Otolaryngology Medicine Research Articles

Evidence-Based Medicine in Otolaryngology, Part XIII: Health Disparities Research and Advancing Health Equity.

To provide a contemporary resource for clinicians and researchers on health equity research and implementation strategies to mitigate or eliminate disparities in health care. Published studies and literature on health disparities, applicable research methodologies, and social determinants of health in otolaryngology. Literature through October 2021 was reviewed, including consensus statements, guidelines, and scientific publications related to health care equity research. This research focus provides insights into existing disparities, why they occur, and the outcomes of interventions designed to resolve them. Progress toward equity requires intentionality in implementing quality improvement initiatives, tracking data, and fostering culturally competent care. Priority areas include improving access, removing barriers to care, and ensuring appropriate and effective treatment. Although research into health care disparities has advanced significantly in recent years, persistent knowledge gaps remain. Applying the lens of equity to data science can promote evidence-based practices and optimal strategies to reduce health inequities. Health disparities research has a critical role in advancing equity in otolaryngology-head and neck surgery. The phases of disparities research include detection, understanding, and reduction of disparities. A multilevel approach is necessary for understanding disparities, and health equity extensions can improve the rigor of evidence-based data synthesis. Finally, applying an equity lens is essential when designing and evaluating health care interventions, to minimize bias. Understanding the data and practices related to disparities research may help promote an evidence-based approach to care of individual patients and populations, with the potential to eventually surmount the negative effects of health care disparities.

Evidence-Based Medicine in Otolaryngology Part XII: Assessing Patient Preferences.

To provide a contemporary resource to update clinicians and researchers on the current state of assessment of patient preferences. Published studies and literature regarding patient preferences, evidence-based practice, and patient-centered management in otolaryngology. Patients make choices based on both physician input and their own preferences. These preferences are informed by personal values and attitudes, and they ideally result from a deliberative evaluation of the risks, benefits, and other outcomes pertaining to medical care. To date, rigorous evaluation of patient preferences for otolaryngologic conditions has not been integrated into clinical practice or research. This installment of the "Evidence-Based Medicine in Otolaryngology" series focuses on formal assessment of patient preferences and the optimal methods to determine them. Methods have been developed to optimize our understanding of patient preferences. Understanding these patient preferences may help promote an evidence-based approach to the care of individual patients.

Evidence-Based Medicine in Otolaryngology, Part XI: Modeling and Analysis to Support Decisions.

To provide a resource to educate clinical decision makers about the analyses and models that can be employed to support data-driven choices. Published studies and literature regarding decision analysis, decision trees, and models used to support clinical decisions. Decision models provide insights into the evidence and its implications for those who make choices about clinical care and resource allocation. Decision models are designed to further our understanding and allow exploration of the common problems that we face, with parameters derived from the best available evidence. Analysis of these models demonstrates critical insights and uncertainties surrounding key problems via a readily interpretable yet quantitative format. This 11th installment of the Evidence-Based Medicine in Otolaryngology series thus provides a step-by-step introduction to decision models, their typical framework, and favored approaches to inform data-driven practice for patient-level decisions, as well as comparative assessments of proposed health interventions for larger populations. Information to support decisions may arise from tools such as decision trees, Markov models, microsimulation models, and dynamic transmission models. These data can help guide choices about competing or alternative approaches to health care. Methods have been developed to support decisions based on data. Understanding the related techniques may help promote an evidence-based approach to clinical management and policy.

Evidence-Based Medicine in Otolaryngology, Part 8: Shared Decision Making-Impact, Incentives, and Instruments.

In our previous installment, we introduced shared decision making (SDM) as a collaborative process in which patients, families, and clinicians develop a mutually optimized treatment plan when more than 1 reasonable treatment option exists. In this subsequent installment of our Evidence-Based Medicine in Otolaryngology Series, we expand on the topic of SDM, including the related current state of clinical decision making, the impact of SDM on health care utilization and patient satisfaction, the potential role of system and society changes, the experience with SDM as it relates to race and ethnicity, existing financial incentives, and the validated instruments that assess the extent to which SDM occurs.

Evidence‐Based Medicine in Otolaryngology, Part 6: Patient‐Reported Outcomes in Clinical Practice

The assessment of patient-reported outcome measures (PROMs) in the outpatient setting is gaining momentum in clinical and research venues. Implementing this data capture into one's practice, however, is not a one-size-fits-all venture, and it is critical to determine when, how, and where to include these patient-centered assessments. This installment of the "Evidence-Based Medicine in Otolaryngology" series provides insight into the implementation process and experiences with successful incorporation of PROMs into clinical practice. Specifically, 4 differing clinical scenarios and collection techniques are described, including data acquisition protocols, formats for clinician data usage, and applications of PROM results in clinical and research scenarios.

Editorial introductions

Editorial introductions

Evidence-Based Medicine in Otolaryngology, Part 5: Patient Decision Aids.

Modern medical decision making is a complex task requiring collaboration between patients and physicians. Related clinical evidence may delineate a clearly favorable path, but in other instances, uncertainty remains. Even in these circumstances, however, there are techniques that optimize decision making by blending existing evidence with individual patient values in the context of physician counseling. This installment of "Evidence-Based Medicine in Otolaryngology" focuses on the crucial issue of how practitioners may approach clinical situations where the data do not delineate a single irrefutable path. We describe decision aids-tools that can educate patients about data related to complex clinical decisions. We review their definition, quality standards, patient interface, benefits, and limitations. We also discuss the related concept of option grids and the role of decision aids in evidence-based practice.

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

Evidence‐Based Medicine in Otolaryngology Part 4: Everyday Probabilities—Nonbinary Diagnostic Tests

Many diagnostic tests have nonbinary results. Thus, this fourth installment of our series in evidence-based medicine in otolaryngology focuses on understanding diagnostic tests with more than 2 possible results. We begin with a brief review of the types of multilevel results to be considered: continuous, ordinal, and nominal. Next, we discuss each of type in greater detail, including the methods to determine the posttest probability associated with each type of test result. The use of serial diagnostic tests and practicalities are also discussed. Frequently used diagnostic tests are utilized as examples.

Evidence‐Based Medicine in Otolaryngology, Part 3: Everyday Probabilities

Recent studies have demonstrated that the majority of physicians cannot accurately determine the predictive values of diagnostic tests. Physicians must understand the predictive probabilities associated with diagnostic testing in order to convey accurate information to patients, a key aspect of evidence-based practice. While sensitivity and specificity are widely understood, predictive values require a further understanding of conditional probabilities, pretest probabilities, and the prevalence of disease. Therefore, this third installment of the series "Evidence-Based Medicine in Otolaryngology" focuses on understanding the probabilities needed to accurately convey the results of dichotomous diagnostic tests in everyday practice.

Evidence‐Based Medicine in Otolaryngology, Part 2

What is the current state of evidence-based medicine in otolaryngology? This question inquires about the state of our literature, our attitudes and capabilities, and our patients' desires. Thus, this installment of "Evidence-Based Medicine in Otolaryngology" focuses on these 3 topics. First, the authors consider the literature relative to benchmarks for study design. Second, the data regarding otolaryngologists' and other surgical specialists' attitudes and understanding of clinical data are discussed. Third, patient-based efforts to promote and participate in evidence-based practice are explored. In addition, a discussion of the relevant supportive efforts made by our professional organizations is included.

Evidence-based medicine in otolaryngology, part 1: The multiple faces of evidence-based medicine

Evidence-based medicine, with its capacity to improve patient outcomes, has grown prominent throughout the medical field. Otolaryngology is at a crucial stage in the expansion of evidence-based medicine, with its impact seen in many arenas. As the evidence continues to shape our field, we hope to serve our otolaryngology community through this invited series, which is dedicated to the exposition of evidence-based medicine and its applications. This first installment examines evidence-based medicine itself and its multiple interpretations, including a purist view, a population-based view, and a view centered on the individual. Strengths and weaknesses of each are discussed, as well the potential for unification and evolution of these concepts. We also place evidence-based medicine in the context of the mindset of traditional medicine and anticipate future developments.

Antibiotic susceptibility of Haemophilus influenzae strains isolated from various clinical sources in Hokkaido Prefecture, Japan

Any increase in beta-lactam-resistant Haemophilus influenzae is a serious problem in respiratory and otolaryngology medicine. In this study, we examined the antibiotic susceptibility and genotype of 457 clinical Haemophilus influenzae strains isolated in Hokkaido Prefecture, Japan. Strains with beta-lactam-resistant mutations in gene encoding penicillin-binding protein 3 were more frequently found in lower respiratory tract specimens (sputa) than in upper respiratory tract specimens, such as rhinorrhea. The existence of the TEM-1 beta-lactamase gene occurred more frequently in adult patients than in pediatric patients. The results suggest that beta-lactam-resistant or nonsusceptible strains are more prevalent in adult patients with respiratory diseases. We observed only a very few strains which were nonsuscpetible to third-generation cephalosporins (CEPs) and carbapenems. However, 12%-13% of the strains were shown to be resistant to penicillins and second-generation CEPs, and approximately 4% of the strains were shown to be nonsusceptible to fourth-generation CEPs. In addition, we identified tetracycline-resistant (2.8%), chloramphenicol-resistant (0.6%), clarithromycin-resistant (2.6%), and fluoroquinolone-nonsusceptible (approximately 2%) H. influenzae strains.

宝塚市立病院における耳鼻咽喉科救急外来の現況

In the Hanshin area, there is one otolaryngological emergency clinic; however, it is not open at night except for during New Year's holidays. To examine problems associated with emergency medicine in otolaryngology, we surveyed otolaryngological emergency patients at Takarazuka Municipal Hospital. The subjects were 242 outpatients who visited the emergency clinic of otolaryngology at Takarazuka Municipal Hospital between April, 2004 and March, 2005. They included 122 males and 120 females, ranging from 0 to 94 years old. One hundred and one patients (41.7%) were less than 10 years old. The five most frequent diseases were acute otitis media (including 1 acute mastoiditis) (30.2%), the presence of a foreign body (15.7%), acute pharyngitis (including acute tonsillitis and acute epiglottitis) (12.4%), epistaxis (11.6%), and balance problems (11.2%). Nine patients in total (3.7%) were admitted. The average number of patients coming to the hospital during night duty was 2.6 on week days, 6.3 on Saturday, 4.2 on Sunday, and 4.7 on holidays. During day duty, it was 1.3 on Saturday, 2.4 on Sunday, and 2.3 on holidays. The time when most patients visited was 8 p.m. on holidays and 9 p.m. on week days. Thirty five patients (14.5%) visited 1 a. m. Most of the patients came from Takarazuka City (41.3%), and the majority were from the Hanshin area (95.0%). Administration of primary emergency medicine in otolarynogology depends on the otolaryngologists on duty in hospitals, and thus their work is difficult. It is therefore necessary to establish their work-load.

Impact of the "Doctor-Heli" system for emergency and critical care medicine in otolaryngology

We reported the "Doctor-Heli" (medical service helicopter) system at the center of emergency and critical care medicine at Tokai University Hospital. From October 1999 to March 2001, the service had transported 485 patients, shortening the time to critical care and improving patient-prognosis. We report a case of cervical and laryngeal trauma occurring during a suicide attempt successfully treated thanks to the rapid start of critical care enabled by use of the helicopter. The service has proven its utility in otolaryngology and head and neck surgery.

Complementary and alternative medicine in otolaryngology.

The widespread interest in and use of complementary and alternative medicine (CAM) by patients in the United States has been established by multiple surveys. One-third of the U.S. population uses some form of CAM, and an estimated 23 billion dollars is spent annually on these therapies. Because of prevalent usage of CAM among patients, it is important that physicians have some knowledge of this subject. With this purpose in mind, this report reviews the current research on CAM as it relates to common disorders of the head and neck: rhinitis, sinusitis, tinnitus, vertigo, and head and neck oncology.

Complementary and alternative medicine in the practice of otolaryngology

The aim of this review is to summarize recent research related to complementary and alternative medicine in otolaryngology. After defining complementary and alternative medicine, the reasons for its popularity are considered. Recent clinical trials are discussed: acupuncture for tempomandibular join