Otolaryngology Community Research Articles

Trends in the Management of Pediatric Chronic Sinusitis: Survey of the American Society of Pediatric Otolaryngology

The management of chronic sinusitis (CS) in children has yet to be fully elucidated. The objective of this study is to assess practice trends within the pediatric otolaryngology community for the management of children with CS. A multiple choice survey of the members of the American Society of Pediatric Otolaryngology (ASPO) was performed to assess for various factors related to the management of CS in children. A total of 175 ASPO members responded to the survey. The majority of respondents initially treat patients medically with oral antibiotics (95%), topical steroids (90%), and nasal saline sprays (68%). Fifty-five percent performed adenoidectomy as part of the treatment of CS, with 81% performing the operation before endoscopic sinus surgery (ESS). Compared with 3 years before the survey, 47% of respondents performed approximately the same number of ESS cases, whereas 35% reported doing fewer cases annually. Seventy-two percent of practitioners do not routinely perform a second-look surgery. The majority of pediatric otolaryngologists use oral antibiotics, nasal steroids, and saline lavage, and will perform adenoidectomy when managing patients with CS. More than a third of pediatric otolaryngologists are using more stringent criteria for surgery and performing less extensive surgery than 3 years before the survey. Surgical outcomes for CS do not appear to have changed over the past 3 years.

Expanding role of otolaryngologists in microvascular reconstruction of the head and neck

Objectives: Reconstruction of complex defects of the head and neck is best accomplished by free tissue transfer. In the past, this was performed by plastic surgeons. Recently microvascular reconstruction of the head and neck has become an otolaryngology-dominated field. The Microvascular Committee undertook a study to examine the microvascular manpower situation in the otolaryngology community. Methods: Survey with direct contact of 105 teaching programs. Results: 90% response rate (41 chairmen, 12 head and neck, 20 microvascular/reconstructive, 19 program directors). The type of specialist performing free tissue transfer changed over the past decade: orthopedics (1->1), plastic surgery (62->39), and otolaryngology (29->51). The role of otolaryngologists in free tissue transfer changed from 1990 (58 programs with no otolaryngologyist doing the reconstruction; 20 programs with 1 and 14 >2) to 2001 (18 had 0; 17 had 1;, 27 had 2; and 29 had 3). In 1990, 75 programs performed <10 flaps/year, 8 between 10–20 flaps/year, 7 between 25–40 flaps/year, and 2 >50 flaps/year. This changed in 2001 to 28 programs >10, 26 between 10–20, 17 between 25–40, and 21 >50. Examining resident education and free tissue transfer revealed that 50 programs had laboratory facilities but only 14 required residents to be trained in microvascular techniques. Residents were involved in harvesting (60), reconstruction (69), anastomosis (34), and donor closure (69). Conclusions: Microvascular reconstruction has come under the domain of otolaryngology. Manpower requirements are small, and a few programs dominate the field.

Elective management of the clinically negative neck by otolaryngologists in patients with oral tongue cancer.

The treatment of patients with squamous cell carcinoma of the head and neck who have a clinically negative (cN0) neck remains controversial. Furthermore, the treatment delivered to patients with a cN0 neck by practicing otolaryngologists is not known. To determine the variability in the management of the cN0 neck in the otolaryngology community. A random survey of 763 board-certified otolaryngologists in the United States. Physician respondents' preferences for observation vs treatment of the cN0 neck and the treatment modalities chosen. Forty-one percent of the surveyed physicians responded. Nearly 10% of the respondents observed all patients with a cN0 neck. Otolaryngologists who treat 35 or more new patients with cancer each year were more likely to perform elective treatment of the neck for a T2 lesion of the oral tongue than those who treat 10 or fewer patients each year (P =.03). They were also more likely to treat patients with a cN0 neck when the risk of occult cervical metastases was greater than 15% to 20% (P =.04). A comprehensive neck dissection was the preferred lymphadenectomy procedure for 21% of the otolaryngologists surveyed. Variations in the treatment of the cN0 neck are associated with differences in the frequency of treatment of patients with head and neck cancer by otolaryngologists. Uniformity of care must be established within the otolaryngology community by developing widely accepted evidence-based guidelines and referring patients to surgeons who routinely treat head and neck cancer.

Some pioneers in plastic surgery of the facial region.

Much of this complex history comes from Europe, with contributions and advances from dentists, otolaryngologists, and general surgeons. Prior to World War I there wasnospecificplasticsurgeryspecialty.For example, Sir Harold Gillies, an otolaryngologist, learned many dental skills and techniques from Charles Auguste Valadier, a rogue French practitioner of dentistry and maxillofacial surgery. (Valadier is said to have treated most of his patients in an automotive vehicle described as a “traveling dental parlour” around 1900.) Gillies,extraordinarilyinnovative,technically superb, and politically adept, was called by some the “father of plastic surgery,” although such a descriptor probablydoesnotpayproperhomageandcredit to his many European predecessors. Gillies drew heavily from these surgeons and teachers in Britain and continental Europe,astheythemselveshadadvancedtheir own training and expertise.

Internet-based continuing medical education in otolaryngology: a survey of Canadian otolaryngologists.

To assess the readiness of the Canadian otolaryngology community for an on-line continuing medical education (CME) program. Data were obtained through surveys mailed to members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Two hundred and eight of 321 (65%) surveys were returned. Seventy-six percent of the respondents indicated that they would be interested in participating in an on-line CME course. A greater proportion of younger otolaryngologists and those with community-based practices were interested in participating. A greater number of those with an academic practice were found to have convenient access to the Internet, the ability to post images on-line, and encountered cases they felt worthy of discussion and were willing to instruct/facilitate future on-line CME. Ninety-three percent of respondents described having easy access to the Internet, but only 32% said that they have the equipment necessary to post computed tomographic scans/audiograms on-line. Twenty-three percent had previous computer-based CME experience. Sinusitis and related topics were of greatest interest, with hearing loss/ear surgery and oncology following respectively. The data suggest that on-line CME would be welcomed and are feasible in the Canadian otolaryngology community.

Partial endoscopic middle turbinectomy augmenting functional endoscopic sinus surgery.

Endoscopic sinus surgery has gained acceptance in the otolaryngologic community as an effective and safe method of treating inflammatory disease of the paranasal sinuses. At our institution, partial endoscopic middle turbinectomy has become a standard component of the procedure and our experience is reported. Middle turbinectomy enhances surgical exposure, specific anatomic anomalies are more completely corrected, and subpopulations of patients at risk for failure because of their underlying disease enjoy decreased rates of synechiae formation and closure of the middle meatus antrostomy when followed over time. Photodocumentation of the surgical technique and a discussion regarding the impact of middle turbinectomy on normal nasal physiology are presented. It is reported that the procedure is safe, and no complications directly attributable to middle turbinectomy (including atrophic rhinitis) are reported in a series of 298 patients.

Rapid Intraoperative Tissue Expansion for Closure of Facial Defects

Rapid intraoperative tissue expansion (RITE) has been shown to have definite applicability to reconstruction in the head and neck. However, widespread use of this modality has yet to be adopted by the otolaryngologic community. Believing that RITE might offer some advantages in the reconstruction of soft-tissue facial defects following Mohs micrographic surgery for cutaneous malignant neoplasms, we evaluated 30 consecutive patients referred for cosmetic reconstruction after Mohs micrographic surgery for the use of RITE. Eight patients were selected and underwent reconstruction using a total of 10 tissue expanders. Herein, we describe our experience with this initial series as well as some background and future applications of RITE.

Indapamide to Treat Meniere's Disease

To the Editor .—Diuretic therapy is a mainstay in the medical treatment of Meniere's disease. 1 In our practice, as well as in many other large otologic practices, the drug of choice has been a fixed combination of hydrochlorothiazide and the potassium-sparing diuretic triamterene (Dyazide). Because of concern regarding the possible effect of this therapy on cholesterol and glucose metabolism, our internal medicine consultants recently advised us to switch our patients' therapy to indapamide (Lozol), a new oral antihypertensive/diuretic reported to have only a slight 2 effect on serum potassium levels. Shortly after changing our patients' therapy to this medication, we began to receive numerous laboratory reports of hypokalemia, as well as calls from patients complaining of its characteristic symptoms (weakness, fatigue, and lethargy). In all cases, symptoms promptly resolved and potassium levels stabilized with resumption of therapy with hydrochlorothiazide and triamterene. We wish to alert the otolaryngologic community to

Head and Neck Presentations of Acquired Immunodeficiency Syndrome

Since December 1980, over 3000 cases of acquired immunodeficiency syndrome (AIDS) have been reported. The charts of 102 patients admitted to the New York University Medical Center with a diagnosis of AIDS were reviewed with particular emphasis on presenting signs, symptoms, and laboratory values. Symptoms tended to be nonspecific and most often resembled those of an upper respiratory infection. Over 71% of the patients presented with at least two of the following four signs: diffuse adenopathy, oral and facial lesions consistent with Kaposi's sarcoma, white oral lesions, and anergy. Laboratory findings included leukopenia, increased erythrocyte sedimentation rate, thrombocytopenia, and anemia. The in-hospital mortality rate was 26%. The current status of our knowledge concerning AIDS is reviewed and discussed. The frequency and types of presenting signs and symptoms in the head and neck are reported to alert the otolaryngologic community to this entity.

Adenoid cystic carcinoma of the nasopharynx after previous adenoid irradiation.

In 1978, Pratt challenged the otolaryngology community to identify an incidence of malignancy in individuals who have previously received radium therapy to the nasopharyngeal lymphoid tissues. This case report is a direct response to that quest and presents a well documented adenoid cystic carcinoma evolving 23 years after radium applicator treatment to the fossa of Rosenmuller. Although a cause-and-effect relationship cannot be scientifically proven, the case history raises several important questions concerning the stimulating effects of radiation on the later onset of frank malignancy.

Head and neck presentations of acquired immunodeficiency syndrome

Since December 1980, over 2,000 cases of acquired immunodeficiency syndrome (AIDS) have been reported. The charts of 72 patients admitted to the New York University Medical Center with a diagnosis of AIDS were reviewed with particular emphasis on presenting signs, symptoms and laboratory values. Symptoms tended to be non-specific and most often resembled an upper respiratory infection. Over 95% of the patients presented with either diffuse adenopathy, oral or facial lesions consistent with Kaposi's sarcoma, white oral lesions, or anergy. Laboratory findings included leukopenia, increased erythrocyte sedimentation rate, thrombocytopenia and anemia. The in-hospital mortality rate was 26%. The current status of our knowledge concerning AIDS is reviewed and discussed. The frequency and types of presenting signs and symptoms in the head and neck are reported in order to alert the otolaryngologic community to this entity.

Electrical control of bone growth in ossicles. A preliminary report.

The purpose of this communication is to draw the attention of the otolaryngologic community to the recent findings relative to the electrical control of bone growth and their application to research in otology. The appropriate findings will be discussed in a general way with a brief explanation as to how they are being applied to the field of otology at present. Original investigative interest in the field of biophysical control of tissue growth was directed toward reparative and regenerative processes. At first it was thought that the central nervous system was completely responsible for certain growth signals in the form of electrical phenomena at the site of injury or repair. It soon became apparent, however, that the current of injury was a relatively constant direct current as opposed to the intermittent pattern characteristic of neural electric potential. It was then established that following an initial appearance of a direct current