Sage Otolaryngology

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.   Click here to read the full article.

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.   Click here to read the full article.

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. Click here to read the full article.

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

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 t

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.   Click here to read the full article. 

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.   Click here to read the full article.

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. Click here to read the full article.

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 sig

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

This podcast highlights a systematic review and meta-analysis published in the September 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 Lisa Ishii and associate editor Eric Kezirian in discussing the role of nasal surgery in the treatment of obstructive sleep apnea (OSA). When considering treatment for snoring and obstructive sleep apnea (OSA), patients frequently inquire about the role of nasal obstruction in leading to the symptoms of OSA.  In addition, patients often ask if there is a role for nasal surgery in lessening these symptoms and in improving control of their OSA.  In the current paper, in examining the role of isolated nasal surgery in patients with OSA, the authors note that among patients with nasal obstruction, nasal surgery improved several sleep parameters, including scores on the Epworth Sleepiness Scale and the Respirator

This podcast highlights original research published in the August 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 Stacey Ishman and associate editor David Darrow in discussing the association of tonsillar size in children, the severity of obstructive sleep apnea (OSA), and the response to surgical treatment for OSA in these children.   Obstructive sleep apnea (OSA) is a problem of increasing concern for children and their parents.  Many otolaryngologists may believe that OSA is worse in children with very large tonsils than it is in children with smaller tonsils.  The present paper, however, suggests that the severity of OSA is independent of tonsillar size, and that children with both small and large tonsils appear to have similar reductions in objective indicators of OSA after adenotonsillectomy.  An important message from this study is tha

This podcast highlights a state of the art review published in the July 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 Ryan Bransky and associate editor Cristina Baldassari in discussing the growing use of electronic cigarettes in the United States.  Over the past decade there has been a rapid expansion in the use of and types of electronic cigarettes, or e-cigarettes, among the US population.  In 2009 less than 1% of the American population had tried using e-cigarettes, and by 2013 over 8% of Americans had used them.  The sales of e-cigarettes are predicted to surpass $10 billion by 2017.  There has also been a rapid expansion in use among teenagers, who enter the use of oral nicotine in early life as their first cigarette experience through “vaping.”  There are establishments that are dedicated to the use of these products, and this use is

This podcast highlights original research published in the June 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 Seth Dailey and associate editor Matthew Brigger in discussing the topic of office-based photoangiolytic laser therapy of Reinke’s edema. Reinke’s edema is a common, benign condition of the vocal folds characterized by edema and vascular congestion in Reinke’s space.  Multiple risk factors are associated with this condition, including tobacco use, vocal abuse, and laryngopharyngeal reflux.  In this paper, the authors discuss an office-based procedure for treating Reinke’s edema using topical anesthesia and flexible transnasal endoscopy.  They report their findings on 19 patients who completed this office-based therapy, and demonstrate improvement in both quality of life and acoustic and aerodynamic measures following the treatment. 

This podcast highlights original research published in the May 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 lead author Lauren Roland and associate editor Meredith Adams in discussing mindfulness-based stress reduction therapy for tinnitus.   Tinnitus is a common problem that affects millions of patients on a chronic basis.  In general there have been few treatment options for patients with tinnitus, and symptoms can be frustrating and debilitating for many individuals.  In this paper, the authors utilize a therapeutic method that includes a cognitive-behavioral approach with planned meditation to reduce stress among patients.  They were able to not only facilitate reduction in bother from tinnitus among a single group of selected patients, but also demonstrated changes in neural connectivity on functional MRI that suggested some adaptation to tinnitus

This podcast highlights the updated clinical practice guideline on adult sinusitis that is published as an April 2015 supplement to Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. In the first of two podcasts for this supplement, Editor in chief John Krouse is joined by authors Ashok Kumar and Maggie Kramper in discussing key findings from the guideline in the diagnosis and treatment of adults with symptoms of sinusitis and their implications for primary care health providers and patients.   Sinusitis affects about 1 in 8 adults in the United States, resulting in more than 30 million annual diagnoses. More than 1 in 5 antibiotics prescribed in adults are for sinusitis, making it the fifth-most common diagnosis responsible for antibiotic therapy.  Many symptoms of sinusitis can overlap with other common conditions such as allergic rhinitis, and can complicate the diagnosis and treatment of these individuals.  C

This podcast highlights the updated clinical practice guideline on adult sinusitis that is published as an April 2015 supplement to Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. In the first of two podcasts for this supplement, Editor in chief John Krouse is joined by lead author Richard Rosenfeld and co-author Richard Orlandi in discussing key findings from the guideline in the diagnosis and treatment of adults with symptoms of sinusitis.   Sinusitis affects about 1 in 8 adults in the United States, resulting in more than 30 million annual diagnoses. The direct cost of managing acute and chronic sinusitis exceeds $11 billion per year, with additional expense from lost productivity, reduced job effectiveness, and impaired quality of life. More than 1 in 5 antibiotics prescribed in adults are for sinusitis, making it the fifth-most common diagnosis responsible for antibiotic therapy.  Rhinosinusitis may be cl

This podcast highlights original research published in the April 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 lead author Travis Lewis and associate editor Cristina Baldassari in discussing the issue of weight gain among patients who have undergone adenotonsillectomy. Adenotonsillectomy remains a commonly performed operative procedure for both obstructive sleep apnea and recurrent infection.  Change in weight following surgery has been discussed for many years, with recent evidence suggesting that some patients gain weight following removal of the tonsils.  The current paper further investigates this clinical issue to try to determine the effective of adenotonsillar surgery on weight, height, and BMI.  In this study, the authors utilized a case control methodology in which 154 patients undergoing adenotonsillectomy were compared with 182 demographically

This podcast highlights original research published in the March 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 lead author Kyle Stansifer and associate editor Daniel Deschler in discussing the topic of modifiable risk factors in patients with thyroid cancers.   While it is well known that the risk of thyroid cancer can be increased by factors that may be outside of the patient’s control, such as exposure to ionizing radiation, the risks of common patient characteristics such as smoking, drinking, and BMI are not well appreciated.  In the present study, the authors examined 467 patients with thyroid cancer from a single institutional database and compared them with a control group of 255 patients without thyroid cancer.  Their analyses demonstrated that none of these modifiable factors were associated with an increased risk of thyroid cancer among their s

The highlighted articles for March 2015 are “Analysis of an online match discussion board: improving the otolaryngology-head and neck surgery match,” “The decline of tracheotomy amongst otolaryngologists: a 14-year review,” “Characteristics and intraoperative treatments associated with head and neck free tissue transfer complications and failures,” “TORP ossiculoplasty outcomes with and without a stapes footplate prosthesis.” Click here to read the full article.