Otolaryngology - Head and Neck Surgery

Otolaryngology - Head and Neck Surgery RSS feed: Current Issue. Otolaryngology-Head and Neck Surgery is the official peer-reviewed publication of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. The mission of Otolaryngology-Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.

Pediatric otogenic intracranial abscesses

We read with great interest the article “Pediatric otogenic intracranial abscesses” by Isaacson et al. They presented clinical analysis and management of otogenic intracranial abscesses in children. The authors presented 30 pediatric patients with epidural, subdural, intraparenchymal, and petrous apex suppurative complications of otitis media. We would like to make some comments concerning this problem, based on our experience and review of the literature.

Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

A physician's personal experience as a cancer of the neck patient

Abstract: The author presents his personal experiences as a physician who had several surgical procedures to remove pyriform sinus squamous cell carcinoma, which included laryngectomy. He recently published a book that captures the three years of his life that followed his throat cancer diagnosis and tells his story of facing and dealing with medical and surgical treatments and adjusting to life afterwards. The editorial highlights some of the book's features that relate to the important role of head and neck surgeons in the care of patients with cancer.

Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

Reducing risk of fire in the operating room using coblation technology

Abstract: Operating room fires are rare, but when they occur, they have potentially devastating and deadly consequences. Coblation (ArthroCare ENT, Austin, TX) technology has become popular for many otolaryngology procedures and seems to have the advantage of reducing fire risk. Our objective was to test the Coblator II on various flammable materials commonly found and used in the operating room. We placed the active Coblator II at the highest settings, in direct contact with flammable operating room equipment and materials, and made the environment even more volatile by introducing oxygen into the testing environment. We found that the Coblator II did not produce fire when in contact with any of the materials. This finding is very important in otolaryngology because airway procedures often take place in environments with high concentrations of oxygen. Our testing shows that the Coblator II is safe to use in these types of environments.

Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

Improving the letter of recommendation

Abstract: The selection of applicants to otolaryngology training programs is a challenging task. Applicants and their evaluators rely on objective and subjective data to facilitate the selection process. Unfortunately, data are often less helpful than either side assumes, suffering from poor validity and reliability in predicting future performance. The traditional resume-based letter of recommendation bears some responsibility in this. It is often a lengthy reiteration of already available objective data and contains nonstandardized, superlative evaluations of personal attributes. As a result, many letters are similar, describing “excellent” candidates who have done well on previous examinations and clerkships. Research has indicated improved reliability and satisfaction as well as decreased time expenditure using standardized letters of recommendation. These letters demonstrate how basic, easy-to-implement improvements can create letters that provide accurate information, separate applicants, and improve the selection process. Consideration should be given to adopting these improvements at the program director and/or educational committee level.

Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

A combination antioxidant therapy prevents age-related hearing loss in C57BL/6 mice

Abstract: Objective: Age-related hearing loss (ARHL) is characterized by gradual, progressive sensorineural hearing loss, which impairs communication, lending to clinical depression and social withdrawal. There are currently no effective treatments for ARHL. The purpose of this study is to evaluate the potential of a combination antioxidant therapy in preventing ARHL.Study Design: Randomized controlled trial.Setting: Animal study.Subjects and Methods: C57BL/6 mice, a recognized animal model of ARHL, were assigned to one of three groups: early treatment (n = 12), late treatment (n = 9), or control group (n = 9). Treatment groups of mice were fed with a combination agent comprising six antioxidant agents that target four sites within the oxidative pathway: L-cysteine-glutathione mixed disulfide, ribose-cysteine, NW-nitro-L-arginine methyl ester, vitamin B12, folate, and ascorbic acid. Auditory brainstem response (ABR) thresholds were recorded at baseline and every three months following initiation of treatment.Results: Threshold shifts from baseline were decreased in the treatment groups when compared to the control group at all tested frequencies (P < 0.001). The ABR threshold shift at 12 months of age for the control group was 34.7 dB with a 95% confidence interval (CI) of ±1.6. The mean threshold shifts for the early and late treatment groups were 7.5 dB (±0.87, 95% CI) and 9.2 dB (±1.6, 95% CI).Conclusion: Combination antioxidant therapy effectively decreased threshold shifts on ABR within an animal model of ARHL. Combination antioxidant therapy, with further research and investigation, may provide a safe and cost-effective method of preventing presbycusis in the growing elderly population.

Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

A practical guide to understanding Kaplan-Meier curves

Abstract: In 1958, Edward L. Kaplan and Paul Meier collaborated to publish a seminal paper on how to deal with incomplete observations. Subsequently, the Kaplan-Meier curves and estimates of survival data have become a familiar way of dealing with differing survival times (times-to-event), especially when not all the subjects continue in the study. “Survival” times need not relate to actual survival with death being the event; the “event” may be any event of interest. Kaplan-Meier analyses are also used in nonmedical disciplines.The purpose of this article is to explain how Kaplan-Meier curves are generated and analyzed. Throughout this article, we will discuss Kaplan-Meier estimates in the context of “survival” before the event of interest. Two small groups of hypothetical data are used as examples in order for the reader to clearly see how the process works. These examples also illustrate the crucially important point that comparative analysis depends upon the whole curve and not upon isolated points.

Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

Cochlear implantations in patients with cochlear fistulae

Cochlear fistula is extremely rare, with only a few patients reported to date. Although cochlear implantation with subtotal petrosectomy has been described in patients with chronically diseased ears, there have been no reports to date of cochlear implantation after repair of a cochlear fistula. We describe here two deaf patients with cochlear fistulae who underwent cochlear implantation after subtotal petrosectomy. This study was approved by the Institutional Review Board of Asan Medical Center.

Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

Primary care perceptions of otolaryngology

Abstract: Objective: To identify diseases of the head and neck for which primary care physicians may underappreciate the role of the otolaryngologist.Study Design: Cross-sectional analysis.Setting: With increasing subspecialization in the world of medicine, there is the potential for confusion about the scope of practice for different specialties by primary care physicians. These clinicians are often faced with patients who have disease processes in which otolaryngologist are trained but may end up referring patients to other specialists.Subjects and Methods: A brief, web-based survey was administered via e-mail to resident physicians of family medicine, pediatrics, and internal medicine programs in the United States. The survey asked responders which specialist they believed was an expert for particular clinical entities: allergies, oral cancer, restoring a youthful face, sleep apnea, thyroid surgery, and tracheostomy. Respondents could choose from a dermatologist, general surgeon, ophthalmologist, oral maxillofacial surgeon, orthopedic surgeon, otolaryngologist, and plastic surgeon. The responder was able to choose more than one specialist for each question.Results: A total of 1064 completed surveys were analyzed. The percentage of primary care residents who picked otolaryngologists as experts was 13.8 percent for allergies, 73.6 percent for oral cancer, 2.7 percent for restoring a youthful face, 32.4 percent for sleep apnea, 47.2 percent for thyroid surgery, and 72.5 percent for tracheostomy.Conclusion: This study demonstrates that many primary care residents are not aware of the scope of expertise that an otolaryngologist may offer. Increased exposure to otolaryngology during primary care residency training may increase understanding of the specialty among primary care physicians.

Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

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Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

Clinical value of office-based endoscopic incisional biopsy in diagnosis of nasal cavity masses

Abstract: Objective: To evaluate clinical features and the diagnostic accuracy of office-based endoscopic incisional biopsy in patients with nasal cavity masses.Study Design: Diagnostic test assessment with chart review.Setting: Tertiary referral center.Subjects and Methods: From January 1997 to August 2006, preoperative diagnosis was achieved using endoscopic incisional biopsy in 521 patients. Cytopathologic and histologic findings were categorized as malignancy, benign neoplasm, or non-neoplastic lesion. Preoperative imaging was done in 462 patients (computed tomography: 438 cases; magnetic resonance imaging: 24 cases). We investigated the accuracy of endoscopic incisional biopsy and preoperative imaging by comparing it with pathologic results from tumor resection as the “gold standard.”Results: Most of the patients had unilateral nasal symptoms (e.g., nasal obstruction, unilateral epistaxis, unilateral facial pain), and the clinical symptoms were of little diagnostic value in the differentiation of tumor and inflammatory lesion. The sensitivity and specificity of endoscopic incisional biopsy were 43.7 and 98.9 percent, respectively, for the diagnosis of nasal cavity malignancies, and 78.2 and 96.2 percent, respectively, for the diagnosis of benign neoplasms. The sensitivity and specificity of preoperative imaging were 78.3 and 97.5 percent, respectively, for the diagnosis of nasal cavity malignancies and 66.4 and 86.3 percent, respectively, for the diagnosis of benign neoplasms. Combining the two modalities increased diagnostic accuracy in nasal cavity masses.Conclusion: Endoscopic incisional biopsy alone did not ensure accurate diagnosis of nasal cavity tumors, but in combination with preoperative imaging it was helpful for the diagnosis of nasal cavity malignancies.

Source: Otolaryngology - Head and Neck Surgery | 31 Aug 2010, 5:00 pm

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