Otolaryngology Literature Research Articles

Product comparison model in otolaryngology: Equivalency analysis of absorbable hemostatic agents after endoscopic sinus surgery.

Evidence-based medicine in otolaryngology literature continues to be lacking, especially with regard to new products brought to market. The marketing of products often includes statements of benefit that have limited objective support in research or literature. To address this, and to adequately determine product equivalency/superiority, careful evaluation must be made. In order to establish standards for this process in rhinology products, we directly compare three different absorbable hemostatic agents in patients with chronic rhinosinusitis (CRS) after undergoing endoscopic sinus surgery (ESS), using both objective and subjective outcomes. Double-blinded prospective (level 1) comparison and equivalency analysis of three plant-based absorbable hemostatic agents (carboxymethylcellulose [CMC] gel, mucopolysaccharide hemospheres (MPH), and potato starch wafer) in patients undergoing bilateral ESS. Patients with medically refractory CRS who underwent bilateral ESS were recruited and prospectively followed. At the conclusion of ESS, one of three different hemostatic agents was applied to each nasal passage. Subjective patient data was obtained using rated symptoms compared between the two sides (nasal obstruction, bleeding, pain, and nasal discharge) at baseline and on postoperative days 1, 7, and 14. Objective data was obtained by blinded endoscopic scoring to rate mucosal edema, inflammation, granulation, crusting, infection, and synechiae formation on postoperative weeks 1, 3, and 6. Forty-eight patients who underwent ESS for CRS were included. There is no statistical difference in subjective scores for any of the variables measured, although (MPH) nearly reached statistical significance at postoperative day 7 for increased pain (P = 0.06) and obstruction (P = 0.22). Objective measures showed equivalency between all products, except the CMC gel approached significance at week 3 for increased crusting (P = 0.10), granulation (P = 0.24), and debridement (P = 0.07). At 6 weeks, increased debridement (P = 0.14) also approached significance. Careful and deliberate consideration should be taken when choosing products to assist our surgical endeavors. Subjectively, patients treated with MPH showed near-significant increases in pain and obstruction. In objective measures, CMC gel nearly reaches significance for more postoperative debridement, with increased crusting and inflammation. Product choice could consider these factors, although it remains at the discretion of the surgeon. This model of comparison allows careful product comparison and should be applied to other hemostatics, as well as other materials in use in otolaryngology. 1b. Laryngoscope, 126:S5-S13, 2016.

Cystic Lesions of the Jaw in Children: A 15-Year Experience.

Pediatric jaw cysts represent a rarely symptomatic clinical entity and are not well addressed in the otolaryngology literature. It is important that otolaryngologists should be familiar with these lesions, which can manifest as jaw swelling or as paranasal sinus abnormalities. To review the clinical presentation, radiologic features, management, and outcomes of jaw cysts in children treated at a single academic institution. Retrospective medical record review at a tertiary care children's hospital among patients 16 years and younger who were seen with a cystic jaw lesion. Medical records were reviewed for data on symptoms, physical examination findings, imaging, pathology, interventions, and outcomes among children who were seen at the Department of Oral and Maxillofacial Surgery or the Department of Otorhinolaryngology-Head and Neck Surgery at the University of Maryland Medical Center between January 1997 and December 2012 and were diagnosed as having a jaw cyst. Fifty-seven patients were identified who were diagnosed as having a true cystic jaw lesion and whose complete medical records were available for review. The most common cystic lesions were keratocystic odontogenic tumors (n = 19) and dentigerous cysts (n = 17). Fifty-six percent (32 of 57) of all cystic lesions were asymptomatic on presentation and were identified by imaging. The second most common presentation was local swelling (n = 15), followed by dental irregularities (n = 6). All patients, except for 1 with an eruption cyst, required surgical intervention, including biopsy, enucleation, curettage, or ostectomy, with reconstruction as indicated. Keratocystic odontogenic tumors tended to require more treatment (median, 2 procedures) for metachronous lesions or recurrence. Pediatric jaw cysts are unusual, and data are scarce regarding their presentation and management. Many of these cysts are asymptomatic and are identified incidentally on orthopantomography. Keratocystic odontogenic tumors were the most common lesion seen in our series, followed by dentigerous cysts. Surgical intervention is required in most patients with a cystic lesion of the jaw.

FNA biopsy of pediatric cervicofacial masses and validation of clinical characteristics of malignancy

IntroductionPediatric head and neck masses can pose a diagnostic challenge due to their ubiquitous nature. The vast majority of masses are inflammatory, however malignancies do occur. This study is a review of fine needle aspiration biopsy (FNA-B) as a diagnostic technique at a single institution over a 13 year period. The objectives were to examine the sensitivity and specificity of FNA-B, correlate these results with clinical characteristics of each mass and determine if such characteristics are associated with malignancy. MethodsThis was a retrospective case series of 143 consecutive pediatric patients who underwent FNA-B of 146 head and neck masses with subsequent follow up examinations from 2000 to 2012 (inclusive). We expected FNA-B to be a sensitive and specific method for determining malignancy. FNA-B diagnoses were confirmed with open biopsy pathology results and clinical follow up greater than 1 year. Physical exam characteristics of each mass including location, tenderness, firmness, and mobility were documented. Chi square and Fisher exact tests were used to determine statistical significance. ResultsThe sensitivity and specificity of FNA-B in determining malignancy were 87.5% and 100% respectively. Positive and negative predictive values were 100% and 99.1%, respectively. On univariate analysis of clinical descriptors associated with malignancy, non-mobile masses significantly correlated (p=0.0025), while the firmness and tenderness of a mass did not reach statistical significance. Of mass locations, the lateral neck had the strongest association with malignancy, but this relationship only demonstrated statistical significance when lymphomas were considered independently (p=0.0428). ConclusionsResults demonstrate FNA-B to be an effective method for the diagnosis of pediatric head and neck masses. It maintained a high sensitivity and specificity with a large sample size, to date one of the largest in the pediatric otolaryngology literature. Also, the data offered statistical validation of classical signs of malignancy and showed fixed masses to have the highest correlation. Finally, the findings support lateral neck masses to warrant a higher degree of suspicion for malignancy compared to other compartments.

CBCT Findings of Complete Calcification of the Stylohyoide Ligament: Case Reports

Calcification of the stylohyoide ligament or Eagle syndrome, which cause is still unclear, is a group of symptoms caused by an elongated ossified styloid process. It can occur unilaterally or bilaterally and most frequently results in symptoms of dysphagia, headache, pain on rotation of the neck, pain on extension of the tongue, change in voice, and a sensation of hyper salivation. This finding is well documented in otolaryngology literature and dentistry literature but has not been sufficiently reported in the radiology literature, although it often goes undetected in the absence of radiographic studies. In these report, we will present some radiographic evidences on a series of CBCT views and 3D reconstructions of three cases with clinical evidence of Eagle syndrome.

English

PURPOSE OF STUDY: Nasal dressing following nasal surgery in an attempt to prevent postoperative bleeding and to modulate the wound healing process. Experience with postoperative nasal dressings in otolaryngologic literature spans more than half a century; despite of this, there is still little agreement between the surgeons on the appropriate choice of nasal dressings following nasal surgery, or whether nasal dressings are required at all. This paper briefly reviews the comparative study between the postoperative cases with and without nasal dressings. STUDY DESIGN: It is a prospective study carried out in a tertiary care, teaching hospital. MATERIALS AND METHODS: A prospective evaluation of patients who underwent nasal surgery at tertiary teaching hospital setting between February 2013 to June 2014 was performed. Nasal dressing was done in some cases who underwent nasal surgery and no dressing was done in some cases. The comparative results between the cases with and without nasal packing in terms of Postoperative bleeding, Adhesion formation, Middle turbinate lateralization were studied. RESULTS: Out of 160 patients included in this study, nasal dressing postoperatively was done in 92 cases and 68 cases were not packed postoperatively. In terms of postoperative bleeding there is no significant difference between the cases with packs (5.43%) and without pack (5.88%). Postoperative Adhesion formation was less in cases without nasal packing (2.94%) than in cases with nasal dressing (8.7%). Middle turbinate lateralization is also less in cases without nasal packing (8.82%) than in cases with nasal packing (17.5%). CONCLUSION: The decision as to whether to pack the nose after nasal surgery remains controversial. There has been an increasing tendency to move away from removable nasal dressings due to discomfort and bleeding upon removal and also postoperative adhesions. This study showcases that there is no considerable difference in postoperative bleeding in patients with or without nasal dressings postoperatively. It also shows that wound healing is better and middle turbinate lateralization is less significant in cases without nasal packings than in cases with post- operative nasal dressings.

Tumors of the pediatric maxillofacial skeleton: a 20-year clinical study.

Pediatric jaw tumors are a rare clinical entity and are not well addressed in the otolaryngology literature. It is important that otolaryngologists be familiar with the clinical features, management, and outcomes associated with these lesions. To review the clinical presentation, management, and outcomes of jaw tumors in children treated at a tertiary care academic center. Retrospective medical record review of children 16 years or younger who presented to the departments of Oral-Maxillofacial Surgery and Otorhinolaryngology at the University of Maryland Medical Center between 1992 and 2012 and were diagnosed as having a jaw tumor. A PubMed review of literature from 1992 to 2013 on jaw tumors in children was also conducted. Medical records were reviewed for data on symptoms, physical findings, pathologic diagnosis, intervention, and outcomes. The medical records of 76 patients evaluated for a jaw mass were reviewed, and 20 were found to have a diagnosis of a jaw tumor. The 2 most common pathologic diagnoses were ameloblastoma (n = 5) and juvenile ossifying fibroma (n = 4). Two tumors were malignant, a rhabdomyosarcoma and a teratoma. Thirteen patients presented with evidence of a mass or swelling, 5 patients were asymptomatic with a lesion found on surveillance panoramic radiography, and 1 patient presented with epistaxis and 1 with facial weakness and pain. All tumors excluding a lymphangioma and a rhabdomyosarcoma were managed surgically. Eight patients underwent more than 1 procedure including secondary reconstruction prior to a satisfactory outcome. Pediatric jaw tumors are rare lesions most commonly presenting with a swelling or mass. Patients can be asymptomatic with the lesion identified on routine imaging. Certain clinical features such as age, location of tumor, and presence or absence of bone and soft tissue can narrow the differential diagnosis and identify tumors that may be malignant. Incisional biopsy is an important first step. A majority of jaw tumors are benign but require surgical intervention for eradication of disease. Multiple procedures, including reconstruction, may be required for certain lesions prior to cure.

Laryngeal Mask Airway versus Endotracheal Tube Intubation for Repairing of Nasal bone Fracture: A 7 Year Single Institution Case-Control Study

Introduction: Closed reduction nasal fracture is a common and well established procedure in the otolaryngology literature. The Laryngeal mask airway (LMA) is being used more frequently for otolaryngologic procedures in recent years because it has been proven safe for select procedures especially in the pediatric population. The frequency of closed reduction nasal fracture repair and the increased propensity to use LMA anesthesia for otolaryngologic cases warrants investigation. Objective: We sought to investigate the benefits, risks and safety of using LMA anesthesia for pediatric patients during closed reduction nasal fracture compared to case controlled equivalents that underwent ETT intubation. Methods: We performed a retrospective case-control study in which all cases of closed reduction nasal fracture at a single pediatric institution by a single surgeon were studied. This included patients from 2007 to 2013 at Ann & Robert H Lurie Children’s Hospital of Chicago. The primary outcomes assessed were postoperative VAS and FACES pain scores, blood loss, cough, stridor and aspiration. Secondary outcomes assessed included timing data to determine if one technique led to greater optimization of operating room (OR) time and/or total hospital stay. The timing data included overall OR duration, prep to cut time, cut to close time, non-operative OR time and the total hospital stay in minutes. Results: Fifty patients met the inclusion criteria. Of the 50 patients included an endotracheal tube was used in 16 patients and a LMA was used for 34 patients. Two of the LMA group 2/34 (6%) had aspiration documented compared to zero of the ETT group. The average total length of hospital stay was 268.5 m when both groups were included. The average total hospital stay was 252.6 minutes for the LMA group and 312.4 for ETT group. The average postoperative VAS pain score, as documented 0-10 by the RN, was 0.47 for the LMA group as opposed to 0.56 for the ETT group. A total of 24 patients had cough noted, 15/34 (44%) of the LMA group and 9/16 (56%) of the ETT group. Ten patients had stridor noted, 5/34 (15%) of the LMA group and 5/16 (31%) of ETT group. Conclusion: These results support the hypothesis that using an LMA versus an ETT for short procedures does save time when assessing overall hospital stay. Additional benefits of the LMA are reduced cough, pain, stridor and ease of placement. The data also supports our second hypothesis that using an LMA for close reduction nasal fracture can lead to more frequent post operative airway obstruction when compared to the ETT. Our data and review suggest that it is the combination of deep extubation (lack of airway protection) and the use of an LMA (allows for blood accumulation) that result in the increase risks of airway obstruction postoperatively. For operations in the pediatric population with a significant risk of bleeding into the pharynx we recommend using an ETT due to the risks of aspiration. If an LMA is used we recommend to only removing the LMA after the patient has been deemed in the state of anesthesia which is awake. For short cases with a low risk of immediate post operative bleeding into the pharynx, we are proponents of the LMA due to its’ time saving effect.

Bilateral meningoencephaloceles with cerebrospinal fluid rhinorrhea after facial advancement in the Crouzon syndrome.

Background:Cerebrospinal fluid (CSF) rhinorrhea and encephaloceles are rare complications of craniofacial advancement procedures performed in patients with craniofacial dysostoses (CD) to address the ramifications of their midface hypoplasia including obstructed nasal airway, exorbitism, and impaired mastication. Surgical repair of this CSF rhinorrhea is complicated by occult elevations in intracranial pressure (ICP), potentially necessitating open, transcranial repair. We report the first case in otolaryngology literature of a patient with Crouzon syndrome with late CSF rhinorrhea and encephalocele formation after previous LeFort III facial advancement surgery.Objectives:Describe the case of a patient with Crouzon syndrome who presented with CSF rhinorrhea and encephaloceles as complications of Le Fort III facial advancement surgery. Review the literature pertaining to the incidence and management of post-operative CSF rhinorrhea and encephaloceles. Analyze issues related to repair of these complications, including occult elevations in ICP, the utility of perioperative CSF shunts, and the importance of considering alternative repair schemes to the traditional endonasal, endoscopic approach.Methods:Review of the literature describing CSF rhinorrhea and encephalocele formation following facial advancement in CD, focusing on management strategies.Results:CSF rhinorrhea and encephalocele formation are rare complications of craniofacial advancement procedures. Occult elevations in ICP complicate the prospect of permanent surgical repair, potentially necessitating transcranial repair and the use of CSF shunts. Though no consensus exists regarding the utility of perioperative CSF drains, strong associations exist between elevated ICP and failed surgical repair. Additionally, the anatomic changes in the frontal and ethmoid sinuses after facial advancement present a challenge to endoscopic repair.Conclusion:Otolaryngologists should be aware of the possibility of occult elevations in ICP and sinonasal anatomic abnormalities when repairing CSF rhinorrhea in patients with CD. Clinicians should consider CSF shunt placement and carefully weigh the advantages of the transcranial approach versus endonasal, endoscopic techniques.

A smartphone-optimized web site for conveniently viewing otolaryngology journal abstracts.

Access to the medical literature has not kept pace with the mobile revolution. We aimed to (1) gauge interest in a smartphone-optimized Web site for conveniently accessing otolaryngology literature and (2) create an easy-to-access and convenient Web site that displays otolaryngology journal abstracts in a format optimized for smartphones. A survey was sent to physicians of a major US academic otolaryngology-head and neck surgery department. Demographics, literature-browsing habits, and barriers to staying updated were assessed. The response rate was 87%. Ninety-one percent of respondents used a smartphone, and 85% wished they could stay more up to date with the otolaryngology literature. Most respondents believed a convenient smartphone-optimized Web site could help them achieve this goal. A Web site was then developed in collaboration with a university creative department as a proof of concept. The site uses a simple RSS aggregator to display journal abstracts formatted for smartphone-sized screens (www.otosurg.com).

The Quality of Economic Evaluations in the Otolaryngology Literature

Objectives: (1) Identify factors that may predict the quality of economic evaluations in the otolaryngology literature. (2) Identify current weaknesses in published economic evaluations for the purposes of improving the quality of future studies. Methods: This is a retrospective quality review of published economic evaluations using the validated Quality of Health Economic Studies (QHES) instrument. A systematic review of the Medline, Embase, PubMed, and NHS economic evaluation databases was performed using otolaryngology key terms combined with the terms cost and effectiveness. A manual search of 33 otolaryngology journals was also performed to prevent missed studies. Included studies were graded using the QHES instrument, a 16-item checklist providing a total quality score of 100. Results: Fifty studies were identified, and the mean QHES rating was 54.7 (SD: 31.0). Higher quality economic evaluations were associated with a higher journal impact factor (correlation coefficient r 0.62, P < .01), having an author with a PhD in health economics ( r 0.56, P < .01), and having authors who have published prior economic evaluations ( r 0.46, P < .01). The most commonly omitted methodology was lack of defining the cost perspective and lack of a robust sensitivity analysis. Conclusions: The quality of economic evaluations is important to properly inform efficient allocation of scarce health care resources. Our study investigated the overall quality of economic evaluations in the otolaryngology literature and demonstrated that there is potential to improve the quality of published studies. Future studies should follow published methodology guidelines and consider collaborating with authors who have experience with economic evaluation.

Arrested Pneumatization of the Sphenoid: A Normal Variant Easily Mistaken for a Pathologic Entitity

Objectives: (1) Describe the radiologic findings of arrested pneumatization of the sphenoid sinus. (2) Recognize this benign developmental variant to prevent unnecessary surgical intervention. Methods: A case series. Between November 2012 to January 2014, 8 subjects presented with radiologic findings consistent with arrested pneumatization of the sphenoid bone, a benign developmental variant. In each case, review of imaging by a neuroradiologist confirmed this diagnosis using strict criteria. This series includes all cases encountered during routine clinical practice during this time period. Charts were reviewed for demographic, clinical, and radiologic data. Results: In all 8 cases, arrested pneumatization of the sphenoid sinus was an incidental finding. All subjects underwent computed tomography (CT) imaging as workup for a variety of otolaryngology-related symptoms, including headache, hearing loss, facial trauma, and sinusitis. Two patients were referred after the finding of a sphenoid lesion was mistaken for a pathologic entity. Based on CT imaging, 7 subjects were recognized as having this benign developmental variant and were managed conservatively. One patient, whose imaging revealed what appeared to be an infiltrative, midline tumor of the sphenoid sinus, underwent surgical biopsy with benign results. Upon subsequent review of CT imaging at our institution, the lesion did appear to have features consistent with arrested pneumatization. Conclusions: Considering the frequency of identification of arrested pneumatization of the sphenoid, there is a paucity of information about this diagnosis within the otolaryngology literature. Familiarity with this entity may prevent additional costly workup or unnecessary surgical intervention.

Trends in American and Canadian Contribution to the Otolaryngology Literature

Objectives: Assess the 2008-2012 American and Canadian contribution to the world otolaryngology literature. Methods: All articles published from January 2008 to December 2012 in 8 otolaryngology journals were reviewed. Book reviews, letters, correspondence, and meeting abstracts were excluded. Nationality, author numbers, and study types were extracted. Nationality of the article was defined by the publishing department’s country of origin. Articles were categorized into primary clinical research, primary basic science research, secondary research such as systematic reviews and meta-analyses, and other articles that did not fit the aforementioned classifications. Articles originating from the United States, Canada, and the rest of the world were statistically compared using Mantel-Haenszel Common Odds Ratio Estimate, Pearsons chi-squared, and Fisher exact tests. Results: A total of 3635 articles published in the journals surveyed were analyzed. Canadian-authored papers decreased from 12.8% in 2008-2009 to 10.2% in 2011-2012, whereas American-authored papers increased from 27.9% in 2008-2009 to 30.1% in 2011-2012. These changes were statistically significant ( P = .031). Multiauthorship (≥5 authors) increased in Canadian papers ( P = .015), whereas this trend had not been observed in American papers ( P = .566). Study types from the United States and Canada had not significantly changed from 2008-2009 to 2011-2012 ( P = .137). Conclusions: There were significant changes in otolaryngology publishing trends in the United States and Canada. Increase in multiauthorship in Canadian-authored papers possibly suggests increased collaboration with multi-disciplines and decreased investigator productivity.

Bilateral Encephaloceles and CSF Rhinorrhea after Facial Advancement in Craniofacial Dysostoses: Considerations for Repair

Objectives: (1) Describe the first reported case in otolaryngology literature of a patient with Crouzon syndrome with late cerebrospinal fluid (CSF) rhinorrhea and encephalocele formation after prior Le Fort III facial advancement surgery. (2) Review the literature pertaining to the incidence and management of this complication in craniofacial dysostoses (CD). (3) Analyze issues surrounding repair of these complications, including occult elevations in intracranial pressure (ICP), the use of perioperative CSF shunts, and the importance of considering alternative repair schemes. Methods: Literature review of studies describing CSF rhinorrhea and encephalocele formation following facial advancement in CD, focusing on management strategies. Results: CSF rhinorrhea and encephalocele formation are rare complications of craniofacial advancement procedures. Occult elevations in ICP complicate the prospect of permanent surgical repair, necessitating the use of transcranial repair and CSF shunts in addition to the now more common endoscopic approach. Though no consensus exists regarding the use of perioperative CSF drains, strong associations exist between elevated ICP and failed surgical repair. Additionally, the anatomic changes in the frontal and ethmoid sinuses after facial advancement present a challenge to endoscopic management. Conclusions: Otolaryngologists should be aware of the possibility of occult elevations in ICP as well as sinonasal anatomic abnormalities when repairing CSF rhinorrhea in patients with CD. Clinicians should consider CSF shunt placement and carefully weigh the advantages of the open, transcranial approach versus endonasal, endoscopic techniques.

A review of multiple hypothesis testing in otolaryngology literature.

Multiple hypothesis testing (or multiple testing) refers to testing more than one hypothesis within a single analysis, and can inflate the type I error rate (false positives) within a study. The aim of this review was to quantify multiple testing in recent large clinical studies in the otolaryngology literature and to discuss strategies to address this potential problem. Original clinical research articles with >100 subjects published in 2012 in the four general otolaryngology journals with the highest Journal Citation Reports 5-year impact factors. Articles were reviewed to determine whether the authors tested greater than five hypotheses in at least one family of inferences. For the articles meeting this criterion for multiple testing, type I error rates were calculated, and statistical correction was applied to the reported results. Of the 195 original clinical research articles reviewed, 72% met the criterion for multiple testing. Within these studies, there was a mean 41% chance of a type I error and, on average, 18% of significant results were likely to be false positives. After the Bonferroni correction was applied, only 57% of significant results reported within the articles remained significant. Multiple testing is common in recent large clinical studies in otolaryngology and deserves closer attention from researchers, reviewers, and editors. Strategies for adjusting for multiple testing are discussed.

Pediatric chronic rhinosinusitis

The timing and role of surgery in the management of pediatric chronic rhinosinusitis (pCRS) remains unclear. This review attempts to summarize the existing literature regarding this topic. pCRS is a complex clinical syndrome that results from multiple potential causes. Multimodal medical therapy is the accepted primary treatment. Adenoidectomy continues to be the appropriate first-line surgical therapy, and the addition of antral lavage or balloon dilation to this procedure may improve outcomes. Functional endoscopic sinus surgery (FESS) in children is safe and effective in relieving symptoms in the majority of patients. Failure to respond to maximal medical therapy continues to be a commonly cited, although poorly defined, requisite for proceeding to surgery. Recent literature has been focused on the outcomes after FESS rather than specifically defining when this intervention should be considered. Nevertheless, the literature seems to continue to support FESS in children with persistent symptoms despite adenoidectomy and appropriate medical treatment for pCRS. As the symptoms of chronic rhinosinusitis (CRS) may result from multiple underlying causes, clinicians must understand that the role and timing of surgery may vary with particular patients' disease. Surgical management of CRS in children continues to be a frequent topic of study in the otolaryngology literature. As recent research tends to be focused on outcomes after surgery, further prospective studies comparing surgical versus nonsurgical treatment of CRS will likely be required to better define indications for proceeding to surgery at all.

Peritonsillar Abscess with Internal Carotid Artery Stenosis

Peritonsillar abscesses are the most common deep infections of the head and neck in young adults, despite the widespread use of antibiotics for treating tonsillitis and pharyngitis. Peritonsillar abscesses can be treated effectively with swift medical and sometimes surgical intervention. There are many complications of peritonsillar abscesses, some of which may be fatal due to the proximity of major vasculature. Here we present a case of a patient with a peritonsillar abscess that resulted in stenosis of the internal carotid artery without neurological sequelae. To our knowledge, this is the first reported case in the otolaryngology literature.

The Canadian contribution to the otolaryngology literature: a five year bibliometric analysis

To assess the 2008-2012 Canadian contribution to the Otolaryngology literature. All articles published from January 2008 - December 2012 in 5 Otolaryngology journals were reviewed. Nationality, number of authors, and study type were extracted. The output, number of authors, and study type of Canadian papers were compared to International papers using Mantel-Haenszel Common Odds Ratio Estimate, Pearson’s Chi-Squared or Fishers exact tests. 4519 papers were analyzed. There was a statistically significant decrease in Canadian authored papers from 12.8% in 2008-9 to 10.2% in 2011-12 (Fishers exact, p = .01). Multi-authorship increased in Canadian papers (χ2, p = .01). The types of studies published by Canadian Otolaryngologists did not change over the study period. Canadian authored papers in a sample of Otolaryngology journals decreased from 2008 to 2012. The increase in multiauthorship, whilst indicating increasing collaboration, suggests reduced per capita publication productivity. These findings warrant further study.

The Canadian contribution to the otolaryngology literature: a five year bibliometric analysis.

ObjectivesTo assess the 2008–2012 Canadian contribution to the Otolaryngology literature.MethodsAll articles published from January 2008 - December 2012 in 5 Otolaryngology journals were reviewed. Nationality, number of authors, and study type were extracted. The output, number of authors, and study type of Canadian papers were compared to International papers using Mantel-Haenszel Common Odds Ratio Estimate, Pearson’s Chi-Squared or Fishers exact tests.Results4519 papers were analyzed. There was a statistically significant decrease in Canadian authored papers from 12.8% in 2008–9 to 10.2% in 2011–12 (Fishers exact, p = .01). Multi-authorship increased in Canadian papers (χ2, p = .01). The types of studies published by Canadian Otolaryngologists did not change over the study period.ConclusionsCanadian authored papers in a sample of Otolaryngology journals decreased from 2008 to 2012. The increase in multiauthorship, whilst indicating increasing collaboration, suggests reduced per capita publication productivity. These findings warrant further study.

Venous thromboembolism in otolaryngology surgical inpatients receiving chemoprophylaxis

The Caprini risk assessment model for stratifying patients' risk for venous thromboembolism (VTE) has been validated in the otolaryngology literature. We sought to determine the incidence of VTE in patients receiving chemoprophylaxis and correlate with the Caprini risk assessment model. A retrospective chart review of adult surgical admissions to an academic otolaryngology service from 2007 to 2012 was performed. Caprini risk assessment model scores were calculated and compared to incidence of VTE based on diagnosis codes. Seven hundred four patients met our inclusion criteria. Fifteen (2.13%) developed VTE. The Caprini risk assessment model score averaged 5.7 (range, 2-16). Patients with VTE had an average score of 9.87 versus 5.62 for those without (p < .0001). No patients with a score of 6 and below, 3.01% with 7-8, and 13.16% with a score >9 developed VTE. The incidence of VTE increases with Caprini risk assessment model score, and a score of >8 predicts a high risk (>13%) of VTE in postoperative otolaryngology inpatients despite chemoprophylaxis.

Unexplained Recurrent Subcutaneous Emphysema of the Face, Neck, and Mediastinum in an Otherwise Healthy Adult

Objectives: 1) Understand the presentation and work-up of a rare cause of recurrent, diffuse subcutaneous emphysema in the head and neck. 2) Apply the findings from this case report and related literature. Methods: We describe a case of a 23 year-old man who presented to the Emergency Department at a tertiary care center complaining of an acute onset of diffuse swelling throughout his face, neck, and chest. Results: The full diagnostic work-up for this patient included routine laboratory studies, computed tomography (CT) imaging of the head, neck, and chest, fluoroscopic esophagram, and prior esophagogastroduodenoscopy and bronchoscopy. Thoracic and otolaryngology consultations were sought. The patient demonstrated a leukocytosis and severe, diffuse subcutaneous emphysema throughout the face, neck, and mediastinum visible on CT imaging. The remaining work-up was negative for organic causes. Several small, inconspicuous wounds were noticed on the patient’s right cheek and buccal mucosa, consistent with self-inflicted needle injuries. It was determined that the patient had intentionally created percutaneous facial and neck defects with a needle and expired against a closed glottis to create the observed symptoms. A psychiatry consultation was sought, and the patient was discharged shortly thereafter in stable condition. A review of the literature suggests that this factitious etiology of subcutaneous emphysema is quite rare and emphasizes the importance of the physical exam the consulting otolaryngologist may employ when evaluating new patients. Conclusions: Factitious subcutaneous emphysema in the United States is a rare, seldom reported finding in the otolaryngology literature but may be suspected when the patient has a prior history of psychiatric disorder or self-harm and work-up for organic causes is negative.