American Academy Of Otolaryngology-Head And Neck Surgery Guidelines Research Articles

Management, Referral Patterns, and Outcomes in Bell's Palsy: A Single-Institution 903 Patient Series.

In 2013, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published guidelines for Bell's palsy (BP), including recommendations for workup, management, and specialist referral. Patients with BP often present to primary care; however, adherence to guidelines may vary by setting. This study sought to evaluate the management of patients with BP presenting to primary care, emergency department (ED), and urgent care settings. Retrospective cohort study. Tertiary care center. Retrospective chart review of patients identified by diagnosis code for BP. A total of 903 patients were included; 687 (76.1%) presented to ED, 87 (9.6%) to internal medicine, 77 (8.5%) to family medicine, and 52 (5.8%) to urgent care. On presentation, 804 (89.0%) patients were prescribed corticosteroids and 592 (65.6%) antiviral therapy. Steroid therapy ranged from 1 dose to greater than a 14-day course, with 177 (19.6%) receiving an adequate duration of 10 days or greater. Referrals were provided to facial plastics and/or otolaryngology for 51 patients (5.6%). For all comers, 283 (31.3%) had complete resolution, 197 (21.8%) had an incomplete resolution, 62 (6.9%) had persistent palsy, and 361 (40.0%) lost to follow-up. In assessing the association between clinic setting and management, appropriate corticosteroid therapy (p < .01), imaging (p < .01), and eye care (p < .01) were statistically significant. Adherence to guidelines for BP management varies amongst providers. In our study cohort, 15.5% of patients received medical therapy in accordance with AAO-HNS guidelines, and only 5.6% were referred to facial plastics. To facilitate more appropriate care, tertiary care institutions may benefit from system-wide care pathways to manage acute BP.

Watchful waiting? Portuguese approach to otitis media with effusion

Introduction and objective: Otitis media with effusion (OME) is an important public health problem. Several clinical practice guidelines for diagnosis and treatment of OME are in place, including from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). This study aimed to evaluate the clinical practice of OME diagnosis and treatment among the Otolaryngology medical community working in Portugal. Material and methods: A questionnaire was developed based on AAO-HNS guidelines regarding placement of tympanostomy tubes in children. Each directive was transformed into a question, and further questions were added to improve the characterization of the population and its practices. Results: Answers provided agreed with “recommendations” and “recommendations against” enunciated in the guidelines. The exceptions were recommendations regarding the adoption of measures to prevent water from entering the external ear canal of children with tympanostomy tubes and the use of drugs. Questions asked outside guidelines scope revealed that 96.7% of doctors consider children’s age and 49.1% wait for the end of summer when deciding about surgery for tube placement, 68% recommend bathing in beaches, and 21.9% recommend mineral water treatment. Conclusion: These results suggest that Portuguese otolaryngologists act according to the latest international guidelines and consider factors like season, bathing in beaches, and mineral water treatment in surgical or treatment decisions.

Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines

Benign Paroxysmal Positional Vertigo (BPPV) is characterized by vertigo, lasting for a few seconds and usually managed by head positioning maneuvers. To educate clinicians concerning the state-of-the art knowledge about its management, the international societies developed guidelines. Aimthe aim of this paper is to discuss, in a practical fashion, the current options available to manage BPPV. MethodStudy design: non-systematic review. This study reviews two recent guidelines regarding the evaluation and treatment of BPPV. The first one was published by the American Academy of Otolaryngology Head and Neck surgery (AAO-HNS) and the other by the American Academy of Neurology (AAN). The similarities were presented in different tables. ResultsThose guidelines presented differences regarding methods. Only the AAO-HNS guidelines recommend the Dix-Hallpike test for the diagnosis of BPPV. Only canalith repositioning maneuver, Semont maneuver and vestibular rehabilitation had showed some benefit and were recommended as good treatment options. ConclusionsBoth guidelines fulfilled all the aspects required for clinicians to diagnosed and manage BPPV; only the AAO-HNS's guidelines were more comprehensive and of better quality.

Functional results of 394 bilateral stapedotomies evaluated with the Glasgow Benefit Plot

This study aimed to evaluate the results of 394 bilateral stapedotomies according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines and with the Glasgow Benefit Plot (GBP) and also analyze the benefit of a second-ear stapedotomy in achievement of normal and symmetrical hearing using retrospective chart review. The charts of 1,369 stapedotomies performed by senior author (J.H.) from 1991 to 2006 were reviewed. Results of 394 bilateral stapedotomies were included. The hearing results were evaluated according to the 1995 AAO-HNS Committee on Hearing and Equilibrium (CHE) guidelines and the GBP criteria. Success rates after the first and second ear surgeries were separately analysed. ABG closure < or =20 dB was demonstrated in 98% of cases after both first and second procedures. Postoperative AC gain was higher in the first ear surgery compared with the second ear surgery in all groups of preoperative hearing impairment. As a result of first ear surgery, 142 (72%) patients changed into the category of unilateral hearing loss. As a result of second ear surgery, 125 (64%) patients changed into the category of normal and symmetric hearing. In this study the largest group of 394 primary bilateral stapedotomies was simultaneously evaluated according to AAO-HNS guidelines and GBP criteria. The results showed that the first ear surgery was more successful in achievement of normal hearing in the operated ear. Second ear surgery was more beneficial in providing symmetric hearing.

RESPONSE TO "LACK OF DIAGNOSTIC VALUE OF HIGH-PASS NOISE MASKING OF AUDITORY BRAINSTEM RESPONSES IN MÉNIÈRE'S DISEASE BY CLAUDIA F. J. DE VALCK, GERD M. E. CLAES, FLORIS L. WUYTS, AND PAUL H. VAN DE HEYNING. OTOLOGY &amp; NEUROTOLOGY 2007;28:700-7"

In the recent paper “Lack of Diagnostic Value of High-Pass Noise Masking of Auditory Brainstem Responses in Meniere’s Disease” by De Valck et al. (2007), the authors concluded that, due to its low sensitivity (31%) and low specificity (28%), the ABR high-pass noise masking technique (Don et al., 2005), commercially known as CHAMP (Natus/Bio-logic Corp.), had “…no discriminative value in differentiating Meniere’s from non-MD subjects with otovestibular symptoms” (p. 706). In reviewing their data and analyses, we found errors that led to misleading and inappropriate conclusions. This response will briefly review the errors and suggest that once these errors are corrected, the revised values of 100% sensitivity and 80% specificity are consistent with the excellent sensitivity and specificity described in the original paper (Don et al., 2005). Before discussing the errors, it is important to note that the authors state, “…when only definite MD patients were included, and only the interpretable tests were used, a 100% sensitivity was obtained as in the study of Don et al. (11).” (p.705) In addition, they state, “…none of our definite MD patients had a test within normal ranges.” (p. 706) Thus, as in our study (Don et al., 2005), these authors found that in all the patients with definite Meniere’s disease (MD) and measurable responses, the test results were abnormal. So, what errors led De Valck et al. (2007) to their erroneous conclusion about the value of the CHAMP test?

Long-term follow-up of transtympanic gentamicin for Ménière's syndrome.

Recent studies have shown that transtympanic gentamicin for Ménière's syndrome is effective. Current treatment protocols vary. One concept has been to perform a chemical ablation; the other has been to perform a chemical alteration. Ablation requires multiple injections and is effective in controlling the vertigo, but it is associated with a significant incidence of hearing loss. Chemical alteration uses a minimal dose to reduce vestibular function without affecting cochlear function. Prospective. Tertiary medical center. Patients had classic unilateral Ménière's syndrome that was unresponsive to medical therapy. A single injection of gentamicin is given, and the patient is seen 1 month after injection. If indicated, the patient receives another injection and is reevaluated 1 month later. Control of vertigo and maintenance of hearing using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines (1995). Fifty-six patients have documented follow-up for 2 years or more, and 21 have 4 years or more of follow-up. This article presents the 4-year results as outlined by the AAO-HNS guidelines. Vertigo classes A and B were seen in 82% of patients. The patients followed 2 to 4 years had 86% vertigo class A and B results. Those followed 4 years or more show 76% with a vertigo class A or B result. In this study there has been minimal cochlear loss. There was vestibular change clinically, which was documented by electronystagmography. It appears that a single transtympanic gentamicin injection is effective in controlling the vertigo of Ménière's syndrome. Cochlear impact has been minimal. It is most useful for those patients who have failed medical management and are severely affected but not totally incapacitated by the disease.