Sage Otolaryngology

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.   Click here to read the full article.

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.   Click here to read the full article.

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.   Click here to read the full article.

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   Click here to read the full article.

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.   Click here to read the full article.

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,

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.   Click here to read the full article.

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 delay

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 d

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.   Click here to read the full article.

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.   Click here to read the full article.

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.   Click here to read the full article.

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

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.   Click here to read the full article.

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 defini

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

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 manage

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