Sage Otolaryngology

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. Click here to read the full article.

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. Click here to read the full article.

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. Click here to read the full article

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 Administ

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.   Click here to read the article.

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.   Click here to read the article.

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.   Click here to read the article.

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.   Click here to read the full issue.

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.   Click here to read the full article.

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.   Click here to read the full article.

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.   Click here to read the full article.

This podcast discusses the implications for non-otolaryngologists of "Tympanostomy Tubes in Children (Update)", 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 Plain Language Summary..

This podcast discusses the implications for otolaryngologists of "Tympanostomy Tubes in Children (Update)", 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 s

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.   Click here to read the full article.

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.   Click here to read the full article.

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.   Click here to read the fu

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.   Click here to read the full article.

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.   Click here to read the full article.