Sage Otolaryngology

This podcast highlights original research appearing in the March 2013 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 Rosenfeld is joined in by author Hossein Mahboubi and associate editor Thomas Eby in assessing how well commercially available earplugs prevent water entry during swimming. Click here to read the full article.

Women comprise nearly half of all US medical students but they remain underrepresented in academic practice within surgical specialties.  To see if this occurs in otolaryngology departments, the authors analyzed faculty listings from academic departments and compared academic rank and h-index by gender.  The h-index was chosen to reflect scholarly productivity, since it reflects the number of manuscripts published by the author that have been cited at least that many times (e.g., an h-index of 10 means they published 10 articles cited by others 10 or more times each).  Men had higher h-indices than women at junior academic ranks, but the productivity rates of women increased and equaled, or surpassed, those of men later in their careers.  Women academic otolaryngologists of senior rank had higher h-indices than their male counterparts.  Despite this higher productivity women are underrepresented in positions of leadership and seniority, which is likely generational since the proportion of female otolaryngolog

As defined by the Institute of Medicine (IOM), clinical practice guidelines are "statements that include recommendations to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options."  In crafting their recent standards for trustworthy guidelines, the IOM repeatedly referenced the AAO-HNS manual discussed in this podcast as an example of best practice.  This third edition of the manual builds upon prior editions (from 2006 and 2009) with new material that includes standards for trustworthy guidelines, updated evidence levels, increased patient and public involvement, assessing confidence in the evidence, documenting differences of opinion, managing conflict of interest, and using computerized decision support for crafting actionable recommendations.  The participants discuss unique features of the manual, the preeminent role of action statement profiles in promoting transparency, and how guideline users and developers

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.