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American Journal of Otolaryngology 2021Mortality from COVID-19 has obscured a subtler crisis - the swelling ranks of COVID-19 survivors. After critical illness, patients often suffer post-intensive care... (Review)
Review
Mortality from COVID-19 has obscured a subtler crisis - the swelling ranks of COVID-19 survivors. After critical illness, patients often suffer post-intensive care syndrome (PICS), which encompasses physical, cognitive, and/or mental health impairments that are often long-lasting barriers to resuming a meaningful life. Some deficits after COVID-19 critical illness will require otolaryngologic expertise for years after hospital discharge. There are roles for all subspecialties in preventing, diagnosing, or treating sequelae of COVID-19. Otolaryngologist leadership in multidisciplinary efforts ensures coordinated care. Timely tracheostomy, when indicated, may shorten the course of intensive care unit stay and thereby potentially reduce the impairments associated with PICS. Otolaryngologists can provide expertise in olfactory disorders; thrombotic sequelae of hearing loss and vertigo; and laryngotracheal injuries that impair speech, voice, swallowing, communication, and breathing. In the aftermath of severe COVID-19, otolaryngologists are poised to lead efforts in early identification and intervention for impairments affecting patients' quality of life.
Topics: COVID-19; Critical Care; Critical Illness; Humans; Intensive Care Units; Otolaryngologists; Otorhinolaryngologic Diseases; Quality of Life; SARS-CoV-2; Survivorship
PubMed: 33545448
DOI: 10.1016/j.amjoto.2021.102917 -
Otolaryngologic Clinics of North America Apr 2024Asthma is frequently comorbid with chronic rhinosinusitis. First-line pharmacologic intervention for asthma includes combination-inhaled corticosteroids with a... (Review)
Review
Asthma is frequently comorbid with chronic rhinosinusitis. First-line pharmacologic intervention for asthma includes combination-inhaled corticosteroids with a long-acting-β-agonist, preferably formoterol. Although short-acting-β-agonists have historically been used as sole rescue option, studies show that this approach can lead to more asthma-related exacerbations and greater mortality. Similarly, oral corticosteroids should be used sparingly due to their significant adverse effect profile. Nonpharmacological interventions for asthma include counseling on modifiable risk factors, such as smoking, physical activity, occupational exposures, and healthy diets. Management of patients with unified airway disease should incorporate a multidisciplinary team consisting of otolaryngologists and asthma specialists.
Topics: Humans; Anti-Asthmatic Agents; Otolaryngologists; Asthma; Formoterol Fumarate; Adrenal Cortex Hormones; Administration, Inhalation
PubMed: 37923591
DOI: 10.1016/j.otc.2023.10.001 -
Otolaryngology--head and Neck Surgery :... May 2022In 2017, the Centers for Medicare and Medicaid Services transitioned clinicians to the Merit-Based Incentive Payment System (MIPS), the largest mandatory...
In 2017, the Centers for Medicare and Medicaid Services transitioned clinicians to the Merit-Based Incentive Payment System (MIPS), the largest mandatory pay-for-performance program in health care history. The first full MIPS program year was 2018, during which the Centers for Medicare and Medicaid Services raised participation requirements and performance thresholds. Using publicly available Medicare data, we conducted a retrospective cross-sectional analysis of otolaryngologist participation and performance in the MIPS in 2017 and 2018. In 2018, otolaryngologists reporting as individuals were less likely ( < .001) to earn positive payment adjustments (n = 1076/1584, 67.9%) than those participating as groups (n = 2802/2804, 99.9%) or in alternative payment models (n = 1705/1705, 100.0%). Approximately one-third (n = 1286/4472, 28.8%) of otolaryngologists changed reporting affiliations between 2017 and 2018. Otolaryngologists who transitioned from reporting as individuals to participating in alternative payment models (n = 137, 3.1%) achieved the greatest performance score improvements (median change, +23.4 points; interquartile range, 12.0-65.5). These findings have important implications for solo and independent otolaryngology practices in the era of value-based care.
Topics: Aged; Cross-Sectional Studies; Humans; Medicare; Motivation; Otolaryngologists; Reimbursement, Incentive; Retrospective Studies; United States
PubMed: 34314266
DOI: 10.1177/01945998211032896 -
The Laryngoscope Jul 2022Balloon sinuplasty (BSP) is associated with varied practice patterns. This study sought to identify otolaryngologist characteristics associated with BSP utilization.
OBJECTIVE
Balloon sinuplasty (BSP) is associated with varied practice patterns. This study sought to identify otolaryngologist characteristics associated with BSP utilization.
STUDY DESIGN
Retrospective analysis of Medicare claims data and the National Physician Compare database.
METHODS
Outlier otolaryngologists were compared to non-outliers. Otolaryngologist characteristics included sex, practice size, geographic setting, years of experience, procedure setting, 10 or fewer endoscopic sinus surgeries per year for 3 or more years, and high number of services per unique Medicare beneficiary. Outlier status was defined as performing an annual total of balloon procedures of 2 standard deviations (SDs) above the mean for all otolaryngologists in the same year.
RESULTS
Between January 2012 and December 2017, 1,408 otolaryngologists performed 101,662 endoscopic sinus surgeries and 97,680 BSP procedures. Sixty-six outlier otolaryngologists (4.7%) accounted for 44.3% of all BSP procedures. Outlier status was associated with practice size of 10 or fewer individual providers (OR, 5.15; 95% CI, 2.73-9.74; P < .001), performance of 10 or fewer total endoscopic sinus surgeries per year for 3 or more years (OR, 3.90; 95% CI, 1.59-9.57; P = .003), and high number of overall services per beneficiary (OR 6.70; 95% CI, 1.19-37.84; P = .031). Provider sex, years of experience, and geographic setting were not associated with outlier status.
CONCLUSION
Outlier BSP patterns are associated with a few otolaryngologists who are more likely to be identified in small practices and record low numbers of endoscopic surgeries. Although BSP is an appropriate and effective tool, identification of outlier patterns may help to facilitate peer-to-peer counsel.
LEVEL OF EVIDENCE
3 Laryngoscope, 132:1340-1345, 2022.
Topics: Aged; Endoscopy; Humans; Medicare; Otolaryngologists; Paranasal Sinuses; Practice Patterns, Physicians'; Retrospective Studies; United States
PubMed: 34405899
DOI: 10.1002/lary.29824 -
The Annals of Otology, Rhinology, and... Nov 2020Recommendations regarding head and neck paragangliomas (HNPGL) have undergone a fundamental reorientation in the last decade as a result of increased understanding of... (Review)
Review
BACKGROUND
Recommendations regarding head and neck paragangliomas (HNPGL) have undergone a fundamental reorientation in the last decade as a result of increased understanding of the genetic and pathophysiologic basis of these disorders.
OBJECTIVE
We aim to provide an overview of HNPGL and recent discoveries regarding their molecular genetics, along with updated recommendations on workup, treatment, and surveillance, and their implications for otolaryngologists treating patients with these disorders.
RESULTS
susceptibility gene mutations, encoding subunits of the enzyme succinate dehydrogenase (SDH), give rise to the Hereditary Pheochromocytoma/Paraganglioma Syndromes. , and mutations each result in unique phenotypes with distinct penetrance and risk for variable tumor development as well as metastasis. Genetic and biochemical testing is recommended for every patient with HNPGL. Multifocal disease should be managed in multi-disciplinary fashion. Patients with mutations require frequent biochemical screening and whole-body imaging, as well as lifelong follow-up with an expert in hereditary pheochromocytoma and paraganglioma syndromes.
CONCLUSION
Otolaryngologists are likely to encounter patients with HNPGL. Keeping abreast of the latest recommendations, especially regarding genetic testing, workup for additional tumors, multi-disciplinary approach to care, and need for lifelong surveillance, will help otolaryngologists appropriately care for these patients.
Topics: Genetic Testing; Head and Neck Neoplasms; Humans; Membrane Proteins; Mutation; Otolaryngologists; Paraganglioma; Phenotype
PubMed: 32486832
DOI: 10.1177/0003489420931540 -
JAMA Otolaryngology-- Head & Neck... Jan 2017Initially discovered in 1947, Zika virus infection received little notoriety as a tropical disease until 2015 when an outbreak of microcephaly cases was reported in... (Review)
Review
IMPORTANCE
Initially discovered in 1947, Zika virus infection received little notoriety as a tropical disease until 2015 when an outbreak of microcephaly cases was reported in Brazil. Zika is a single-stranded RNA arbovirus of the Flaviviridae family. The primary source of infection in humans stems from Aedes aegypti mosquito bites but can also occur through sexual, blood, and perinatal transmission. With expectations that 3 to 4 million people across the Americas will be infected over the next year, the World Health Organization has declared this event a Public Health Emergency of International Concern.
OBSERVATIONS
Although acute Zika virus infection is typically mild and self-limited, researchers have demonstrated serious neurologic complications associated with it such as microcephaly and Guillain-Barre syndrome. Otolaryngologists should be aware of head and neck manifestations which include conjunctivitis, retro-orbital pain, cephalgia, and odynophagia. The Centers for Disease Control and Prevention have developed specific molecular and serologic testing protocols and algorithms for follow-up care of suspected cases. Currently, the mainstay of management is conservative care while researchers attempt to develop a vaccine. Strategies to contain the Zika virus include vector control, travel restriction for women who are pregnant or trying to become pregnant, and avoidance of mosquito bites in endemic regions of the world.
CONCLUSIONS AND REVELANCE
The future outlook regarding the current Zika virus outbreak in the Americas remains uncertain. What is certain is our need to promptly and efficiently address research gaps in our understanding of clinical outcomes from infection and environmental factors that influence emergence meanwhile improving diagnostic, therapeutic, and preventive measures against the disease.
Topics: Clinical Competence; Communicable Disease Control; Disease Outbreaks; Female; Global Health; Humans; Incidence; Male; Needs Assessment; Otolaryngologists; Pregnancy; Risk Assessment; Travel; Zika Virus; Zika Virus Infection
PubMed: 27892990
DOI: 10.1001/jamaoto.2016.3427 -
The Laryngoscope Jan 2024Qualitative and mixed methods methodology is becoming more commonplace in otolaryngology as the field strives to understand more complex concepts of the ear, nose, and... (Review)
Review
OBJECTIVE
Qualitative and mixed methods methodology is becoming more commonplace in otolaryngology as the field strives to understand more complex concepts of the ear, nose, and throat. This methodology can have tremendous utility in studies directed at patient-centered care by offering practical insights and granular detail-directly from patients-which may not be realized by quantitative approaches.
METHODS
Narrative Review.
RESULTS
This review focuses on what questions can be answered by qualitative research, the basics of the underlying principals and different methodologies utilized, and describes the pearls, pitfalls, and rigor of qualitative research.
CONCLUSIONS
This understanding of qualitative inquiry is critical for the otolaryngologist to stay current on what is published and have the ability to include this in their research repertoire. Laryngoscope, 134:27-31, 2024.
Topics: Humans; Otolaryngologists; Qualitative Research; Research Design; Pharynx
PubMed: 37345617
DOI: 10.1002/lary.30817 -
International Forum of Allergy &... Aug 2021Odontogenic sinusitis (ODS) is distinct from non-odontogenic rhinosinusitis, and often requires multidisciplinary collaboration between otolaryngologists and dental... (Review)
Review
BACKGROUND
Odontogenic sinusitis (ODS) is distinct from non-odontogenic rhinosinusitis, and often requires multidisciplinary collaboration between otolaryngologists and dental providers to make the diagnosis. The purpose of this study was to develop international multidisciplinary consensus on diagnosing ODS.
METHODS
A modified Delphi method was used to assess for expert consensus on diagnosing bacterial ODS. A multidisciplinary panel of 17 authors with ODS expertise from 8 countries (8 otolaryngologists, 9 dental specialists) was assembled. Each author completed 2 of 3 surveys (2 specialty-specific, and 1 for all authors). Thirty-seven clinical statements were created, focusing on 4 important diagnostic components: suspecting ODS; confirming sinusitis in ODS; confirming different dental pathologies causing ODS; and multidisciplinary collaborative aspects of diagnosing ODS. Target audiences were all otolaryngologists and dental providers.
RESULTS
Of the 37 clinical statements, 36 reached consensus or strong consensus, and 1 reached no consensus. Strong consensus was reached that certain clinical and microbiologic features should arouse suspicion for ODS, and that multidisciplinary collaboration between otolaryngologists and dental providers is generally required to diagnose ODS. To diagnose ODS, otolaryngologists should confirm sinusitis mainly based on nasal endoscopic findings of middle meatal purulence, edema, or polyps, and dental providers should confirm dental pathology based on clinical examination and dental imaging.
CONCLUSION
Based on multidisciplinary international consensus, diagnosing ODS generally requires otolaryngologists to confirm sinusitis, and dental providers to confirm maxillary odontogenic pathology. Importantly, both dental providers and otolaryngologists should suspect ODS based on certain clinical features, and refer patients to appropriate providers for disease confirmation.
Topics: Consensus; Endoscopy; Humans; Maxillary Sinusitis; Otolaryngologists; Sinusitis
PubMed: 33583151
DOI: 10.1002/alr.22777 -
American Journal of Rhinology & Allergy Jul 2020Cystic fibrosis (CF) is a genetic disease that may result in multiple systemic disorders and potentially fatal severe respiratory compromise. However, the advent of CF... (Review)
Review
BACKGROUND
Cystic fibrosis (CF) is a genetic disease that may result in multiple systemic disorders and potentially fatal severe respiratory compromise. However, the advent of CF transmembrane conductance regulator (CFTR) modulators has changed the management of CF for patients with select mutations. Although clinical trials have highlighted increased pulmonary function and decreased exacerbations as a result of these novel therapies, their effect on the sinuses has not been well-described.
OBJECTIVE
Our objective is to review the CFTR modulators to provide otolaryngologists, physicians who frequently care for patients with CF, a basic understanding of these drugs and their effects on chronic rhinosinusitis (CRS) in patients with CF.
METHODS
The clinically approved and available CFTR modulators and specific indications for their use are reviewed. Additionally, a systematic review of these therapies and effects on CRS in CF was performed.
RESULTS
Four Food and Drug Administration approved CFTR modulators are available for patients with CF. Current drugs are approved for gating, residual function, or F508del mutations. Multiple reports describe CFTR modulators' increase in transepithelial ion transport in nasal epithelial cultures; however, clinical studies regarding effects of these modulators on sinonasal health are limited to 5 studies that present new data of the effects of CFTR modulators in CRS.
CONCLUSIONS
CFTR modulators have changed management of CF. Initial studies of these medications demonstrate promising results in CF; however, there is a paucity of literature describing the effect of CFTR modulators on CF-associated CRS, although initial results are encouraging.
Topics: Aminophenols; Aminopyridines; Benzodioxoles; Chronic Disease; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Drug Approval; Humans; Indoles; Mutation; Nasal Mucosa; Otolaryngologists; Pyrazoles; Pyridines; Pyrrolidines; Quinolones
PubMed: 32168995
DOI: 10.1177/1945892420912368 -
Pediatric Emergency Care Sep 2022Caustic ingestion in children is a significant cause of morbidity despite preventive measures. Upon arrival to the emergency department, these children are often...
OBJECTIVES
Caustic ingestion in children is a significant cause of morbidity despite preventive measures. Upon arrival to the emergency department, these children are often initially seen by the otolaryngologist and later on by the gastroenterologist. This study aimed to determine which otolaryngological and gastrointestinal signs and symptoms can better predict abnormal findings on imaging, esophagogastroduodenoscopy (EGD), and complications development.
METHODS
We performed a retrospective chart review of children 18 years or younger admitted because of caustic ingestion between January 2007 and November 2019.
RESULTS
Forty-one children with a median age of 4.2 years (interquartile range, 1.7-16.7 years) were included; of them, 22 (53.6%) were males. Nineteen children (46.3%) underwent EGD, which revealed no pathology in 13 cases (68.4%). Most ingested substances were in the form of liquid (82.9%), accidentally ingested (82.9%), and with an alkaline pH (57.5%). Stridor, dyspnea, drooling, abnormal oral cavity findings, dysphagia, and vomiting were significantly associated with pathological findings on imaging and/or EGD and/or complications development ( P = 0.028, P = 0.028, P = 0.022, P = 0.02, P < 0.001, and P = 0.01 respectively). Laryngopharyngeal group of findings (dyspnea, stridor, hoarseness, sore throat, and/or drooling) predicted a higher risk for complications development than the gastrointestinal group (dysphagia, abdominal pain, vomiting, or abdominal swelling and/or tenderness) ( P = 0.011, P = 0.31 respectively).
CONCLUSIONS
In children, after caustics ingestion, laryngopharyngeal signs and symptoms may predict a higher risk for complications development in comparison with gastrointestinal signs and symptoms. We therefore stress the importance of otolaryngological examination upon arrival to the emergency department.
Topics: Adolescent; Burns, Chemical; Caustics; Child; Child, Preschool; Deglutition Disorders; Dyspnea; Eating; Female; Humans; Infant; Male; Otolaryngologists; Respiratory Sounds; Retrospective Studies; Sialorrhea; Vomiting
PubMed: 35580175
DOI: 10.1097/PEC.0000000000002738