Other ENT Topics

Osteosarcoma of the skull base in a 15-year-old boy

October 26, 2011     Gretchen M. Oakley, BA, Dary J. Costa, MD, Ron B. Mitchell, MD, and Cirilo Sotelo, MD
article

Clinical improvement after escalation for sublingual immunotherapy (SLIT)

September 20, 2011     Jamie Woody, PA-C, MSPAS, Sarah K. Wise, MD, Sarah Koepp, PA-C, MSPAS, and Rodney J. Schlosser, MD
article

Abstract

Sublingual immunotherapy (SLIT) permits rapid antigen escalation with an improved safety profile over that of subcutaneous immunotherapy. Outcomes for SLIT in terms of the timing of clinical improvement were investigated in a retrospective review of patients undergoing SLIT who completed quality of life (QOL) and medication-use questionnaires at baseline and immediately after antigen escalation was performed. A subset of patients (n = 24) also completed maintenance-phase questionnaires. Paired post-escalation data (mean 5.5 weeks; N = 38) demonstrated improvement (p< 0.05) in overall QOL scores and in 6 of 14 symptom domains. Maintenance phase data (n = 24) revealed significant improvements in total QOL scores and in 5 symptom domains. A significant reduction in nasal steroid use was also demonstrated during the maintenance phase of treatment (p < 0.05). Significant improvement is seen immediately post-escalation in SLIT patients. This improved QOL appears to be maintained, and perhaps even increases, during the maintenance phase, with decreased nasal steroid use.

Women in otolaryngology-head and neck surgery

August 15, 2011     Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief
article

Women are now well established in medicine, but historically this was not always true. Hence, it seems reasonable for each specialty to analyze itself from time to time to determine where it stands on the inclusion of women in practice and in leadership positions.

Nonattendance at a hospital-based otolaryngology clinic: A preliminary analysis within a universal healthcare system

August 15, 2011     Molly S. Zirkle, MD, FRCS(C) and Laurie R. McNelles, PhD
article

Abstract

Missed appointments at specialty clinics generate concerns for physicians and clinic administrators. Appointment nonattendance obstructs the provision of timely medical interventions and the maximization of systemic efficiencies. Yet, empiric study of factors associated with missed appointments at adult specialty clinics has received little attention in North America. We conducted a preliminary study of otolaryngology clinic nonattendance in the context of a universal healthcare system environment in Canada. Our data were based on the schedule of 1,512 new patient appointments at a hospital-based clinic from May 1 through Sept. 30, 2008. Gathered information included the employment status of the attending physician (i.e., full-time vs. part-time), the patient's sex and age, the day of the week and the time of the appointment, and the attendance status. We found that the rate of nonattendance was 24.4% (n = 369). Nonattendance rates varied significantly according to physician employment status (more common for part-time physicians), patient sex (women) and age (younger adults), and the day of the appointment (Wednesdays), but not according to the time of day. Our findings suggest that there are predictable patient and systemic factors that influence nonattendance at medical appointments. Awareness of these factors can have implications for the delivery of healthcare services within a universal healthcare context.

Return to contact sports following infectious mononucleosis: The role of serial ultrasonography

August 15, 2011     Tony E. O'Connor, FRCS(ORL-HNS), Liam J. Skinner, FRCS(ORL-HNS), Patrick Kiely, FFR, RCSI, and John E. Fenton, FRCSI, FRCS(ORL-HNS), MCh
article

Abstract

Splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. Athletes returning to contact sports following infectious mononucleosis are at potential risk of splenic rupture secondary to abdominal trauma. No clear consensus exists as to when it is safe to allow these athletes return to contact sports. Suggested periods of abstinence have ranged from 2 weeks to 6 months. We outline our experiences with the use of abdominal ultrasonography at 1 month after the diagnosis of infectious mononucleosis as a means of determining when athletes can safely return to contact sports. Our study group was made up of 19 such patients (mean age: 16.7 yr). We found that 16 of these patients (84%) had normal splenic dimensions on ultrasonography 1 month after diagnosis, and they were therefore allowed return to contact sports. While the remaining 3 patients had an enlarged spleen at 1 month, their splenic dimensions had all returned to normal when ultrasonographic examination was repeated at 2 months postdiagnosis. We conclude that serial abdominal ultrasonography allows for informed decision making in determining when athletes can safely return to contact sports following infectious mononucleosis.

Ear stapling application as an alternative treatment for weight loss

July 13, 2011     Yavuz Beyazit, MD, Murat Kekilli, MD, Tugrul Purnak, MD, and Jeffrey Spiegel, MD, Professor
article

Video recording the surgeon's viewpoint cheaply: How we do it

March 1, 2011     Christopher Y. Chang, MD and H. Stewart Lindsey, RO
article

EHR/EMR: “Meaningful use,” stimulus money, and the Serenity Prayer

February 1, 2011     K.J. Lee, MD and Robyn M. Smith, MS, MEd, CCC-A, PA-C
article

Otolaryngologic uses for spinal drains

September 30, 2010     Raymond C. Maguire, DO, John Gull, DO, Michael Weaver, MD, and Robert T. Sataloff, MD, DMA, FACS
article

Abstract

Cerebrospinal fluid (CSF) fistulae have been encountered by otolaryngologists often since the advent of modern endoscopic sinus surgery, otologic surgery, and skull base surgery. Treatment of CSF leaks may include bed rest, head-of-bed elevation, stool softeners, external spinal fluid drainage, and surgery. External CSF drainage is accomplished via a lumbar spinal drain. Placement of spinal drains is often performed by neurosurgeons and anesthetists. A few otolaryngologists have been trained in the placement and management of lumbar drains, but at most otolaryngology training institutions, education in lumbar drains is not provided. However, in some circumstances, it may fall to an otolaryngologist to accomplish the task. We believe that every otolaryngologist, from the generalist in private practice to the academic neuro-otologic surgeon, should understand the proper technique for the insertion and management of a lumbar drain. Otolaryngologists should be familiar with the physiologic properties of CSF, the methods used to diagnose fistulae, and the techniques used to repair leaks. External spinal drainage is an important element in the management of CSF fistulae, and it has been used in treating perilymphatic fistulae and “gushers.” Much controversy surrounds its routine use. Otolaryngologists need to understand the risks, benefits, and outcomes of spinal drain use in order to decide which patients may benefit from this procedure.

Fancy new technology: Doing the right thing

May 31, 2010     Peak Woo, MD
article

It seems to me that the longer one practices, the more difficult it becomes not to become cynical about claims of new and great technology. This is especially true when it comes to investing in expensive new technology.

Ear stapling: A risky and unproven procedure for appetite suppression and weight loss

January 1, 2010     Leslie K. Winter, MD and Jeffrey H. Spiegel, MD, FACS
article

Abstract

In an effort to achieve weight loss, many people are pursuing alternative medical interventions. Widely available as a variant of acupuncture, ear stapling (in which a surgical staple is placed in the conchal bowl of the ear) is reported by practitioners to decrease the appetite and induce weight loss. This practice lacks proven efficacy and has a significant risk of infection and deformity. We report a series of 3 patients who developed complications from ear stapling and present this article to describe the practice so that physicians will be prepared when encountering a staple in the ear.

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