriers surrounding incorporation of integrative medicine.
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This podcast discusses the implications for primary care providers and patients of "Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)", published as a supplement to the January 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This update of the 2008 American Academy of Otolaryngology—Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidencebased recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both.
The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management. Another purpose of the guideline is to highlight needs and management options in special populations or in patients who have modifying factors. The guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, and it applies to any setting in which cerumen impaction would be identified, monitored, or managed.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)", published as a supplement to the January 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
This update of the 2008 American Academy of Otolaryngology—Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidencebased recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both.
The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management. Another purpose of the guideline is to highlight needs and management options in special populations or in patients who have modifying factors. The guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, and it applies to any setting in which cerumen impaction would be identified, monitored, or managed.
Click here to read the Guideline.
This podcast highlights original research published in the January 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Adherence to the allergic rhinitis clinical practice guideline is being considered as a potential focus for national performance metrics. To help inform this discussion, we assessed patient- and clinician-reported medication administration among nationally representative populations of patients with allergic rhinitis.
Within the National Health and Nutrition Examination Survey, an estimated 29.2 million patients were diagnosed with “hay fever,” while 92.2 million were diagnosed with “allergies.” Patients with symptoms of allergic rhinitis reported that antihistamines or nasal steroids were prescribed in 21.1% to 24.0% of cases. Leukotriene receptor antagonists were given to 1.7% of those without asthma or use of other allergy medications. Within the National Ambulatory Medical Care Survey / National Hospital Ambulatory Medical Care Survey, observations representing 149.5 million visits for allergic rhinitis demonstrated that nasal steroids were administered in 29.6% of cases, while nonsedating and sedating antihistamines were given in 22.4% and 17.2%, respectively.
Despite a high prevalence of allergic rhinitis, per patient report and clinician entry, a substantial number of affected patients do not receive antihistamines and nasal steroids.
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This podcast highlights original research published in the December 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to suppress expression of periostin, a matricellular protein that is markedly elevated in nasal polyp tissue. The purpose of this study was to determine whether use of these antihypertensive agents affects the time to revision sinus surgery in patients with polyp regrowth.
Use of ACEIs and ARBs is associated with an increased time to revision sinus surgery among patients with concurrent nasal polyps and asthma. A possible mechanism of this observed effect is suppression of periostin expression through inhibition of the angiotensin pathway.
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This podcast highlights original research published in the November 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Persistent dysphonia from vocal fold scar remains a clinical challenge, with current therapies providing inconsistent outcomes. The objective of this study was to evaluate voice outcomes after a single office-based steroid injection. Office-based steroid injection combined with voice therapy for mild/moderate vocal fold scar is associated with improved patient-reported and functional voice measures. These findings provide preliminary support for this approach. Importantly, the procedure is low risk and can be performed in the office, thus offering a simple treatment alternative to patients with a disorder that has traditionally been difficult to manage. Prospective studies evaluating the effects of multiple injections are warranted.
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This podcast highlights original research published in the October 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this article was to determine the prevalence and also accuracy of the laryngopharyngeal reflux (LPR) referring diagnosis and to determine the most useful clinical tool in arriving at the final diagnosis in a tertiary laryngology practice. It concluded that LPR appears to be an overused diagnosis for laryngologic complaints. For patients who have already had transnasal flexible laryngoscopic exams prior to their referral, laryngeal stroboscopy is the key diagnostic tool in arriving at the correct diagnosis.
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This podcast highlights original research published in the September 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this case series was to determine the effect of ibuprofen on posttonsillectomy bleeding when compared with codeine in posttonsillectomy analgesia. It concluded that age is an independent risk factor for posttonsillectomy bleeding. When age is controlled, there is no statistically significant increase in the incidence of posttonsillectomy bleeding events among patients treated with ibuprofen when compared to patients treated with codeine.
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This podcast highlights original research published in the August 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to evaluate parental recall of surgical risks and benefits in pediatric otolaryngology and to assess for factors that may influence recall. The study found that parental recall of benefits and risks associated with common pediatric otolaryngology procedures was poor. This information is important because a low rate of recall may influence parents’ perspectives of the procedure and could alter their decision-making processes or expectations. Methods to improve parental recall should be further studied.
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This podcast highlights original research published in the July 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
Avoiding oral steroids for otitis media with effusion (OME) is endorsed as a performance measure by the National Quality Foundation, but data regarding current gaps and practice patterns are lacking. Our objectives were to evaluate oral steroid use for OME and the related diagnoses of eustachian tube dysfunction (ETD) and tympanic membrane retraction (TMR), to assess variations by visit setting, and to identify opportunities for measurable performance improvement. OME/ETD/TMR is infrequently treated with oral steroids, particularly in children. Opportunities for performance improvement are limited.
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This podcast highlights original research published in the June 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this study was to investigate intra- and postoperative outcomes of endoscopic stapes surgery. The present multicentered study of endoscopic stapes surgery demonstrates similar audiometric and postoperative outcomes previously published in the literature, with a median postoperative air-bone gap of 9.0 dB HL. Future prospective endoscopic stapes surgery studies, addressing the need for scutum removal, postoperative taste changes, and pain scores, are merited.
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This podcast highlights original research published in the May 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this study was to evaluate differences in sinus surgery rates in the US Medicaid population by ethnicities. The Medicaid database was selected for this analysis to eliminate payer and wealth as potential confounders in access to health care. Despite this approach, significant differences in surgery rates among ethnic groups were observed. Further research is critical to understand those differences and provide actionable and effective recommendations for change.
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This podcast highlights original research published in the April 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The purpose of this study was to investigate the epidemiology of wire-bristle grill brush injury. The study found that injury from wire-bristle grill brush is uncommon but prevalent during certain seasons. Otolaryngologists play an important in the diagnosis and treatment of these injuries. Awareness among consumers and product manufacturers is necessary to promote safety.
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This podcast highlights original research published in the March 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The indications for neck dissection concurrent with salvage laryngectomy in the clinically N0 setting remain unclear. The goals of this study are to determine the prevalence of occult nodal disease, analyze nodal disease distribution patterns, and identify predictors of occult nodal disease in a salvage laryngectomy cohort. Histologically positive occult nodes are identified in 17% of cN0 patients undergoing salvage laryngectomy with neck dissection. Occult nodal disease varies in frequency and distribution based on tumor subsite. Predictors of high (>20%) occult nodal positivity include T4 tumors and supraglottic subsite. In glottic LSCC, the most frequent sites of occult nodal disease are the paratracheal nodal basins.
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This podcast discusses the implications for primary care providers and patients of ‘Clinical Practice Guideline: Otitis Media Effusion (Update),’ published as a supplement to the February 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline “Otitis Media With Effusion in Young Children,” which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology- Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline.
Click here to read the Guideline.
This podcast discusses the implications for otolaryngologists of ‘Clinical Practice Guideline: Otitis Media Effusion (Update),’ published as a supplement to the February 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline “Otitis Media With Effusion in Young Children,” which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology- Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline
Click here to read the Guideline.
This podcast highlights original research published in the February 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this retrospective review was to determine the variability of ratings given to students on the otolaryngology standardized letter of recommendation (SLOR)
The review found that the explosion of applications being sent out by candidates for otolaryngology residency programs has prompted the implementation of the SLOR. The lack of variation in the ratings across the 10 domains does not allow for differentiation among student applicants. Reliance on the narrative letter of recommendation attached to the SLOR still remains the most significant way to differentiate among applicants. Refinements will need to be made in either the structure or use of the SLOR for it to be a more useful tool.
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This podcast highlights a systematic review published in the January 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objectives of this study were to analyze the sensitivity and specificity of fine-needle aspiration (FNA) in distinguishing benign from malignant parotid disease, and to determine the anticipated posttest probability of malignancy and probability of nondiagnostic and indeterminate cytology with parotid FNA.
FNA has moderate sensitivity and high specificity in differentiating malignant from benign parotid lesions. Considerable heterogeneity is present among studies.
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This podcast highlights a systematic review published in the December 2015 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.
The objective of this study was to critically review published literature for treatment-related outcomes for bilateral inferior turbinate reduction (IFTR) via either microdebrider-assisted turbinoplasty (MAT) or radiofrequency turbinoplasty. The primary outcomes were relief of nasal obstruction according to visual analog scale and nasal airflow, volume, and resistance measures based on acoustic rhinomanometry.
This review found that IFTR produces a significant subjective and objective improvement in nasal airflow in the short term. This change does not appear to be related to the technique used for IFTR.
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This podcast highlights a systematic review and meta-analysis published in the November 2015 issue of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief John Krouse is joined by senior author Luke Rudmik and associate editor Gordon Sun in discussing geographic variation in the use of endoscopic sinus surgery.
The phenomenon of geographic variation in the delivery of health care has been recognized for decades. Variation in small areas can be a driver of health care costs and is associated with differences in the utilization of both medical and surgical services. The importance of variation in both the cost and the quality of care has been highlighted by many, including several impactful publications by Atul Gawande. In the present study, Dr. Rudmik and colleagues review differences in the number of endoscopic sinus surgical procedures in the province of Alberta, Canada, and demonstrate that significant differences can occur in proximate geographic areas, much as the authors have previously noted in the United States. In this podcast, Dr. Rudmik discusses the measurement of geographic variation, the findings from his important study, and the implications for both practice and further investigation. Drs. Rudmik and Sun then discuss the implications of these interesting observations for health care delivery and some of their potential causes, as well as examining the importance of additional research in further characterizing the nature of surgical variation in otolaryngology.
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This podcast highlights a systematic review and meta-analysis published in the October 2015 issue of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief John Krouse is joined by senior author Nausheen Jamal and associate editor Kenneth Altman in discussing partial epiglottoplasty for specific forms of pharyngeal dysphagia.
Patients commonly experience difficulty swallowing due to structural abnormalities that impinge on their normal pharyngeal anatomy. In these patients various pathologies, such as severe cervical osteophytes or the presence of cervical spinal hardware, can interfere with their ability to swallow smoothly and successfully. In this study, Dr. Jamal describes a simple transoral procedure that was demonstrated to significantly improve swallowing in this select group of 12 individuals with pharyngeal dysphagia. In this podcast, she discusses this procedure as well as the outcomes of its use to treat dysphagia. Drs. Jamal and Altman then discuss the implications of these interesting findings and the potential complications that could arise, as well as examining the need for additional research in expanding and further demonstrating the role for this innovative procedure.
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