Sage Otolaryngology

Although tracheostomy is one of the oldest and most common surgical procedures, management is often based on opinion and local practices because of a paucity of high level evidence to guide care.  To address this issue, the AAO-HNS convened a national expert panel representing pediatric and adult otolaryngology, laryngology, head and neck oncologic surgery, advanced nursing practice, respiratory therapy, and emergency medicine.  Using systematic review and a modified Delphi method the group achieved consensus on 77 statements that address emergencies, complications, decannulation, perioperative care, ancillary devices, and patient education.  Part one of this podcast emphasizes supportive care and patient education from the perspective of two nurses on the expert panel.  Part two offers the physician perspective from two panel participants with expertise in adult and pediatric tracheotomy care.  A common theme is the importance of engaging patients and caregivers in all aspects of decision making and supporti

Although tracheostomy is one of the oldest and most common surgical procedures, management is often based on opinion and local practices because of a paucity of high level evidence to guide care.  To address this issue, the AAO-HNS convened a national expert panel representing pediatric and adult otolaryngology, laryngology, head and neck oncologic surgery, advanced nursing practice, respiratory therapy, and emergency medicine.  Using systematic review and a modified Delphi method the group achieved consensus on 77 statements that address emergencies, complications, decannulation, perioperative care, ancillary devices, and patient education.  Part one of this podcast emphasizes supportive care and patient education from the perspective of two nurses on the expert panel.  Part two offers the physician perspective from two panel participants with expertise in adult and pediatric tracheotomy care.  A common theme is the importance of engaging patients and caregivers in all aspects of decision making and supporti

Using data from a national database the authors analyzed more than 8 million ambulatory health care encounters for adults with obstructive sleep apnea (OSA).  Although OSA affects up to 7% of adults in the United States, only 10% of ambulatory health care visits studied were associated with otolaryngologic care.  This presents an opportunity for increased awareness of OSA and the unique role of otolaryngologists in management.  OSA was significantly associated with commonly encountered comorbid conditions, including obesity, asthma, depression, and hypertension.  Otolaryngologists who diagnose and treat patients with OSA should be aware of increased risk for these background conditions since their presence could impact therapeutic outcomes.  Clinicians in general are likely to see more OSA patients given the rising prevalence of obesity and the aging of the population, since elderly patients are more likely to have the multiple chronic conditions associated with an increased risk for OSA.

Although computed tomography (CT imaging) is an essential diagnostic tool for patients with paranasal sinus disease the test is associated with significant costs, radiation exposure, and overuse concerns.  To help define appropriate use of CT imaging an expert panel was convened and areas of clinical consensus were identified using a 3 round modified Delphi method. Statements reaching consensus included (a) CT imaging is not indicated for clinicall diagnosed uncomplicated acute sinusitis or when sinusitis has fully responded to antibiotic therapy, (b) CT imaging is indicated for adults with chronic sinusitis, recurrent acute sinusitis, and those not responding appropriately to medical management, and (c) CT imaging is indicated for tumor surveillance, complicated sinusitis, complicated dental infections, and for facial pain following dental surgery (odontogenic sinusitis). When CT imaging is obtained for routine chronic sinusitis intravenous contrast is not indicated.  Further, plain radiographs and ultrasono

Although computed tomography (CT imaging) is an essential diagnostic tool for patients with paranasal sinus disease the test is associated with significant costs, radiation exposure, and overuse concerns.  To help define appropriate use of CT imaging an expert panel was convened and areas of clinical consensus were identified using a 3 round modified Delphi method. Statements reaching consensus included (a) CT imaging is not indicated for an uncomplicated "cold" lasting less than 10 days or for uncomplicated acute sinusitis in children under age 3 years, (b) CT imaging is indicated for chronic sinusitis in children that persists despite adenoidectomy or medical management, and (c) CT imaging is indicated for at any age for suspected tumor, complications from sinusitis, or prior to sinus surgery.  The presenters stress that the diagnosis of uncomplicated, acute bacterial sinusitis in children should be based on clinical signs and symptoms, not on CT imaging.

The Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) is a 35-item standardized tool that asks consumers and patients to report and evaluate their experiences and satisfaction with their surgical care (completion time of 15-20 minutes).  In this prospective study, 354 adult patients completed the S-CAHPS survey through and electronic data capture system 7 to 28 days after otolaryngologic surgery.  Most patients rated their surgeons very high (at least 9.5 out of 10.0), but there was more variability in communication practices: the top-box scores for were 79% for surgeon communication prior to surgery, 61% for surgeon attentiveness on day of surgery, 64% on information to guide recovery, 77% for surgeon communication after surgery, and 88% for helpful and courteous office staff.  The overall 40% survey response rate confirms the feasibility of the S-CAHPS, which may ultimately become a platform for quality improvement, financial incentives (from insurers and health plans),

This podcast highlights original research appearing in the September 2012 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 Richard M. Rosenfeld is joined by lead author Max Pusz and associate editor Julie Wei in discussing the quality of information about common otolaryngology problems that would be encountered by consumers through Google internet searches.

This podcast highlights original research appearing in the August 2012 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 Richard M. Rosenfeld is joined by lead author Michael Brandt and associate editor David Stepnick in discussing patient concerns prior to thyroid surgery.

This podcast highlights original research appearing in the July 2012 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 Richard M. Rosenfeld is joined by corresponding author Jeffrey Spiegel and associate editor Mark K. Wax in discussing the preoperative incidence of olfactory dysfunction in nasal surgery patients.   Click here to read the full article.  

This podcast highlights a systematic review appearing in the June 2012 edition 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 Richard M. Rosenfeld, MD, MPH, is joined by Jason L. Acevedo, MD, lead author and Craig S. Derkay, associate editor for pediatric otolaryngology, in comparing the complication rates of total vs. partial (intracapsular) tonsillectomy.   Click here to read the full article.  

This podcast highlights a systematic review entitled "Esophageal reflux disease proton pump inhibitor therapy impact on sleep disturbance" in the April 2012 edition Otolaryngology-Head and Neck Surgery, the official journal of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief Richard M. Rosenfeld, MD, MPH is joined by lead author Elliot Regenbogen, MD, and associate editor Kenneth Altman, MD, in discussing how proton pump inhibitor therapy can improve sleep quality for patients with reflux disease. Click here to read the full article.

This podcast is the second in a two-part series highlighting the Clinical Practice Guideline on Sudden Hearing Loss, which is a supplement to the March 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by guideline assistant chair Sujana S. Chandrasekhar, MD, and co-author Seth R. Schwartz, in discussing the how the guideline was developed and what steps were taken to ensure it is trustworthy. Click here to read the full article.

This podcast is the first in a two-part series highlighting the Clinical Practice Guideline on Sudden Hearing Loss, which is a supplement to the March 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by lead author Robert J. Stachler, MD, and co-author Seth R. Schwartz, in discussing the how the guideline was developed and what steps were taken to ensure it is trustworthy. Click here to read the full article.

This podcast highlights a commentary appearing in the May 2012 edition 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 Richard M. Rosenfeld, MD, MPH, is joined by Gordon H. Sun, MD, lead author and David Nielsen, EVP and CEO of the AAO-HNS, in a timely discussion of health care reform its impact on otolaryngology practice and research.   Click here to read the full article.

This podcast highlights original research appearing in the March 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by corresponding author Cecelia E. Schmalbach, MD, and associate editor Mark K. Wax, MD, in discussing practice patterns and perceptions of junior otolaryngologists in treatment of maxillofacial and neck trauma. Click here to read the full article.

This podcast highlights original research appearing in the February 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by lead author Aaron M. Fletcher, MD, and associate editor Cristina Baldassari, MD, in discussing which demographic and practice characteristics predict professional burnout in otolaryngologists. Click here to read the full article.

This podcast highlights original research appearing in the January 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by lead author Reena Dhanda Patil, MD, and associate editor Eric A. Mair, MD, in discussing a survey of Veterans Affairs Health Care Providers on preoperative screening and postoperative care of patients with obstructive sleep apnea. Click here to read the full article.

This podcast highlights original research appearing in the December 2011 edition 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 Richard M. Rosenfeld, MD, MPH, is joined by lead author Inessa Fishman, MD, and associate editor Peter Roland, MD, for an informative and clinically relevant discussion of managing tympanostomy tube otorrhea that is refractory to oral or topical antibiotics. Click here to read the full article.

This podcast highlights a commentary appearing in the October 2011 edition 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 Richard M. Rosenfeld, MD, MPH, is joined by Gordon Hughes, MD, corresponding author and Director of Clinical Trials at the National Institute on Deafness and Other Communicative Disorders (NIDCD), and David Nielsen, EVP and CEO of the AAO-HNS, in a lively discussion of health care reform and the role of evidence-based medicine. Click here to read the full article.